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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
Q

graft survival in cadaveric kidney

A

65% at 5 yearws

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26
Q

living donor kidney survival

A

80% in 5 years

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27
Q

(4) Major indications for Kidney transplant

A

diabetes

hypertension induced neuropathy

glomerulonephritis

polyscytic kidney disease

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28
Q

Hematologic problems associated with ESRD

A
  • anemia
  • platelet dysfunction
  • coagulopathies
  • increased capillary fragility
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29
Q

neurologic problems associated with ESRD

A

peripheral and autonomic neuropathy

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30
Q

Gastrointestinal problems associated with ESRD

A
  • impaired gastric emptying
  • gastroparesis
  • nausea
  • vomitting
  • anorexia
  • peptic ulcer disease
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31
Q

endocrine problems associated with ESRD

A
  • hyperparathyroidism
  • osteodystrophy
  • impaired growth and development
  • glucose intolerance
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32
Q

pulmonary problems associated with ESRD

A
  • pneumonia
  • pulmonary edema
  • pleuritis
  • atelectasis
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33
Q

hepatic problems associated with ESRD

A
  • hypoalbuminemia
  • cytochrome P450 abnormality
  • hepatitis
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34
Q

CVP should be maintained between _____ in renal patients

A

10 - 15 mmHg

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35
Q

(3) drugs that should be avoided in renal patients due to decreased renal elimination

A

pancuronium, morphine, and meperidine

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36
Q

50% of post-transplant of kidneys are related to ____ problems

A

cardiac

detection of CAD prior to transplantation is vital

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37
Q

diabetics are at increased risk of ______ after a kidney transplant

A

hypotension, bradycardia, and sudden death

diabetics require hourly monitoring of blood glucose

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38
Q

systolic blood pressure goal during graft reperfusion

A

130-140 mmHg

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39
Q

A-I of liver functions

A

A - albumin

B - bile

C - coagulation

D - drug metabolism

E - elimination

F - fat metabolism

G - gluconeogensis

H - hormones

I - immunologic

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40
Q

drug given to end-stage liver with encephalopathy

A

lactulose

given to clear ammonia

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41
Q

Wilson’s Disease

A

copper accumulation

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42
Q

Below what albumin level indicates the liver is not functioning well?

A

below 3

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43
Q

Common causes of End-stage liver disease

A
  • chronic hepatitis (B or C)
  • alcoholic cirrhosis
  • cholestatic cirrhosis
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44
Q

(2) patient classification for liver disease

A

Child-pugh and model of ESLD (MELD)

MELD is more common and evaluates creatinine, bilirubin, and INR

45
Q

CNS problems associated with end-stage liver

A

hepatic encephalopathy

increased intracranial pressure

46
Q

cardiac complications associated with end-stage liver

A

hyperdynamic circulation

cirrhotic cardiomyopathy

47
Q

respiratory complications associated with end-stage liver

A

hepatopulmonary syndrome

portopulmonary hypertension

48
Q

GI complications associated with end-stage liver

A

portal hypertension

upper GI bleeding

ascites

49
Q

hematologic complications associated with end-stage liver

A
  • anemia
  • thrombocytopenia
  • prolonged PT and PTT
  • decreased plasma fibrinogen
  • DIC
  • protein C and S deficiency
50
Q

renal complications associated with end-stage liver

A

hepatorenal syndrome

acute tubular necrosis

51
Q

surgical phases of liver transplant

A

preanhepatic (dissection)

anhepatic

neohepatic (reperfusion)

52
Q

Anhepatic phase of liver transplant

A
  • vascular anastomosis
  • veno-veno bypass used sometimes to minimize decreases in preload and CO
53
Q

Criteria for diagnosis of brain death

A
  • 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
Q

Surgical steps in Organ procurement

A
  • 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
Q

Order of organ removal

A

heart > lungs > liver > pancreas > small intestine > kidney

56
Q

when does anesthesia time end in organ donation?

A

aortic cross-clamp

(unless lung procurement)

57
Q

Multi-organ procurement generally takes about _____ hours

A

4 hours

58
Q

Common physiologic derangements seen following brain death

A
  • hypotension
  • arterial hypoxemia
  • hypothermia
  • cardiac dysrhythmias
59
Q

Respiratory management in brain dead patients

A
  • TV 10-12 mL/kg
  • PaCO2 30-35 mmHg
  • pH 7.35-7.45
  • PIP less than 40% to prevent oxygen toxicity
60
Q

If harvesting heart-lung, FiO2 should be kept below _____

A

40%

61
Q

hemodynamic goals of brain-dead patients

A
  • CVP 10-12 cmH2O
  • MAP 60-100 mmHg
  • SBP > 100 mmHg
  • PCWP > 12 mmHg
  • SVR 800-1200
  • UOP > 1 mL/kg/hr
62
Q

Treatment for bradycardia if also hypotensive

A

isoproterenol

dopamine

epinephrine

pacing

(resistant to atropine)

63
Q

donor patients should maintain HCT greater than _____

A

30

64
Q

are muscle relaxants necessary in organ procurement?

