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CNOR > Surgical Emergencies > Flashcards

Surgical Emergencies Flashcards

1
Q

During the laser microlaryngoscopy there is an airway explosion and fire. The first thing to do is…

A

Remove the endotracheal tube in its entirety

ensuring the entire tub is removed, turn off the gasses and oxygen, pour water or saline into the airway reintubate and examine the airway. Next steps are decided upon examination.

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2
Q

During the laser microlaryngoscopy there is an airway explosion and fire. The first thing to do is…

A

Remove the endotracheal tube in its entirety

ensuring the entire tub is removed, turn off the gasses and oxygen, pour water or saline into the airway reintubate and examine the airway. Next steps are decided upon examination.

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3
Q

Action point

A

The moment when an individual recognizes that an employee may be on the path toward committing some type of violent act in the workplace and subsequently takes action to prevent it
-talk to person directly, supervisor, HR, security

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4
Q

Flash point

A

Moment when workplace violence occurs, & it’s too late for any type of prevention strategy & best avoided by implementing initiatives early, once an action point has been detected

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5
Q

Vasogenic shock

A

Resulting from anaphylaxis or sepsis

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6
Q

Moderate blood loss

A

750 mL to 1500 mL
15% to 30% of total blood volume
Crystalloids are the recommended fluid replacement 

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7
Q

Disseminated intravascular coagulation (DIC)

A

Inappropriate clotting, followed by hemorrhaging
Coagulation goes systemically instead of locally

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8
Q

Two causes of DIC

A

Systemic response
-Trauma
-Sepsis
-Obstetrics: amniotic fluid into mothers blood

Release of procoagulant into the bloodstream
-Boney tumor

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9
Q

DIC complications

A

-Severe bleeding
-stroke (clots cause most harm, in spine or kidney)
-Reduced blood flow to organs
-Overload of liver and kidneys

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10
Q

DIC treatment

A

-Correct the cause
-Treat with FFP and cryoprecipitate (replaces clotting factors)
-Heparin sometimes used in the beginning (draw PTTs, order for heparin once PTT is trending down)
-volume/blood replacement

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11
Q

Venous air embolism risk

A

-pressure in the right atrium is less than atmospheric pressure
-Neuro procedures where the patient is sitting
-hysteroscopy and TUR procedures

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12
Q

Arterial air embolism risk

A

-bypass
-Dialysis

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13
Q

Air embolism signs and symptoms

A

-Rapid onset pulmonary edema (fluid in air sacs in lungs)
-Drop in ET CO2
-Hypoxia
-Hypotension
-Arrhythmias
-Neurologic damage

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14
Q

Venous air embolism treatment

A

-first identify and occlude the sites of air entry
-Sloppy wet sponges, irrigation syringe
-Bone wax
-Discontinue nitrous oxide
-Place patient in left lateral position (Durant’s maneuver)*
-Aspirate RA (right atrium) catheter

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15
Q

Arterial air embolism treatment

A

-Deep Trendelenburg position
-Aspirate air from circuit

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16
Q

Cardiac arrest, medical reasons

A

-MI
-Arrhythmias
-Anaphylactic reaction
-Emboli
-Vagal stimulation
-Malignant hyperthermia
-Anesthesia overdose
-Hypoxia
-Laryngospasm
-Aspiration
-Hypothermia
-Electrolyte imbalance

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17
Q

Cardiac arrest surgical reasons

A

-hypovolemic shock related to blood loss (Nick something and bleeding out)

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18
Q

OMI (Oh my) for cardia emergencies

A

Oxygenation
Monitors
IV Fluids

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19
Q

Treatments for Vfib with inadequate heart rate/blood pressure

A

-CPR
-Defibrillator
-Epinephrine (for BP)
-Amiodarone (good for her myocardium, helps it contract)

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20
Q

Treatment for Vfib with adequate heart rate

A

-Epi (for blood pressure)
-Amiodarone (good for myocardium, helps it contract)
-dopamine
-ICU monitored bed
-Cardioversion, after meds and when controlled

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21
Q

Premature ventricular contraction (PVC)

A

Relatively common event where the heartbeat is initiated by the ventricles rather than by the Sino atrial (SA) node

