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Intro To AA > Systems Review > Flashcards

Systems Review Flashcards

1
Q

How much blood does the heart pump out every minute?

A

About 5 quarts (4.7L)

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2
Q

3 functions of the heart:

A
  1. Pump blood through the lungs removes CO2 and refreshes blood with oxygen
  2. Oxygenated blood is pumped to the body to provide oxygen and nutrients and to remove waste products
  3. Coronary arteries are blood vessels that supply blood and oxygen to the heart
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3
Q

Is heart a single or double pump?

A

Double

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4
Q

Narrowing of coronary arteries that prevent adequate blood supply to the heart. Caused by atherosclerosis, it may progress to the point where heart muscle is damaged due to lack of blood supply and oxygen (infarction, arrhythmias, heart failure)

A

Coronary artery disease

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5
Q

Males or females have higher cause of death from CVD?

A

Females

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6
Q

3 complications of atherosclerosis:

A
  1. Narrowing of arterial lumen
  2. Plaque fissure
  3. Thrombus formation
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7
Q

Causes of CAD? (5)

A 
High blood cholesterol 
High BP 
Smoking 
Obesity 
Lack of PA
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8
Q

How many cardiac arrest in the OR occur per year?

A

> 17,000

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9
Q

S/S of CAD

A

None
Chest pain
Heart attack
Shortness of breath

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10
Q

5 minor clinical predictors

A
  • advanced age
  • abnormal DCG
  • rhythm other than sinus
  • history of CVA
  • uncontrolled HTN
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11
Q

5 intermediate clinical predictors

A
  • remote MI (>1month)
  • stable angina
  • compensated CHF
  • creatinine 2
  • diabetes
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12
Q

5 high clinical predictors

A
  • acute or recent MI (<1month)
  • unstable or severe angina
  • large ischemic burden (+stress test)
  • decompensated CHF
  • significant arrhythmias
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13
Q

What does STEMI stand for?

A

ST elevation myocardial ischemia

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14
Q

What is STEMI?

A

Abrupt occlusion/decrease in coronary perfusion

  • inflammatory process
  • mortality rate 15-20%
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15
Q

3 period MI mechanisms

A
  1. Unstable plaque
  2. Catecholamines
  3. BP swings
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16
Q

Low surgery risk: (4) <1%

A

Endoscopic
Breast
Skin
Cataracts

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17
Q

Intermediate surgery risk: (4) 1-5%

A

Intraperitoneal/intrathoracic
Orthopedic
Head and neck
Carotid endarterectomy

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18
Q

High surgery risk: (3) >5%

A

Emergent
Aortic
Peripheral vascular

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19
Q

Treatments for CAD: (4)

A

Lifestyle changes
Medications
Angioplasty
Surgery

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20
Q

How to beta blockers work?

A

Reduce myocardial oxygen consumption by decreasing HR, contractility, and BP

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21
Q

How does Ca+ channel blockers work?

A

Dilate arteries-decrease SVR which decreases workload and O2 consumption
Decrease HR and myocardial contractility

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22
Q

Antiplatelets

A

Prevent platelet aggregation on atheroma or thrombus

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23
Q

How do you monitor heparin?

A

Partial thromboplastin time (PTT)

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24
Q

What do statins do?

A

Lower cholesterol; decrease LDL

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25
Q

What do ACE inhibitors do?

A

Treat HTN, and lower risk of recurrent MI

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26
Q

Oxygen therapy through nasal cannula

A

2L/min

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27
Q

Balloon is inflated, compressing the plaque against the artery wall and then balloon catheter is deflated and removed

A

Angioplasty

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28
Q

Blood vessel removed from leg, arm, chest to create new blood flow path in heart

A

Bypass surgery

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29
Q

Average SV

A

60-100ml

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30
Q

Average CO

A

3-9liters/min

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31
Q

Vasodynamic parameter

  • relates CO to body surface area (BSA)
  • heart performance to the size of individual
A

Cardiac index (CI)

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32
Q

Normal CI

A

2.1-4.9 L/min/m2

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33
Q

Right atrial, central venous pressure

A

3-12

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34
Q

Right ventricular pressure systolic and diastolic

A

15-30

3-8

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35
Q

Pulmonary artery pressure systolic and diastolic

A

15-30

4-12

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36
Q

Pulmonary vein/capillary wedge pressure

A

2-15

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37
Q

Left ventricular pressure systolic and diastolic

A

100-140

3-12

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38
Q

Pressure of blood in thoracic vena cava, near the right atrium
-reflects amount of blood returning to the heart and ability of heart to pump the blood into the arterial system

A

Central venous pressure (CVP)

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39
Q

What is good estimation for CVP

A

Right atrial pressure, which is major determinant of R ventricular end diastolic volume

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40
Q

Factors that decrease CVP:

A

Hypovolemia
Deep inhalation
Distributive shock

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41
Q 
Hypervolemia 
Forced exhale 
Tension pneumothorax 
Heart failure 
Pleural effusion 
Decrease CO
Cardiac tamponade 
Mechanical ventilation and PEEP
A

Factors that Increase CVP

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42
Q

3 things to avoid in valvular insufficiency:

A

Cardiac depression
Hypoxemia, hypercarbia, and acidosis bc they increase SVR
Over sedation preop

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43
Q

What is the most common type of heart defect?

