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Quarter 4 > Principles Final > Flashcards

Principles Final Flashcards

1
Q

Risk Factors of CAD

A
  • genetics
  • diet
  • environment
  • hypertension
  • smoking
  • diabetes
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2
Q

(3) Factors increasing myocardial oxygen demand

A

wall tension, contractility, and heart rate

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3
Q

(4) Factors affecting myocardial oxygen supply

A

coronary blood flow

diastolic time

oxygen saturation

myocardial oxygen extraction

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4
Q

Which part of the heart is most vulnerable to ischemia?

A

left ventricular subendocardium

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5
Q

(3) methods for monitoring Ischemia

A

ECG, pulmonary artery catheter, and TEE

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6
Q

(3) disadvantages of using Agents with CAD

A
  • myocardial depression
  • systemic hypotension
  • lack of post-op analgesia
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7
Q

drug of choice for coronary vasospasms

A

Nitroglycerin

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8
Q

Nitroglycerin

A

treats coronary vasospasm

  • venodilator
    • decreases venous return and filling pressures
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9
Q

Phenylephrine

A

increases myocardial oxygen requirements, but increases coronary perfusion pressure

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10
Q

Verapamil

A

CCB for treating SVT

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11
Q

Normal pulmonary wedge pressure

A

12

(above 18 is too high)

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12
Q

How would you treat decreased BP and increased PCWP in a patient with CAD?

A

phenylephrine, NTG and an inotrope

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13
Q

An ejection fraction less than ____ indicates myocardial dysfunction

A

0.4

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14
Q

LVED pressure greater than _____ indicates myocardial dysfunction

A

18 mmHg

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15
Q

“LAMPS” before CPB

A
  • Labs
    • ACT and HCT
  • Anesthesia
  • Monitor
    • BP, CVP, and PACWP
  • Patient
  • Support
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16
Q

(7) Components of Cardiopulmonary Bypass

A
  • circuit
  • oxygenator
  • pump
  • heat exchanger
  • primer
  • anticoagulants
  • myocardial protection
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17
Q

In CPB, blood is drained form the _____ and returned to the ____

A

right atrium

ascending aorta

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18
Q

(2) Types of CPB Oxygenators

A

bubble and membrane

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19
Q

(3) Types of CPB Pumps

A

roller, centrifugal, and pulsatile

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20
Q

CPB primer decreases HCT to ____

A

< 30%

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21
Q

ACT goal during CPB

A

> 400 seconds

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22
Q

Hypothermia during CPB

A

10 - 15 oC

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23
Q

Systemic BP decreased to _____ before aortic cannulation during CPB

A

80 - 100 mmHg

(reduces risk of aortic dissection)

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24
Q

Most likely cause of neurologic injury after CPB

A

emboli

(with hypotension being a contributing cause)

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25
Q

Laboratory tests during CPB

A
  • ACT
  • HCT
  • ABG
  • potassium
  • glucose
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26
Q

Monitoring during CPB

A
  • BP
  • CVP
  • ECG - flat line
  • urine output
  • temperature
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27
Q

Why should mixazolam be given before rewarming?

A

high risk of awareness

5 - 10 mg

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28
Q

dose of Protamine

A

1 mg/100 units of Heparin

  • administer slowly
  • double check with surgeon
  • Check ACT before giving
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29
Q

Intra-aortic balloon pumps ___ before systole to ____ afterload and ____ during diastole to ____ coronary blood flow

A

Intra-aortic balloon pumps deflate before systole to decrease afterload and inflates during diastole to increase coronary blood flow

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30
Q

(3) Side effects of Protamine

A

hypotension, allergic reaction, and pulmonary hypertension

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31
Q

normal Mitral valve area

A

4 - 6 cm2

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32
Q

Normal Aortic valve area

A

2.5 - 3.5 cm2

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33
Q

mitral stenosis area

A

< 1 cm2

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34
Q

aortic stenosis area

A

< 0.75 cm2

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35
Q

Murmur in Mitral stenosis

A

rumblic diastolic

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36
Q

Murmur in aortic stenosis

A

systolic ejection murmur

(right upper sternal border)