A

yes

use a long-acting neuromuscular blocker

65
Q

Treatment for hypertension in donor patients

A

volatile agents, nitroprusside, or nitroglycerin

66
Q

Standard monitoring in donor patients

A

standard ASA, A-line, CVP, foley

monitor ABG, H&H, electrolytes, and glucose hourly

(for lung and heart, check ABG every 30 minutes)

67
Q

What happens when a donor patient goes into cardiac arrest?

A

begin CPR and rapid procurement of liver and kidneys

(patient is not eligible for heart and lung procurement)

68
Q

How to increase urine output

A

check adequate volume and BP

consider dopamine, lasix, and mannitol

69
Q

what can be given if donor patient develops diabetes inspidus?

A

vasopressin or DDAVP

70
Q

Peritoneal vs Hemodialysis

A

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
Q

first sign of myocardial ischemia

A

wall motion abnormality in TEE

72
Q

ASRA

A

american society of regional anesthesia

73
Q

which narcotics should not be used in ESRD?

A

morphine and demerol

74
Q

fentanyl infusion rate

A

0.25 - 1.0 mcg/kg/hr

75
Q

remifentanyl infusion rate

A

0.05 - 2 mcg/kg/hr

76
Q

Fenoldapam

A

Dopamine-1 agonist

(specific to the kidneys)

used in the prophylaxis and attenuation of contrast-induced nephropathy

77
Q

Why is Ketoralac contraindicated in patients with compromised renal function?

A

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
Q

ATN

A

acute tubular necrosis

79
Q

acute tubular necrosis

A

intrinsic acute renal fialure

most common cause for renal failure in the perioperative period, accounting for up to 75% of cases

80
Q

(2) major causes of ATN

A

ischemia and nephrotoxins

81
Q

Nephrotoxic agnets

A
  • antibiotics
    • aminoglycosides, cephalosporins, penicillins, vancomycin, sulonamides, and amphotericin B
  • IV contrast
  • anesthetic agents
  • NSAIDs
  • myoglobin
  • chemotherapeutic agents
82
Q

prerenal oliguria

A

inadequate urinary output

< 400 cc/day

83
Q

causes of prerenal oliguria

A
  • hypovolemia
  • mechanical ventilation
  • cardiomyopathy
  • aortic stenosis
  • medications that impair renal autoregulaiton
    • NSAIDsm ACE inhibitors, ARBs
84
Q

laboratory tests indicative or prerenal oliguria

A
  • specific gravity > 1.018
  • osmolality > 500 mmol/kg
  • urine/plasma urea nitrogen > 8
85
Q

AKI

A

acute kidney injury

86
Q

acute kidney injury

A

abrupt reduction in kidney function

(within 48 hours)

87
Q

chronic kidney disease

A

decreased GFR persisting over 3 months

GFR < 15

88
Q

Lisinopril

A

ACE inhibitor

89
Q

Lasix

A

loop diuretic

90
Q

Novolog

A

fast-acting insulin

91
Q

hemodynamic goals in mitral stenosis

A

adequate preload

maintain contractility

reduce heart rate

increase SVR

decrease PVR

92
Q

SIRS

A

systemic inflammatory response syndrome

93
Q

Systemic Inflammatory Response Syndrome

A

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
Q

septic shock

A

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
Q

hemodynamic conditions in septic shock

A

BP < 90 mmHg

MAP < 60 mmHg

96
Q

clinical signs of septic shock

A

elevated LFTs

altered mental status

ARDS

elevated renal markers

97
Q

infusion rate of Vasopressin

A

0.01 - 0.04 units/min

98
Q

signs of propofol infusion syndrome

A

cardiac failure

rhabdomyolysis

severe metabolic acidosis

renal failure

99
Q

dosing leading to propfol infusion syndrome

A

greater than 5mg/kg/hour for over 2 days

100
Q

Prerenal Azotemia

A

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
Q

normal GFR

A

90 - 120 mL/min/1.73 m2

102
Q

nephrotic syndrome

A

kidney disorder that causes the body to excrete too much protein in the urine

103
Q

name for infection from hospital

A

nosocomial infection

104
Q

lowest age of pediatric in outpatient surgery

A

60 weeks gestational

105
Q

following a cold, a patient should wait ______ weeks before elective surgery

A

2 - 4 weeks

106
Q

aortic valve stenosis less than _____ is considered severe

A

1 cm2

107
Q

each hospital is required to own ____ bottles of dantrolene if they have sux or agents

A

32 bottles

108
Q

STOP BANG

A

snore

tired

observed apnea

pressure

BMI > 35

age > 50

neck circumference > 17in

gender: male

109
Q
A

Quarter 5 (8 decks)

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