Review deck 3 Flashcards
Joules to shock an open heart is at
10-30 J
HPV works to
divert blood away from hypoxic regions of the lung, decreased blood flow to the non-ventilated lung, helps improve arterial oxygen content–>
improving hypoxemia, decreases shunt
Blood flow distribution in two lung ventilation is
40% in nondependent and 60% in dependent
Isoflurane shifts blood flow in the lungs to
20% in the upper lung & 80% in the lower lung
_________ can inhibit HPV which is why you may see a drop in SPO2
nitroglycerin
Describe which double lumen tube is more difficult to place.
a right tube
With inhalation anesthestics, 1 MAC leads to a ____ in shunt
4% increase
If you have placed a left tube & you clamp the tracheal cuff, you should hear breath sounds on
the left but not the right
The most common problem encountered when positioning a right endobronchial tube is
excluding the right upper lobe from ventilation
The minimal predicted postoperative FEV1 necessary for long-term survival is
800-1000 mL
The systemic syndromes of mediastinal tumors can be related to
hypertension, myasthenia gravis, myasthenic syndrome, ectopic parathyroid hormone, hypercalcemia
Prior to instituting OLV, it is important to
always get baseline ABG
The greatest risk with OLV management is
hypoxemia
If you have high peak inspiratory pressures,
check ETT position
reduce VT
increase RR to maintain minute ventilation
If hypoxemia is occurring during OLV, then you can
add CPAP to collapsed lung
If you are going to keep a patient intubated after a OLV procedure, then you must
exchange the tube to a single lumen tube
The most likely intraoperative complications of thoracoscopic procedures is
gas embolism into venous circulation
For a mediastinoscopy, it is important to
keep pulse ox & a-line on the right arm and ask surgeon to reposition mediatinoscope if absent waveform due to poor cerebral perfusion
For a patient presenting for mediastinoscopy who lays down and has respiratory distress,
sit them up
The most common complication of mediastinoscopy is
mediastinal hemorrhage
ECG leads to monitor are
II & V5
Vagally- mediated reflex bradycardia from compression of trachea or great vessels may occur and you should
tell the surgeon to stop & give glyco
Cardiac oxygen utilization can be decreased by
anesthesia
hypothermia
cardioplegia
Cardioplegia can cause issues with
renal patients due to high K
Contraindications for TEE include
esophageal pathology like varices or tumors
TEE can be used to help diagnose underlying problems like
valvular pathology
evaluation of ventricles
when to give volume
when there is air in the heart
You know when the swan enters the PA when the waveform shows _______ diastolic pressure in the PA versus RV
INCREASED
Complications of a swan include
arrhythmias, heart block, pneumothorax, valve damage, PA rupture
To go on cardiac bypass, ACT must be
> 400
The weight based dose of heparin is
300-400 units/kg
Heparin binds to
ATIII
Heparin should be administered
via CVP or directly into RA
Pts with _______ are unresponsive to heparin
ATIII deficiency and FFP can be given
When cannulating the aorta, systolic BP should be
<90
Heparin should be given
before any cannulas are placed
Retrograde cardioplegia occurs into
the coronary sinus
Problems with bypass include
bleeding, arrhythmias, hypertension, hypotension
When transitioning to CPB-
look at head/pupils
pull back PAC 2-3 cm
stop the ventilator once the heart is empty
When a patient is on bypass, a hematocrit of ____ is accepted
20%
Hemodilution is associated with
decreased viscosity
decreased SVR
promotes blood flow to tissues
