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1
Q

Most common ECG change seen in intra-operative MI

A

ST elevation or depression

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2
Q

Goal of hemodynamic mgmt during intraoperative MI

A
  • increase myocardial O2 delivery
  • decrease myocardial O2 demand
  • maintain CO
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3
Q

T/F: Antiplatelet therapy should always be administered after an intraoperative MI is identified

A

False

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4
Q

Manifestations of intraoperative MI

A
  • hemodynamic changes
  • ST elevation or depression/EKG changes
  • elevated cardiac biomarkers (not solely indicative)
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5
Q

Patients at high risk for intraoperative MI

A
  • recent MI or unstable angina
  • recent PCI
  • emergency sx
  • high-risk procedure
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6
Q

2 first line drugs when patient is experiencing hypoxia

A
  • albuterol
  • epi
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7
Q

5 causes of hypoxemia

A
  • reduced FiO2
  • hypoventilation
  • V/Q mismatch
  • diffusion impairment
  • shunt
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8
Q

Benefit of doing a manual recruitment manever

A
  • correct atelectasis
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9
Q

Cause of hypoxemia that does not respond to supplemental oxygen

A

shunt

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10
Q

Cardinal sign of hypoxemia

A

decreased pulse oximetery

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11
Q

3 causes of inaccurate SpO2

A
  • hypothermia
  • poor circulation
  • artifact
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12
Q

Late signs of hypoxemia

A
  • brady/tachycardia
  • arrhythmia/ischemia
  • HoTN
  • cardiac arrest
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13
Q

Maneuver where you increase inspiratory pressure to 40cmH2O x 15 seconds

A

recruitment maneuver

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14
Q

3 airway problems that can cause hypoxia

A
  • R mainstem
  • autoPEEP
  • hypoventilation
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15
Q

3 circulation problems that can cause hypoxia

A
  • severe sepsis
  • embolism
  • heart disease
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16
Q

Normal amount of fluid in pericardial sac

A

30mL

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17
Q

Findings consistent with untreated cardiac tamponade

A
  • HoTN
  • JVD
  • muffled heart sounds
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18
Q

Beck’s Triad

A
  • HoTN
  • JVD
  • muffled heart sounds
19
Q

2 findings on the monitor consistent with cardiac tamponade

A
  • electrical alternans
  • pulsus paradoxus
20
Q

A (slow/fast) developing cardiac tamponade requires quicker intervention

21
Q

Hemodynamic goals for cardiac tamponade

A
  • fast (tachycardia)
  • full (hypervolemia)
  • tight (increased SVR)
22
Q

Metabolic disturbances commonly associated with delayed emergence

A
  • hypoglycemia
  • hypercarbia
  • hypernatremia
23
Q

Flumazenil dose

A

0.2mg IV Q1min, max dose of 1mg

24
Q

Definition of delayed emergence

A

failure of return of consciousness 30-90min after GA

25
Priority intervention for a patient suspected of delayed emergence
check for widened pulse pressure, bradycardia, and irregular respirations
26
Naloxone dose
40mcg IV
27
2 most common electrolyte derangements associated with mass transfusions
- hypocalcemia - hyperK+
28
Definition of massive hemorrhage:
- 10 units RBCs - ongoing blood loss (4 units RBCs with continued bleeding) - loss of >1 circulating blood volume within 24 hours
29
Lethal triad of complications associated with massive hemorrhage
- acidosis - hypothermia - coagulopathy
30
Ratio of PLT : plasma : RBCs for hemorrhage
1:1:1
31
Priorities for mgmt of hemorrhage
- adequate IV access - 100% O2 - 1:1:1 - coags - correct electrolyte and acid/base abnormalities - warm patient
32
T/F: Permissive HoTN is contraindicated in TBI patients
True
33
2 locations of SPEC
- right side of anesthesia machine - Mayo intranet
34
High spinal to level of T4 would have..
- HoTN - bradycardia - LE weakness
35
T/F: Placing a patient in steep Trendelenburg is a treatment for high spinal to help with HoTN
False
36
T/F: high BMI is a r/f high spinal
True (reduced intrathecal volume)
37
Ventilation pressure appropriate to reduce the risk of aspiration
<20 cmH2O
38
Risk factors for aspiration
- delayed gastric emptying - emergency surgery (4x) - anything that blunts sphincter tone - higher ASA - age
39
Consequences of aspiration
- airway obstruction - bronchospasm - impaired gas exchange - bacterial resp infxn
40
Reflexes that prevent aspiration
- laryngeal adductor reflex - esophagoglottal & pharyngoglottal closure reflexes
41
Management of aspiration during intubation
1) suction mouth and pharynx 2) turn pt's head lateral, place in Trendeleburg 3) assess airway, suction secretions 4) insert ETT 5) sx ETT BEFORE starting PPV 6) connect to vent
42
Indicator of mortality post aspiration
mechanical ventilation >24hrs
43
Methods to prevent aspiration
- adhere to fasting guidelines - premedicate - awake intubation - RSI - decompress prior to intubation - preop US to assess gastric contents

ACRM (9 decks)

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