A

Ventricular septal defect (VSD)

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44
Q

Septum between the two ventricles does not fully develop, leaving a hole
-blood flows from L to R ventricle and into lungs

A

Ventricular septal defect (VSD)

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45
Q

Slow, shallow breathing

CO2 buildup in blood (acidosis)

A

Hypoventilation

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46
Q

Rapid, deep breathing

CO2 blown off (alkalosis)

A

Hyperventilation

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47
Q

Primary muscles of respiration

A

Diaphragm
External intercostal muscles
Accessory muscles

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48
Q

Amount of air remaining in lungs at end of normal exhale

A

Function residual capacity (FRC)

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49
Q

Measures lung function, specifically the amount and/or speed of air that can be inhaled and exhaled

A

Spirometry

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50
Q

4 most common measured in spirometry?

A
  1. Forced vital capacity
  2. Forced expiratory volume at timed intervals (FEV1)
  3. Forced expiratory flow
  4. Maximal voluntary ventilation
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51
Q

Volume of air that can forcibly be blown out after full inspiration (L)

A

FVC

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52
Q

Volume of air that can forcibly be blown out in 1sec, after full inspiration

A

FEV1

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53
Q

Flow of air coming out of lung during the middle portion of forced expiration

A

Forced expiratory flow (FEF)

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54
Q

Mild severity of COPD

A

> 80 FEV1

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55
Q

Moderate severity of COPD

A

50-79 FEV1

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56
Q

Severe severity of COPD

A

30-49 FEV1

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57
Q

Very severe severity COPD

A

<30 FEV1

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58
Q

Renal auto-regulate at what MAPs

A

50-150mmHg

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59
Q

Is urine output auto regulated?

A

No but is linearly related to MAP >50mmHg

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60
Q

What are renal protective drugs?

A

Dopamine

Fenoldopam

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61
Q

How does dopamine help renal?

A

Increase renal blood flow

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62
Q

How does fenoldopam help renal?

A

AntiHTN, arterial/arteriolar vasodilation

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63
Q

What 2 are most problematic antimicrobials?

A

Aminoglycosides

Amphotericin B

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64
Q

What are the 3 nephrotoxins?

A

Antimicrobials
Contrast
NSAIDs

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65
Q

What drugs are affected by kidney function (6)

A

Propofol
Morphine and hydromorphone
Midazolam
Vecuronium and rocuronium

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66
Q

Which of the drugs that affect kidney function, is though tot have the least amount of renal excretion?

A

Vecuronium

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67
Q

2 surgical consideration with renal?

A

Increased intra-abdominal pressure during laparoscopy

Aortic cross clamping

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68
Q

Most common cause of death in pts with end stage renal failure?

A

Cardiovascular disease

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69
Q

Percent of blood flow through portal vein?

A

70%

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70
Q

Percent of blood flow through hepatic artery?

A

30%

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71
Q

Percent of blood flow of CO?

A

25%

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72
Q

Does liver maintain auto regulation of blood flow with cirrhosis and exposure to volatile anesthetics?

A

NO

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73
Q

What vit K factors are produce by liver?

A

10,9,7,2 (1972)

74
Q

Portupulmonary HTN can increase risk of RHF if become….

A

Acidotic
Hypoxic
Hypercapnic

75
Q

How much can hepatic blood flow decrease from volatiles and regional without stimulation?

76
Q

What drugs can cause spasm of sphincter of oddi?

A

Narcotics (fentanyl, morphine, meperidine, nalbuphine)

77
Q

How to treat spasm of sphincter of oddi?

A

Naloxone or glucagon (1-3mg)

78
Q 
Reglan
Neostigmine 
Sux
Metoprolol
Alpha adrenergic stimulants 
Antacids
A

Increase lower esophageal sphincter tones

79
Q 
Atropine
Glycopyrrolate 
Dopamine 
Beta adrenergic stimulants 
Opioids
Propofol
A

Decrease lower esophageal sphincter tone

80
Q

Propranolol
Atracurium
Nitrous oxide

A

Not change lower esophageal sphincter tone

81
Q

Protrusion of portion of stomach through hiatus of diaphragm and then into the thoracic cavity?

A

Hiatal hernia

82
Q

Rigid structure with fixed volume of brain, blood, CSF

83
Q

Normal ICP

84
Q

Management of neuro pts relies on what manipulation?