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37
Q

Pathophysiology of Mitral Stenosis

A
  • increased left atrial pressure and volume overload
  • impaired blood flow from left atrium to left ventricle
  • right ventricular hypertrophy
  • pulmonary edema
  • increase in left atrial pressure reflected back to pulmonary circulation
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38
Q

most common cause of mitral stenosis

A

rheumatic fever

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39
Q

Anesthetic considerations in Mitral Stenosis

A

avoid increased HR or decreased SVR

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40
Q

Dysrhythmia that commonly occurs with Mitral Stenosis

A

atrial fibrillation

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41
Q

Mitral stenosis has impaired blood flow from _____ to _____

A

left atrium to left ventricle

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42
Q

(3) Symptoms of Aortic Stenosis

A

angina, CHF, and syncope

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43
Q

Murmur in mitral regurgitation

A

holosystolic

(best heard at lower left sternal border)

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44
Q

Murmur in Aortic regurgitation

A

decrescendo diastolic

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45
Q

(3) symptoms of right heart failure

A
  • hepatic congestion
  • peripheral edema
  • JVD
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46
Q

Diagnostic methods of Mitral regurge

A

ECHO and angiogram

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47
Q

Mitral Regurge Treatment

A
  • cardiac glycosides
  • hydralazine
  • ACE inhibitor
  • CHF regimen
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48
Q

mangement goals in Mitral regurge

A
  • small increase in HR
  • derease in SVR
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49
Q

Management goals in Aortic Regurgitation

A
  • avoid overzealous fluid
  • decrease afterload
  • maintain contractility
  • slight increase in HR
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50
Q

(4) classic symptoms of CHF

A

dyspnea, fatigue, fluid retention, and edema

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51
Q

decompensated fluid retention due to CHF may manifest as:

A
  • pulmonary rales
  • JVD
  • peripheral edema
  • ascites and hepatomegaly
  • S3 gallop
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52
Q

Acute treatment of CHF

A
  • optimize preload and afterload
  • dobutamine, milrinone, and amrinone
  • vasodilators
  • acute beta blockers
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53
Q

(3) causes of CHF

A
  • weakening of heart muscle
  • stiffening of heart muscle
  • disease that increase oxygen demand
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54
Q

Patients recieving ____ valves are required to begin anti-coagulaiton therapy

A

mechanical

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55
Q

CVP may significantly _____ LVEDP

(in aortic valve replacement)

A

underestimate

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56
Q

anticoagulation for mechanical valves should be started ___ days post-op

A

2 - 3

57
Q

aortic stenosis generally has a ____ prognosis than aortic regurge

A

better

58
Q

Total Cardiopulmonary Bypass

A

all venous return from superior and inferior vena cava and coronary sinus is drained

  • PA and systemic pressure tracings are non-pulsatile
59
Q

Partial Bypass

A

some of the blood return is still pumped by the ventricles

  • example: femorofemoral bypass
60
Q

Keep HCT higher than ____ during priming for CPB

A

18-20%

61
Q

(3) Common priming solutions

A

Normosol, albumin, and mannitol

62
Q

PA and CVP should be ___ during CPB

A

low or near zero

63
Q

urine output rate during CPB

A

1 mL/kg/hr

64
Q

Duing CPB, maintain MAP between ____ to ensure adequate tissue perfusion

A

50 - 100 mmHg

65
Q

Treatment of Hypotension during CPB

A

increase flow rate

phenylephrine

66
Q

How do you treat hypertension during CPB?

A

inhalational agents via pump

(do not lower pump flow rate)

67
Q

_____% of normal cardiac output is usually enough to maintain tissue oxygenation

A

70

68
Q

normal pump flow

A

50 - 70 mL/kg/min

69
Q

Do you give muscle relaxants during CPB?

A

yes

  • prevents diaphragmatic movement and shivering
70
Q

How does CPB affect muscle relaxants?

A
  • requires more
  • reduces renal excretion
  • prolonged onset
71
Q

Normal mixed venous oxygen tension should be _____ during CPB

A

40 - 45 mmHg

72
Q

How do you preserve myocardium during CPB?

