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Anesthesiology Round 2!!! > Syncope and collapse > Flashcards

Syncope and collapse Flashcards

1
Q

Syncope definition:

A

Transient, self-limiting loss of consciousness with an inability to maintain postural tone

It has a relatively rapid onset with variable warning symptoms and is followed by spontaneous recovery

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2
Q

Pre-syncope:

A

Light-headedness without loss of consciousness

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3
Q

Drop attack:

A

Loss of posture without loss of consciousness

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4
Q

Coma:

A

Loss of consciousness without spontaneous recovery

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5
Q

Collapse:

A

Sudden, and often unannounced, loss of postural tone (going weak), which is often, but not necessarily always, accompanied by loss of consciousness

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6
Q

3 categories of Syncope:

A

Reflex/neural mediated
Orthostatic hypotnesion
Cardiac causes

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7
Q

Reflex/neural mediated causes of syncope:

A
  • Vasovagal syncope
  • Situational syncope
  • Carotid sinus syncope
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8
Q

Vasovagal syncope:

A

Most ocmmon typw of syncope
Caused by a sudden drop in BP and a reduction in blood flow to the brain
Caused by vasodilation, bradycardia and/or increased PNS activity
Orthostatic vasovagal syncope
Emotional vasovagal syncope due to fear, phobia and pain

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9
Q

Situational syncope:

A

Loss of consciousness after defecation, swallowing, micturation and/or coughing
Caused by abnormal autonomic control - cardioinhibitory response, vasodepressor response, both

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10
Q

Carotid sinus syndrome:

A

Carotid baroreceptors react too strongly to detecting increased pressure -> leadds to an excessive drop in BP

I.e. when someone ties a tie too tight - glossopharyngeal nerve is compressed -> activate cardiac vagal efferent nerve fibres

Often in men over 50

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11
Q

Orthostatic hypotension causes:

A

-Volume depletion
- Autonomic depletion

Use the acronym DAAD:
Drugs - BP, diuretics, TCA’s
Autonomic insufficiency - Parkinson’s, DM, shy-dragger, adrenal insufficiency
Alcohol
Dehydration

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12
Q

Volume depletion causes:

A
  • Hemorrhage, vomiting, diarrhea
  • Autonomic faliure - affects vasodilation and vasoconstriction - can be caused by primary autonomic faliure - ex. due to old age, parkinson’s disease
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13
Q

Pathophysiology of Syncope:

A

Global hypoperfusion of both the cerebral cortices or focal hypoperfusion of the reticular activating system in the midbrain

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14
Q

__% reduction in cerebral blood flow causes syncope

A

35

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15
Q

Cessation of cerebral perfusion for ____ seconds causes syncope

A

5-10

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16
Q

San Francisco Syncope Rule:

A

High risk for a serious cause of syncope:

40% mortality in 2 years after unexplained and recurrent syncope is anyone who has structural heart disease (CHF), anemia, hematocrit <30%, ECG abnormality, SOB, or htn (SBP<90mmhg)

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17
Q

Cardiac causes:

A

*** most dangerous
- Rarely causes syncope but may lower the threshold for syncope

  • Arrhythmia
  • Sturctural defects - aortic stenosis, hypertrophic cardiomyopathy, prosthetic vavle dysfunction, MI
  • Great vessel defects - PE, acute aortic dissection
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18
Q

Neurocardiogenic syncope:

A

Vigorous myocardial contraction of relatively empty LV -> activates myocardial mechanoreceptors and vagal afferent nerve fibres that inhibit sympathetic activity and increase parasympathetic activity -> vasodilation and syncope

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19
Q

Drop in BP and fixed HR?

A

Dysautonomic disorder

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20
Q

Drop in BP and increase in HR?

A

Vasodialtion or volume depletion

21
Q

Insignificantdrop in BP and marked HR increase

A

Postural orthostatic tachycardia

22
Q

Orthostatic htn is defined as a fall in sys BP of at least __ mmHg or dia BP of at least __ mmHg when a person stands

A

20
10

23
Q

Monitoring after Syncope:

A

History
Physical ex
Medication review
ECG
Carotid sinus massage to assess carotid sinus hypersensitivity - CONTRAINDICATED if carotid bruit present or TIA/stroke

24
Q

High-risk work-up:

A

Holter monitor, echo, stress test, ischemic evaluation, posterior circulation imaging of the brain if you suspect neurological syncope

25
Q

Syncope patients considered low-risk?