A

Intracranial volume and pressure

85
Q

How much adult brain weighs

A

1400kg

2% of TBW

86
Q

High oxygen consumption of brain

A
  1. 3ml/100g/min

- 20% of total body consumption

87
Q

Cerebral blood flow

A

50ml/100g/min

-15% of CO

88
Q

Auto regulation of CBP

A

50-150 (60-160)

89
Q

Cerebral vasodilation is max
Vessels collapse
CBF falls passively with falls in MAP

A

Lower limit of cerebral auto regulation

90
Q

Vasoconstriction is max
Elevated intraluminal pressure
-force vessels to dilate
-increase CBF but damage BBB

A

Upper limit to cerebral auto regulation

91
Q

3 consequences to increase ICP

A

Cerebral ischemia due to reduction of cerebral perfusion pressure
Brain shifts
Brain herniation

92
Q

What are most pts at high risk for with neurosurgery

A

Electrolyte abnormalities

93
Q

6 ways to lower ICP

A 
Elevate head 
Hyperventilate (PaCO2 25-30)
Drain CSF
Osmotic diuretics
Steroids
Barbiturates, propofol
94
Q

How much decrease in CBF for every 1mmHG decrease in PaCO2 levels?

A

2% decrease

95
Q

Hyperventilation effects on CBF diminish over how long?

96
Q

Hyperventilation to what PaCO2 has shown to induce cerebral ischemia?

97
Q

4 monitors for neurosurgery

A

Arterial catheter
Second IV
Urinary catheterization
Central line

98
Q

5 best agents for neurosurgery

A 
Propofol 
Desflurane 
Sevoflurane 
Fentanyl 
Remifentanil
99
Q

All IV drugs except what decrease CBF and CMRO2?

100
Q

Narcotics reduce MAC by up to what?

101
Q

What two things are coupled with neurosurgery?

A

Cerebral blood flow and cerebral metabolic rate

102
Q

CBF with volatile agents

A

Halothane>des>iso>sevo

103
Q

What does volatile agents do to CMRO2?

104
Q

What is the only exception that actually leads to increase CBF and increase CMRO2?

A

Nitrous oxide

105
Q

What does IV anesthetics do to CBF?

106
Q

What does IV anesthetics do to CMRO2?

107
Q

What does ketamine do to CBF and CMRO2?

A

Increase both

108
Q

What does benzodiazepines do to CBF?

A

Minimal change unless over sedation, then hypercarbia

109
Q

What does benzodiazepines do to CMRO2?

110
Q

What does opioids do to CBF?

A

No affect until rapid infusion and decrease MAP which increase ICP

111
Q

What does opioids do to CMRO2?

A

Minimal effect

112
Q

What does non depolarizing NMBDs cause to CBF and CMRO2?

A 
No effect 
(Other agents do decrease CBF tho)
113
Q

What does Sux do to CBF and CMRO2?

A

Increase both

114
Q

What should you consider doing right after induction?

A

Hyperventilate

115
Q

Typical presentation/diagnosis of intracranial tumors:

A

40-60yrs
Increasing ICP
Seizure disorder
Diagnosed by CT or MRI

116
Q

what kind of emergence is needed for neuro assessment with intracranial tumors?

A

Rapid emergence

117
Q

Most common hypertonic solution used to provide relaxed brain by cerebral dehydration and decreasing ICP?

118
Q

How fast should mannitol be given?

A

Slowly over 10min

119
Q

What other drug should be considered if pt has cardiac disease and not tolerate volume load?

A

Furosemide

120
Q

What 2 complications has caused sitting position to be life threatening?

A

Venous air embolism and severe hypotension

121
Q

What can acute flexion of neck cause with neurosurgery?

A

Airway obstruction and obstruction to cerebral venous outflow (brain swell)

122
Q

Problem with elevation of head above heart with neurosurgery?

A

Risk of venous air embolism from open veins

123
Q

How can nociceptive stimulation during 3pin hold application be prevented?

A

Fentanyl or infiltration of scalp with LA

124
Q

Where are ruptured aneurysm most common in adults?

A

Subarachnoid hemorrhage

125
Q

6 anesthetic goals for intracranial aneurysms:

A
  1. Avoid HTN
  2. Decrease ICP
  3. Maintain CPP >70mmHg
  4. Prevent cerebral ischemia
  5. No movement, brain relaxed
  6. Maintain euvolemia
126
Q

What can N2O cause with intracranial aneurysm emergence?

A

Tension pneumocephalus

127
Q

3 things to do to prevent intraop hemorrhage on emergence:

A
  1. Do not reverse paralytics until head dressing is on
  2. Give 1.5 mg/kg IV lidocaine 90sec before suction/extubation
  3. Consider prophylactic labetalol
128
Q

What kind of tube for ENT?