22
Q

Ventricular tachycardia

A

Tachycardia with beats initiated in the ventricles
Sawtooth rhythm

23
Q

Ventricular fibrillation

A

Uncoordinated contractions of the ventricles
Quivering rhythm

24
Q

Ventricular arrhythmias - Couplet

A

Pair of PVCs

25
Q

Ventricular arrhythmias - Run

A

Several PVCs in a row
Think of it as unsustained Vtach

26
Q

Supraventricular tachycardia (SVT)

A

Tachycardia caused by an electrical impulse originating above the ventricles

27
Q

SVT treatment

A

-Vagal stim
-Adenosine: have to slam it in IV (short half-life, metabolizes fast) and causes long cardiac pause (asystole)
-sync cardioversion

28
Q

Treating bradycardia

A

-Atropine (contraindicated for glaucoma patients, give epi instead)
-Dopamine drip
-Pacer

29
Q

Pulseless electrical activity (PEA)

A

Dead patient
Causes are 6 Hs and 6 Ts

30
Q

PEA causes (6 Hs)

A

-hypovolemia
-Hypoxia
-Hydrogen ions (acidosis)
-hyper/hypokalemia
-Hypoglycemia
-Hypothermia

31
Q

PEA causes 6 Ts

A

-Toxins (drug overdose)
-Tamponade, cardiac
-Tension pneumothorax
-Thrombosis (MI/PE)
-Tachycardia
-Trauma

32
Q

Treatment for PEA

A

CPR
Treat the underlying cause

33
Q

PH normal value

A

7.35-7.45

34
Q

pO2 normal value

A

80-100

35
Q

pCO2 normal value

A

35-45
Respiratory acid
Leaves through lungs

36
Q

HCO3 normal value

A

22-26
Metabolic base
Leaves through kidneys

37
Q

Respiratory acidosis caused by

A

decrease ventilation
Treat with ventilation

38
Q

Respiratory alkalosis cause by

A

hyperventilation
Treat with sedation or decreased ventilation

39
Q

Metabolic acidosis caused by

A

Excess production of metabolic acids (lactic acid from ischemic tissue)
-cardiac arrest
-Sepsis
-Ketoacidosis
-Renal failure

Treat with bicarb (make my liver)

40
Q

Metabolic alkalosis caused by

A

Acid loss
-Upper GI loss, vomiting
-diuretics (potassium loss= hydrogen ion loss)
-Over administration of alkali

Treat the cause

41
Q

Compensated ABG

A

PH= within normal limits
CO2 and HCO3= not within normal limits

42
Q

Partially compensated ABG

A

PH, CO2 and HCO3= not within normal limits

43
Q

Uncompensated ABG

A

PH= not WNL
CO2 and HCO3= 1 not WNL and 1 WNL

44
Q

The perioperative nurse would expect labs for the patient with the DIC to look like

A

Prolonged PT/PTT
Low fibrinogen and low platelets (using them up)

45
Q

Diagnostic peritoneal lavage (DPL)

A

-For hemodynamically unstable or uncooperative (intoxicated) pts
-indicated for hypotension and LUQ pain to determine intraabdominal bleeding
-done with local, infra/supraumbilical incision
-blood maybe present, if not use NS/LR 10mL/kg to instill into abdomen
-fluid then sent to lab for evaluation

46
Q

Focused assessment with sonography in trauma (FAST)

A

-reveals fluid in the chest or abdomen
-Portable, noninvasive scan
-Performed on chest, pelvis, and all for quadrant of the abdomen
-Ideal for pregnant trauma patients
-Cannot evaluate organs

47
Q

Glasgow coma scale (GCS)

A

Used to assess level of brain injury
-3 indicators: eye-opening, verbal communication, noxious stimuli
-Best score: 15
-Worst score: 3

48
Q

Hemorrhage class one

A

<15%
Less than 750 mL

49
Q

Hemorrhage class two

A

Mild
15-30%
750 -1500 mL

50
Q

Hemorrhage class three

A

Moderate
30-40%
1500 -2000 mL

51
Q

Hemorrhage class four

A

Severe
>40%
Greater than 2000 mL

CNOR (14 decks)

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