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Quarter 5 > Principles Exam I > Flashcards

Principles Exam I Flashcards

1
Q

Supraventricular Tachycardia (unstable)

[signs]

A

systolic blood pressure < 80

(if no pulse, go to PEA event)

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2
Q

Supraventricular Tachycardia (unstable)

[treatment]

A
  • 100% oxygen
  • synchronized cardioversion
    • narrow and regular: 50-100J
    • narrow and irregular: 120-200J
    • wide and regular: 100J
    • wide and irregular: 200J unsynchronized
  • Consider Adenosine 6mg if narrow and regular
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3
Q

Supraventricular Tachycardia (stable)

[treatment]

A
  • 100% oxygen
  • 12-lead EKG
  • place A-line and check ABG
  • consider stat cardiology consult
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4
Q

which type of SVT should you prepare to defibrillate

A

wide and irregular

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5
Q

Which type of SVT should you give Amiodarone only?

A

wide and regular

(may also consider procainamide or sotalol)

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6
Q

Which beta blockers can be used for narrow complex SVTs?

A

Esmolol - 0.5 mg/kg over 1 min

Metoprolol - 1.0 - 2.5 mg

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7
Q

Which calcium channel blocker may be sued for narow complex SVTs?

A

amiodarone

150 mg IV over 10 minutes

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8
Q

Bronchospasm

[treatment]

A
  • 100% oxygen
  • lengthen expiratory time
  • deepen volatile agent
  • rule out mainstem or kinked ETT
  • Albuterol +/- Ipatropium
  • epineprhine
  • ketamine 0.2-1.0 mg/kg
  • hydrocortisone 100mg
  • nebulized racemic epi
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9
Q

Hypotension

[differential diagnosis]

A
  • decreased preload
  • low SVR
  • decreased contractility
  • low HR
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10
Q

hypotension

[rule out these first]

A
  • hemorrhage
  • anesthetic overdose
  • auto-PEEP
  • pneumothorax
  • anaphylaxis
  • MI, low EF, mitral valve
  • pneumoperitoneum
  • IVC compression
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11
Q

hypoxemia

[differential diagnosis]

A
  • hypoventilaiton
  • low FiO2
  • V/Q mismatch or shunt
  • diffusion problem
  • increased metabolic O2 demand
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12
Q

Dantrolene for MH

[dose and concentration]

A

2.5 mg/kg

dilute each 20mg dantrolene vial in 60 mL sterile water

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13
Q

Malignant Hyperthermia

[differential diagnosis]

A
  • light anesthesia
  • hypoventilation
  • insufflaiton of CO2
  • over-heating
  • hypoxemia
  • thyroid storm
  • pheochromocytoma
  • neuroleptic malignant syndrome
  • serotonin syndrome
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14
Q

Pneumothorax

[signs]

A
  • tachycardia
  • hypotension
  • hypoxemia
  • decreased breath sounds
  • hyperresonance of chest to percussion
  • tracheal deviation
  • increased JVD/CVP
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15
Q

Pneumothorax

[treatment]

A

14 or 16 gauge needle mid-clavicular 2nd intercostal space

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16
Q

most common problem leading to cardiac transplant

A

end-stage cardiac failure from:

ischemic or idiopathic cardiac dilated cardiomyopathy

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17
Q

(4) bridges to heart transplant

A
  • intravenous inotropes
  • intra-aortic balloon pump
  • ventricular assist devices
  • mechanical ventilation
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18
Q

what (2) factors may preclude a patient’s eligibility for heart transplant?

A

increased PVR

(wood units > 6)

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19
Q

Surgical stages of Heart transplant

A
  • sternotomy
  • cannulaiton before bypass
  • CPB when donar heart arriveds
  • systemic cooling
  • explanted heart excised
  • withdraw CVP or PAC when heart is removed
  • anastomosis of aorta, pulmonary artery, right atria, and left atria
  • IV corticosteroids prior to unclamping
  • prepare for separation from bypass
    *
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20
Q

what inotropic agents can be used with a transplanted heart?

A
  • dopamine
  • dobutamine
  • epinephrine
  • norepinephrine
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21
Q

target heart rate after separation from bypass

A

90 - 110 beats/min

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22
Q

(3) Post-bypass priorities

A
  • correction of coagulopathy
  • maintaine circulatory stability
  • maintain temp, electrolytes, and acid-base
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23
Q

most common cause of death in kidney transplant patients

A

infection

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24
Q

Other than infection, what else is at increased risk in transplant patients?