129
Q

What paralytic is used for ENT?

130
Q

What kind of LA is good to minimize blood loss?

A

Cocaine or LA with Epi

131
Q

Why crucial to monitor chest wall motion during ENT?

A

Avoid air trapping and barotrauma

132
Q

Should you ever completely remove the ETT during a tracheotomy?

133
Q

What 3 steps to do if airway fire occurs:

A
  1. Disconnect circuit
  2. Remove ETT
  3. If fire continues, flood field with saline
134
Q

Should yo avoid NMBDs for ear surgery?

135
Q

What kind of extubation for ear surgery?

136
Q

Mixing methyl methacrylate powder with a liquid methyl methacrylate monomer, which leads to exothermic polymerization rnx

A

Bone cement

137
Q

What could force marrow, fat, and cement into circulation that produces pulmonary emboli?

A

Increasing intracellular pressure (500mmHg) from introduction of hot acrylic cement under pressure

138
Q

What are the most dangerous for bone cement?

A

Femoral prosthetics

139
Q

Hemodynamic effects of medullary fat embolism, rather than toxic effects of cement itself

A

Bone cement implantation syndrome

140
Q

Pneumatic tourniquet should be inflated to how much?

A

100mmHg over highest anticipated systolic pressure

141
Q

Temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of 6-8wks before full recovery

A

Postop neuropraxias

142
Q

What does cuff deflation of pneumatic tourniquet immediately lower?

A

CVP and MAP

143
Q

Which cases have the highest risk to venous thromboembolism?

A

Total hips, knees and lower extremely trauma (50%)

144
Q

5 other risk factors for venous thromboembolism

A 
Immobility (>4dys)
Age (>60)
Use of tourniquet 
Duration of procedure 
Type of anesthesia
145
Q

3 potential life threatening complications with total hip:

A

Hemorrhage
Venous thromboembolism
Bone cement implantation syndrome

146
Q

Which anesthesia lowers the risk of VTE?

A

Regional anesthesia

147
Q

What kind of ETT should be used with cervical spine surgery?

A

Armored ETT

148
Q

When is there increase risk of aspiration with pregnancy?

A

After 8-12wks

149
Q

4 physiologic changes with pregnancy:

A
  1. Increased risk of aspiration
  2. Increased circulation blood volume but diluted
  3. Increased CO
  4. Decrease SVR
150
Q

What two drugs cross placental barrier?

A

Versed and narcotics

151
Q

What has traditionally been the vasopressors of choice in pregnant women?

152
Q

What is now the suggest vasopressor to use in pregnant women?

A

Phenylephrine

153
Q

Neonate age

154
Q

Infant age

A

1-12months

155
Q

Child age

156
Q

5 differences of peds airways

A
  1. Tongue is larger
  2. More anterior and cephalad larynx
  3. Long, floppy epiglottis
  4. Short trachea and neck
  5. Narrowest part at cricoid cartilage
157
Q

6 different respiratory system factors for peds

A
  1. LOWER FRC
  2. Lower closing volume
  3. Less compliant lungs (Sm.alveoli)
  4. Greater chest wall compliance
  5. O2 requirement 2x
  6. CO2 production 2x
158
Q

What is the main determinant of CO up to age 2?

A

Heart rate

159
Q

Normal function of renal?

160
Q

Adult function of renal

161
Q

Main difference of GI for peds?

A

Increase GERD

162
Q

When does hepatic become fully matured?

163
Q

Normal hematocrit full term

164
Q

Normal hematocrit 3months

165
Q

Normal hematocrit 6months

166
Q

NPO of breast milk

167
Q

NPO of formula, non human milk

168
Q

IV line access for peds

A

Saphenous

Love vein

169
Q

Normal induction for peds

A

70/30 N2O/O2 then sevo 8%

170
Q

Rapid induction for peds

A

Prime with 8% sevo and 100% O2

171
Q

Steal induction with peds

A

N2O/O2 under blanket

172
Q

Neonate RR, HR, BP

A

40
140
65/40

173
Q

12months RR, HR, BP

A

30
120
95/60

174
Q

3yrs RR, HR, BP

A

25
100
100/70

175
Q

12yrs RR, HR, BP

A

20
80
110/60

176
Q

4 physiologic changes for elders

A
  1. Basal organ function unchanged
  2. Decreased functional reserve
  3. Decreased ability to compensate
  4. HEARING LOSS
177
Q

How much does CO decrease with elders?

A

1% /year after 30

178
Q

Renal function maintained for elders:

A

> .5ml/kg/hr

179
Q

Basal metabolic rate decreases by how much with elders?

A

1% /yr after 30

180
Q

Does post-op shivering increase with age?

181
Q

What diuretic to use with renal transplant?

Intro To AA (8 decks)

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