Principles Exam II Flashcards
What is the incidence of herbal medicine use in the surgical population?
40%
women greater than men
Ephedra
weight loss and energy
- cardiovascular and CNS stimulants
- can cause severe hypertension, dysrhythmia, MI, seizures, CVA, and death
Vitamin E
prevent cardiovascular disease, diabetes, and cancer
- can antagonize vitamin K dependent clotting factors and platelet aggregation
Fish Oil
hyperlipidemia, hypertension, and inflammation
- decrease blood viscosity, increase red blood cell deformability, inhibits prostacyclin, and prolongs bleeding time
Gingko
dementia
- inhibits platelet aggregation
Ginseng
general “well-being”
- can raise blood pressure and interferes with platelet aggregation
Ginger
arthritis, GI, and anti-emetic
- inhibits prostaglandin, leukotriene synthesis, and decreases platelet aggregation
IV contrast
typically Iodine
What patients are at increased risk of renal failure following the use of contrast?
- renal disease, diabetes, jaundice, myeloma, and decreased renal blood flow
- patients taking Metformin must be discontinued for 48 hours
percentage of cross-sensitivity between penicillins and cephalosporins
8-10%
Anaphylaxis
Severe immune mediated allergic reaction manifest as hypotension, tachycardia, cardiovascular collapse, bronchospasm, flushing, urticaria, angioedema, GI Symptoms
anaphylactoid reaction
severe non-immune allergic reaction
- release of inflammatory mediators from mast cells and basophils results in activation of complement cascade
80% of all anaphylactic reactions in the OR are due to ______
muscle relaxants or latex
percentage of cross sensitivity between amides and esters
none
key factors associated with awareness
higher ASA and muscule relaxants
most common organ injured in penetrating trauma
liver
most common organ injured in blunt trauma
spleen
approximately ____% of all patients requiring laparotomy for trauma will have _____ injuries
30% of all patients will have hepatic injuries
Shock and transfusion related coagulopathy in the immediate postop period are responsible for ______% of deaths in liver injury patients
80%
Portal Triad
portal vein, hepatic artery, and common bile duct
at what percentage of blood loss will you see a drop in pressure?
15-30%
Signs of Tension Pneumothorax
uneven chest rise, unequal breath sounds, deviated trachea, distended neck veins, increased airway pressure
Treatment of Tension Pneumothorax
large bore needle in 2nd intercostal space midclavicular line
Easy Cap
detect expired CO2
y=yellow= yes for CO2
massive transfusion
- 3-4 units over 1 hour
- replacement of 50% total blood volume within 3 hours
- transfusion greater than 20 units in 24 hours
Complications of Massive Transfusion
- coagulopathy
- hyperkalemia
- hypocalcemia
- acidosis
- decreased 2,3 DPG
- hypothermia
average human blood volume
5 L
(3L of plasma and 2L of RBC)
HCT in one unit of RBC
70%
volume in one unit of RBC
300-350 mL
what are leukocyte reduced RBCs used
to reduce febrile transfusion reactions
Risk of Hepatits
C = 1:800k
B = 1:220k
Risk of HIV
1 : 1,000,000
What blood component has the greatest risk of transmission of infectious disease?
platelets
why is cryoprecipitate given?
replace factor VIII
- hemophilia, fibrinogen deficiencies, von Willebrand’s disease, DIC
storage defects that occur in stored blood
- decreased
- pH
- 2,3 DPG
- ATP
- glucose
- clotting facotrs V and VIII
- Inreased
- potassium and phosphate
plasma makes up ____% of total blood volume
55%
shelf-life of PRBC
42 days
1 Unit of platetles will increase platelet count by _____
10,000 / mm3
how much plasma is in each cryo unit?
15 mL
frozen expiration date for cryo
365 days
1 unit of cryo will increase fibrinogen by _____
20-30 mg / 100 mL
AHTG
Acute Hemolytic Transfusion Reaction
Acute Hemolytic Transfusion Reaction
occurs when ABO incompatible blood is transfused
- RBC lysis
- release of bradykinin -> hypotension
- mast cell activation -> serotonin and histamine release
signs and sypmtoms of AHTR
- fever
- hypotension and tachycardia
- hemoylobinuria
- unexplained bleeding
- renal shutdown
Incidence of fatal hemolytic transfusion reaction
1 in 1,000,000
symptoms of AHTR in awake patients
chills, fever, nausea, chest pain, and flank pain
Delayed Hemolytic Transfusion Reaction
[causes]
incompatible minor antigens
presentation of delayed HTR
2 days to 1 month after transfusion
characterized by extravascular hemolysis
FNHTR
Febrile Non-Hemolytic Transfusion Reaction
most common transfusion reaction
FNHTR
most common cause of FNHTR
platelets
With what blood component is there the greatest risk of transmission of infectious disease?
allergic transfusion reaction
recipient antibody response to donor plasma proteins
TRALI
transfusion related acute lung injury
TRALI cause
Reaction between recipient WBC and donor leukocyte antibodies
Metabolic complications in massive blood transfusion
K+, Ca2+, acid/base, and DIC
transfusion is usually more acidodic or alkalotic?
alkalotic
- banked blood is usually acidic, but the citrate has a higher effect
NAT
Nucelic Acid Testing
a 6 pack of platelets will raise the patient’s paltelet count by _____
25,000 cells/mm3
FFP is necessary when PT and/or PTT is greater than _____
1.5x normal
each bag of cryo contains _____ and _____
200mg of fibrinogen and 100 units of Factor VIII
indications for transfusion:
O2ER > _____ in patients with adequate CO
0.5
indications for transfusion
VO2 < _____
100 mL/min/m2
1 cause of transfusion related death in the US
TRALI
CPDA
citrate-phosphate-dextrose-adenine
anticoagulant given to whole blood
AABB
american association of blood banks
CMV
cytomegalovirus
what sound is heard in an obstructing patient
stridor
Mendelson syndrome
aspiration pneumonitis
chemical injury to the lungs caused by inhalation of sterile acidic gastric contents
aspiration pneumonia
inhalation of particulates that become colonized by bacteria
cardiogenic pulmonary edema
elevated left atrial pressure that may be precipitated by fluid overload
causes of pre-renal AKI
decreased blood volume or impaired renal hemodynamics
causes of post-renal AKI
obstruction of urinary blood flow
always rule out ___ and ____ in delirium
hypoxia and hypercarbia
Differential Diagnosis of Anaphylaxis
- vasovagal reaction
- MI
- pulmonary embolism
- aspiration
- seizure
- carcinoid tumor
TIPS
Transjugular intrahepatic portosystemic shunt
Transjugular intrahepatic portosystemic shunt
procedure that may be used to reduce portal hypertension