A

cancer

due to chronic immunosuppresion

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25
graft survival in cadaveric kidney
65% at 5 yearws
26
living donor kidney survival
80% in 5 years
27
(4) Major indications for Kidney transplant
diabetes hypertension induced neuropathy glomerulonephritis polyscytic kidney disease
28
Hematologic problems associated with ESRD
* anemia * platelet dysfunction * coagulopathies * increased capillary fragility
29
neurologic problems associated with ESRD
peripheral and autonomic neuropathy
30
Gastrointestinal problems associated with ESRD
* impaired gastric emptying * gastroparesis * nausea * vomitting * anorexia * peptic ulcer disease
31
endocrine problems associated with ESRD
* hyperparathyroidism * osteodystrophy * impaired growth and development * glucose intolerance
32
pulmonary problems associated with ESRD
* pneumonia * pulmonary edema * pleuritis * atelectasis
33
hepatic problems associated with ESRD
* hypoalbuminemia * cytochrome P450 abnormality * hepatitis
34
CVP should be maintained between _____ in renal patients
10 - 15 mmHg
35
(3) drugs that should be avoided in renal patients due to decreased renal elimination
pancuronium, morphine, and meperidine
36
50% of post-transplant of kidneys are related to ____ problems
cardiac detection of CAD prior to transplantation is vital
37
diabetics are at increased risk of ______ after a kidney transplant
hypotension, bradycardia, and sudden death diabetics require hourly monitoring of blood glucose
38
systolic blood pressure goal during graft reperfusion
130-140 mmHg
39
A-I of liver functions
A - albumin B - bile C - coagulation D - drug metabolism E - elimination F - fat metabolism G - gluconeogensis H - hormones I - immunologic
40
drug given to end-stage liver with encephalopathy
lactulose given to clear ammonia
41
Wilson's Disease
copper accumulation
42
Below what albumin level indicates the liver is not functioning well?
below 3
43
Common causes of End-stage liver disease
* chronic hepatitis (B or C) * alcoholic cirrhosis * cholestatic cirrhosis
44
(2) patient classification for liver disease
Child-pugh and model of ESLD (MELD) MELD is more common and evaluates creatinine, bilirubin, and INR
45
CNS problems associated with end-stage liver
hepatic encephalopathy increased intracranial pressure
46
cardiac complications associated with end-stage liver
hyperdynamic circulation cirrhotic cardiomyopathy
47
respiratory complications associated with end-stage liver
hepatopulmonary syndrome portopulmonary hypertension
48
GI complications associated with end-stage liver
portal hypertension upper GI bleeding ascites
49
hematologic complications associated with end-stage liver
* anemia * thrombocytopenia * prolonged PT and PTT * decreased plasma fibrinogen * DIC * protein C and S deficiency
50
renal complications associated with end-stage liver
hepatorenal syndrome acute tubular necrosis
51
surgical phases of liver transplant
preanhepatic (dissection) anhepatic neohepatic (reperfusion)
52
Anhepatic phase of liver transplant
* vascular anastomosis * veno-veno bypass used sometimes to minimize decreases in preload and CO
53
Criteria for diagnosis of brain death
* loss of cerebral function * no spontaneous movement * unresponsive to external stimuli * loss of brainstem function * apnea * absent cranial nerve reflexes * supporting documentation * EEG * cerebral blood flow studies
54
Surgical steps in Organ procurement
* chest and abdomen open * aorta and IVC are dissected * 30,000 units of Heparin * supraceliac aorta clamped * organs perfused with hyperosmotic, hyperkalemic solution contianing insulin, glucose, and reducing agents * ventilator turned off unless extracting lungs
55
Order of organ removal
heart \> lungs \> liver \> pancreas \> small intestine \> kidney
56
when does anesthesia time end in organ donation?
aortic cross-clamp | (unless lung procurement)
57
Multi-organ procurement generally takes about _____ hours
4 hours
58
Common physiologic derangements seen following brain death
* hypotension * arterial hypoxemia * hypothermia * cardiac dysrhythmias
59
Respiratory management in brain dead patients
* TV 10-12 mL/kg * PaCO2 30-35 mmHg * pH 7.35-7.45 * PIP less than 40% to prevent oxygen toxicity
60
If harvesting heart-lung, FiO2 should be kept below \_\_\_\_\_
40%
61
hemodynamic goals of brain-dead patients
* CVP 10-12 cmH2O * MAP 60-100 mmHg * SBP \> 100 mmHg * PCWP \> 12 mmHg * SVR 800-1200 * UOP \> 1 mL/kg/hr
62
Treatment for bradycardia if also hypotensive
isoproterenol dopamine epinephrine pacing (resistant to atropine)
63