A

High suspection of vasovagal or neuroardiogenic etiology

26
Q

Vasovagal syncope treatment:

A

B-blockers
SSRI’s
Fludrocortisone (also for postural htn)
a-adrenoreceptor agonist
Disopyramide (vagolytic antiarrhythmic)
Permanenr dual chamber cardiac pacing

Compression stockings for orthostatic htn

27
Q

___ reduction in cerebral blood flow

A

35%

28
Q

Cessation of global perfusion for _____ -> syncope

A

5 to 10 seconds

29
Q

Drop in BP w/ fixed HR =
Drop in BP w/ increased HR =
Insignificant drop in BP w/ markedly increased HR =

A

ANS failure
Volume depletion/ vasodilation
Postural orthostatic tachycardia syndrome

30
Q

Shock management:

A
  • Intubate early to ensure adequate oxygenation
  • Keep central venous pressure above 8mmHg w/ IV fluids
  • Keep mean arterial BP above 65mmHg
  • Keep hematocrit above 30%

Early recognition is key use inotropes if required by the heart

31
Q

Crystalloids:
Contents
Application
Place of action
Half life

Examples
Dose

A
  • Electrolytes (small)
  • First line of choice for volume resuscitation
  • 25% in plasma, 75% expands interstitial volume
  • Short HL - 30-60 mins

Sodium chloride 0.9%, sodium lactate

1000mL

32
Q

Colloids:
Contents

Examples
Dose

A
  • Large solute molecules that do not pass from plasma to interstitial fluid
  • 75% in plasma, 25% expands interstitial volume
  • Longer HL - 2-4 hours
  • Suitable for small volume resuscitation

Albumin, dextran, fresh frozen plasma, packed RBC’s

300-500mL

33
Q

Infusion of one liter of 0.9% NaCl adds ____ mL to the plasma volume and ____mL to the interstitial volume. The total increase in extracellular volume _____mL is slightly greater than the infused volume. This is the result of fluid shift from the intracellular to extracellular fluid.

A

275
825
1,100

34
Q

5% dextrose:
composition
mechanism

A
  • 50g dextrose in 1kg of water
  • The dextrose slows down transfer of water into the ICF to prevent cellular lysis from over-swelling
  • Even distribution (ECF, ICF
35
Q

Normal CVP:
Normal CPWP:

A

8-12mmHg
4-14mmHg

36
Q

Endotracheal intubation can cause hypo or hypertension?

A

Typically Hypo but can be hyper under stress and hypoxia

37
Q

Goals of treatment:

A

Urine >0.5mL/kg/h
CVP 8-12 mmHg
MAP 65-90 mmHg
CVo2 conc. - >70%

38
Q

Position in shock:

A

supine

39
Q

Packed RBC’s:
What is it? Indications?

A

Blood is centrifuged at 3000revs/min.
1 unit of packed cells increases Hg by 1g/dL and hematocrit by 3%

  • Used when whole blood may overload the circulation

1 - symptomatic chronic anemia w/o hemorrhage
2 - acute sickle crisis
3 - cardiac failure
4 - acute blood loss (30% or more)
5 - perioperative anemi

40
Q

FFP vs Cryoprecipitate

A

Cryoprecipitate
- Derived from plasma
- Concentrated form of certain clotting factors (fibrinogen, factor 8, vwf, fibronectin)
- Undergoes thawing and centrifuging
- Cryoprecipitate is primarily used to treat bleeding or to prevent bleeding in patients with specific coagulation disorders, such as hypofibrinogenemia (low fibrinogen levels), von Willebrand disease, and hemophilia A. It is particularly rich in fibrinogen, making it effective in cases where fibrinogen levels need to be quickly replenished, such as in massive bleeding or during surgical procedures.

FFP
- Liquid portion of blood that is seperated from whole blood and frozen within hours of collection
- FFP is used to replace multiple coagulation factors in patients with significant deficiencies or abnormalities in coagulation. It is often indicated in patients with liver disease, disseminated intravascular coagulation (DIC), massive transfusion, and certain congenital coagulation disorders. FFP can also be used as an emergency treatment for acute bleeding when specific factor concentrates are not available.

41
Q

Hg, hct levels required for transfusion:

A

Hg <10g/dL
Hct <30%

42
Q

Start transfusion slowly for first ____ mins @ _____

A

15
2mL/min

43
Q

Febrile transfusion reaction:

A
  • Fever, chills, malaise
  • Acetominophen, supportive
  • Most common transfusion reaction
44
Q

Hemolytic transfustion reaction:

A
  • Immediate fever/ chills, headache, N/V, dark urine, hypotension
  • Vigorous crystalloid infusion + diuretic to maintain urine output
  • Most serious reaction
45
Q

Allergic reaction:

A
  • Urticaria or hives
  • Antihistamines
46
Q

Transfusion-related acute lung injury:

A
  • Indistinguishable from ARDS
  • Supportive
47
Q

Delayed transfusion reaction:

A
  • Fall in Hg, rise in bilirubin
  • Supportive
48
Q

Transfusion-associated graft versus host disease:

A
  • Rash, elevated LFT’s, pancytopenia
  • Supportive
  • Immunocompromised patenients
  • Use irradiated blood products

Anesthesiology Round 2!!! (30 decks)

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