A

cardioplegia and hypothermia

73
Q

Components of Cadrioplegia

A
  • potassium
  • magnesium
  • THAM or bicarbonate
  • steroids, calciu, and insulin
  • nitroglycerin
74
Q

Aorta may be cross-clamped for ____ without perfusion

A

60 - 120 minutes

75
Q

At what temperature can patients be weaned from CPB?

A

37 oC esophageal/naso

35oC rectal/bladder

76
Q

How do you defibrillate the heart internally during CPB?

A

DC at 5 - 10 joules

77
Q

platelet function returns to normal ____ hours post CPB

A

2 - 4 hours

78
Q

Thrombocytopenia is more common with ____ oxygenators

A

bubble-type

79
Q

What is the most common cause of bleeding post CPB?

A

platelet dysfunction

80
Q

Laboratory tests for termination of CPB

A
  • HCT 20-25%
  • potassium 4 - 5.5
  • ionized calcium 1.1 - 1.2
  • mixed venous oxygen more than 70%
81
Q

IABP is used when LVEF is predicted to be less thatn ___

A

25%

82
Q

If LVEF is between 25 - 35%, which inotropic drug should be used?

A

milrinone

83
Q

Mechanism of action of protamine/heparin

A

heparin is a strong aid

(protamine a strong base)

84
Q

(3) Types of Protamine reaction

A
  • I - systemic hypotension from rapid injection
  • II - anaphylactic or anaphylactoid
  • III - catastrophic pulmonary vasoconstriction with sytemic hypotension
85
Q

How do you treat hypotension after protamine administration?

A

rapid volume infusion and vasoconstrictors

86
Q

Bystolic

A

beta blocker

87
Q

Lamisil

A

treats fungal infections

88
Q

Lipitor

A

treats high cholesterol

89
Q

Transvalvular gradient

A

greater than 50 mmHg represents significant aortic stenosis

90
Q

Gingko

A

increases blood flow through atherosclerotic vessels

(may increase bleeding)

91
Q

Aortic stenosis represents obstruction to ______ tract

A

left ventricular outflow

92
Q

Pathophysiology of Aortic Stenosis

A
  • concentric hypertrophy of LV
  • decreased ventricular compliance

(contractility and ejection fraction usually maintained)

93
Q

Hemodynamic goals of aortic stenosis

A
  • adequate volume
  • maintain SVR, HR and normal rhythm
  • maintain contractility
94
Q

Hemodynamic goals of Aortic Regurge

A
  • adequate preload
  • increase HR
  • decreased afterload
95
Q

Risks associated with cannulation of vein during PAC

A

bleeding, infection, air embolism

96
Q

Risks associated with floating PA catheter

A

arrhythmias, PA rupture, failure to wedge

97
Q

What should be done before sternal splitting?

A

additional narcotics and lung deflation

98
Q

What are some causes of hypotension during CPB?

A

limited pump flow, aortic dissection, and low peripheral resistance

99
Q

(3) types of burns

A

thermal, eletrical, and chemical

100
Q

Most common type of burn

A

thermal

101
Q

second degree burn

A

blisters

102
Q

third degree burn

A

burn through dermis

(insensitive)

103
Q

Pulmonary complications of burns within 24 hours

A

CO poisoning, inhalational injury, and edema

104
Q

pulmonary complications days to weeks after burn injury

A

pneumonia, atelectasis, and pulmonary emboli

105
Q

Problems with cabon monoxide poisoning

A
  • tissue hypoxia
  • left shift of oxy-hemoglobin curve
  • cardiovascular depression
  • cytochrome inhibition
106
Q

Intial cardiovascular effects of burns

A
  • hypovolemia
  • depressed myocardial function
  • increased blood viscosity
  • release of vasoactive substances
107
Q

Problems with renal function due to burns

A
  • decreased function and GFR
  • increased ADH
  • acute renal failure
  • hemoglobinuria and myoglobinuria
108
Q

How are hemoglobinuria and myoglobinuria treated?