donor patients should maintain HCT greater than \_\_\_\_\_
30
64
are muscle relaxants necessary in organ procurement?
yes use a long-acting neuromuscular blocker
65
Treatment for hypertension in donor patients
volatile agents, nitroprusside, or nitroglycerin
66
Standard monitoring in donor patients
standard ASA, A-line, CVP, foley monitor ABG, H&H, electrolytes, and glucose hourly (for lung and heart, check ABG every 30 minutes)
67
What happens when a donor patient goes into cardiac arrest?
begin CPR and rapid procurement of liver and kidneys (patient is not eligible for heart and lung procurement)
68
How to increase urine output
check adequate volume and BP consider dopamine, lasix, and mannitol
69
what can be given if donor patient develops diabetes inspidus?
vasopressin or DDAVP
70
Peritoneal vs Hemodialysis
**hemodialysis**: blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine. **peritoneal dialysis**: the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles
71
first sign of myocardial ischemia
wall motion abnormality in TEE
72
ASRA
american society of regional anesthesia
73
which narcotics should not be used in ESRD?
morphine and demerol
74
fentanyl infusion rate
0.25 - 1.0 mcg/kg/hr
75
remifentanyl infusion rate
0.05 - 2 mcg/kg/hr
76
Fenoldapam
Dopamine-1 agonist (specific to the kidneys) used in the prophylaxis and attenuation of contrast-induced nephropathy
77
Why is Ketoralac contraindicated in patients with compromised renal function?
COX inhibitor causes inhibition of prostaglandin synthesis which leads to decreased GFR, renal blood flow, and increased renal vascular resistance may result in hyperkalemia
78
ATN
acute tubular necrosis
79
acute tubular necrosis
intrinsic acute renal fialure most common cause for renal failure in the perioperative period, accounting for up to 75% of cases
80
(2) major causes of ATN
ischemia and nephrotoxins
81
Nephrotoxic agnets
* antibiotics * aminoglycosides, cephalosporins, penicillins, vancomycin, sulonamides, and amphotericin B * IV contrast * anesthetic agents * NSAIDs * myoglobin * chemotherapeutic agents
82
prerenal oliguria
inadequate urinary output \< 400 cc/day
83
causes of prerenal oliguria
* hypovolemia * mechanical ventilation * cardiomyopathy * aortic stenosis * medications that impair renal autoregulaiton * NSAIDsm ACE inhibitors, ARBs
84
laboratory tests indicative or prerenal oliguria
* specific gravity \> 1.018 * osmolality \> 500 mmol/kg * urine/plasma urea nitrogen \> 8
85
AKI
acute kidney injury
86
acute kidney injury
abrupt reduction in kidney function | (within 48 hours)
87
chronic kidney disease
decreased GFR persisting over 3 months GFR \< 15
88
Lisinopril
ACE inhibitor
89
Lasix
loop diuretic
90
Novolog
fast-acting insulin
91
hemodynamic goals in mitral stenosis
adequate preload maintain contractility reduce heart rate increase SVR decrease PVR
92
SIRS
systemic inflammatory response syndrome
93
Systemic Inflammatory Response Syndrome
includes 2 of the following: fever \> 38, or chills \< 36 heart rate \> 90 RR\> 20 or PaCO2 \< 32 mmHg WBC \> 12,000 per mm3 or 10% immature forms
94
septic shock
hypermetabolic state in which the body’s ability to extract, deliver, and utilize oxygen is impaired secondary to endotoxemia which can lead to metabolic acidosis and multiorgan dysfunction syndrome (MODS)
95
hemodynamic conditions in septic shock
BP \< 90 mmHg MAP \< 60 mmHg
96
clinical signs of septic shock
elevated LFTs altered mental status ARDS elevated renal markers
97
infusion rate of Vasopressin
0.01 - 0.04 units/min
98
signs of propofol infusion syndrome
cardiac failure rhabdomyolysis severe metabolic acidosis renal failure
99
dosing leading to propfol infusion syndrome
greater than 5mg/kg/hour for over 2 days
100
Prerenal Azotemia
most common cause of acute renal failure excess of nitrogen compounds in your blood stream due to a lack of blood flow to each kidney
101
normal GFR
90 - 120 mL/min/1.73 m2
102
nephrotic syndrome
kidney disorder that causes the body to excrete too much protein in the urine
103
name for infection from hospital
nosocomial infection
104
lowest age of pediatric in outpatient surgery
60 weeks gestational
105
following a cold, a patient should wait ______ weeks before elective surgery
2 - 4 weeks
106
aortic valve stenosis less than _____ is considered severe
1 cm2
107
each hospital is required to own ____ bottles of dantrolene if they have sux or agents
32 bottles
108
STOP BANG
snore tired observed apnea pressure BMI \> 35 age \> 50 neck circumference \> 17in gender: male
109

Quarter 5 (8 decks)

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