A

fluid resuscitation and alkalinization with bicarb

then osmotic diuretics

109
Q

Rule of 9’s

A

A. Head and Neck 9%

B. Arms 9% each

C. Anterior chest 9%

D. Posterior chest 9%

E. Abdomen 9%

F. Lower Back 9%

G. Legs 18% each

H. Perineum 1%

110
Q

(2) formulas used for fluid resuscitation in burn patients

A

Parkland and Brooke

111
Q

Parkland forumla

A

LR 4 mL/kg/% BSA burn

  • 50% given in first 8 hours
  • after 24 hours, use colloids
112
Q

Common procedures in burn patients

A
  • escharotomies
  • burn excision and skin graft
  • reconstruction
  • tracheostomy
113
Q

Drug resposnes in burn patients

A
  • increased opioid requirement
  • prolonged duration in those that need liver
  • albumin bound drugs will have a prolonged effect
114
Q

Most common complication following massive transfusion

A

dilutional thrombocytopenia

115
Q

After how many PRBC will a patient need FFP and platelets?

A

12 units - FFP

20 units - platelets

116
Q

What causes a hemolytic transfusion reaction?

A

ABO incompatibility

  • Kell, Kidd, Lewis, and Duffy antigens
  • hemolysis takes place in either extravascular or intravascular space
117
Q

Signs and symptoms of hemolytic transfusion reaction in patient under GA

A
  • hypotension
  • hemoglobinuria
  • diffuse bleeding
  • oliguira leading to renal failure
118
Q

Signs and symptoms of hemolytic transfusion reaction in awake patient

A
  • fever, chills, nausea
  • hypotension
  • tachycardia
  • restlessness
  • flused and dyspneic
119
Q

Types of Blood transfusion reactions

A
  • febrile non-hemolytic (most common)
  • hemolytic and delayed hemolytic
  • allergic urticarial
120
Q

What is the treatment for febrile non-hemolytic transfusion reaction?

A
  • acetaminophen, NSAIDS
  • antihistamines
  • leukocyte depleted blood products
121
Q

What lab value abnormalities would you expect in a patient with DIC?

A
  • Prolonged PT and PTT
  • Reduced platelet count
  • Reduced fibrinogen level
  • Elevated fibrin degradation products
122
Q

Citrate

A

anticoagulant used in stored blood products

  • can cause hypocalcemia and dysrhythmias
123
Q

TRALI

A

non-cardiac pulmonary edema occuring within 6 hours of transfusion

  • related to antibodies to leukocytes
  • resolves within 96 hours
  • treat with oxygen, mechanical ventilation, and support of BP and CO
124
Q

Shunt

A

phenomenon that occurs when portion of venous return of one circulation (pulmonary or systemic) is redirected back to arterial outflow of the same circulation

125
Q

(3) Types of Shunt

A

simple, bidirectional, and complex

126
Q

Left to Right shunt

A

pulmonary venous directed towards pulmonary arterial system

127
Q

Potential problems of L-to-R shunt

A
  • hypotension
  • pulmonary edema
  • increased PVR
128
Q

Right to Left Shunt

A

systemic venous return directed to systemic arterial outflow

  • bypasses the lungs
  • results in arterial oxygen desaturation
129
Q

(5) Lesions characterized by excessive pulmonary blood flow

A
  • atrial septal defects
  • ventricular septal defects
  • atrioventricular septal defects
  • truncus arteriosus
  • hypoplastic left heart
130
Q

(4) lesions characterized by inadequate pulmonary blood flow

A
  • transposition of great vessels
  • tetralogy of fallot
  • tricuspid atresia
  • total anomalous pulmonary venous return
131
Q

Marfan’s Syndrome

A

disorder of connective tissue

132
Q

Symptoms of Marfan’s

A
  • lens dislocation
  • aortic dissection, myocardial ischemia, and arrhythmias
  • restrictive lung disease
  • tall stature, joint hypermobility, and hernias
133
Q

Preoperative preparation for Marfan’s

A
  • antibiotics for SBE
  • BB
    • reduce risk of aortic wall tension
134
Q

airway concerns in Marfan’s

A
  • high arched palate
  • potential cervical instability
  • potential for TMJ dislocation
135
Q

Lifespan of tissue valve

A

12 - 15 years

136
Q

Advantage and Disadvantage of mechanical valves

A

lasts forever

require anticoagulation for remainder of life

137
Q

In a mitral valve replacement, the heart is opened through the _____

A

left atrium

138
Q

In mitral stenosis, avoid increases in ____

A

PVR and tachycardia

139
Q
A

Quarter 4 (15 decks)

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