Test 3 Flashcards
Bezold jarish reflex triad
HotN, bradycardia, coronary artery dilation
when is bezold jarish most often seen?
awake pt with interscalene block
tourniquet pain starts after?
30min, or 45-60min for GA
what fiber types involved in tourniquet pain?
c fibers and a delta
Tourniquet placment pressues and max time
LE:
max 2 hours, 100-150 above SBP
UE: Max 90min, 50-75 above SBP
Bleeding ammount in trachanteric/subtrochanteric hip fx?
1200ml
bleeding ammount in intracapsular hip fx?
800ml
Off NSAIDs for how long before spinal?
no delay
off coumadin for how long before spinal?
INR 1.4 after 5 days
off plavix for how long before spinal?
7 days
off Ticlid for how long before spinal?
14 days
Off xarelto/rivaroxaban for how long before spinal?
3 days
When is surigical correcton done for scoliosis? ANd what is the goal?
when cobb angle is greater than 50%
stop cardiac and resp compromise
S/s of VAE
unexplain HoTN, and increased ET nitrogen
VAE tx
wound irrigated with saleine, DC N20, pressors, aspiration of air from CVP, lay pt right side up
Tell me about BAEP
brainstem auditory evoked potentials
used in resections of acoustic neuromas
uses sound waves to stimulate cochlea
SSEP key info
somatosensory evoked potentials
stimulate peripheral nerves, impulse goes up spinal cord via dorsal root.
monitors the afferent sensory pathway
the failure of SSEPs to reliably predict post-op deficits is well documented
you can have motor deficits with unchagned SSEPs
blood supply for afferent sensory pathway?
post spinal arteries
EMG info
Electromyogram
used to record electrical activity of muscles, used to find the cause of weakness, paralysis, or muscle twitching
doesn’t show brain or spinal cord disease
During spinal surgery for stenosis/degneration: used to protect nerve roots; extremely sensitive to nerve root irritation
MEP
stimulate spinal cord above operative site and recording resonse below operative site
monitors descending motor pathways supplied by anterior spinal artery
monitors motor tracts, especially corticospinal tract
MEPs are the gold standard for monitoring motor pathways
Anesthetic plan for SSEP
avoid N2o
avoid VA >1 MAC
anesthetic plan for EMG
limit NMB to 2-4 twitches
With NIMs tube, no NMB past intubation
anesthetic plan for MEPs
TIVA or balanced technique with VA < 0.6 mac
propofol 75-150mcg.kg/min
Drugs that affect SSEPs
VA senstive > 1 MAC
N20 sensitive decease amplitiude
opiods mild depression no change in amplitude or latency
midazolam: mild depression: ^ latency and decrased amplitude
ketamine desierable
Propofol amplitude depression with induction but rapid recovery
NMBs: insenstive, may improve responses due to less EMG interference
Drugs that effect Transcranial MEPs
VA >0.6 MAC
N20 sensitive
midazolam less desirable, CMAP depression
muscle relaxants, senstive and usually avoided
define amplitue and latency
amplitude: height
latency length
change in evoked potentials means what?
worsening situation; critical decrease in amplitude or increase in latency indicates early warning of structures in danger.
acute increase of only ___ to ___ ml of fluid can cause tamponade?
40-50ml
What is kussmauls sign?
JVD in inspiration
how often is pulsus pradoxus present?
75% in actue tamponade and only 30% in chronic pericardial effuseion
what do both kussmauls and pulsus pradoxus represent?
ventricular discordance or apposing resonses of the RV and LV to filling during the resp cycle
what is becks triad? How often is it seen?
distended neck veins, HotN, muffled heart tones
only seen in 1/3 of actue tamponade patients
Pressure volume loop in tamponade?
short and shifted to the left
three word acronym for mgnmt of tamponade?
Fast Tight Full
Goals: tachycardia, vasoconstriction, and volume
What treatments can reverse remodeling in HF?
ACE-I
Beta blockers
cardiac reschyronization
Dont drink alcohol
restrictive cardiomyopathy affects filling or systole?
filling. Systolic fxn usually normal
most common type of cardiomyopathy?
dilated cardiomyopathy
SVT and vertricular dysrhythmias common in which cardiomyopathy?
dilated
When is EF > 80%?
HOCM
pathcy scaring is seen when?
HOCM
when do you see speckled ventricle?
restrictive cardiomyopathy
How does lying down affect symptoms of HOCM?
releives them
how does valsava affect symptoms of HOCM?
aggravates them
SNS stimulation redisributes blood from where to where?
from kidneys, splanchnic and skeletal circulation to vital organs
mild tachycardia can be helpful in which type of HF?
systolic
How does ANP protect CV system? What is the caveat?
by decreasing RAAS and SNS
over time response to ANP is blunted
are ANP and BNP antiinflammatory?
yes
Why are opiods benficial in anesthetic mgmt of HF?
they temper teh SNS
what is gold standard/1st lean tx for pericarditis?
NSAIDS1
cholchicine in pericarditis is associated with what?
less relapse
why don’t we like to use steroids in pericarditis?
frequently cause relapse once discontinued, so only use if other therapies don’t work.
resistance pericarditis may respond to what?
Imuran / azathiprine
tell me about dresslers syndrome
delayed form of pericarditis that occurs week sto months after myocardial event, it is often auto-immune
3 thigns that can move oxyhgb dissasociate curve to the right
sickle cell, materanl hbg, renal failure
3 things that can move oxyhgb diss curve to the left?
fetal hbg, carboxyhgb, methgb
heart O2 extraction ratio
55-70%
brain o2 extraction ratio
30-35%
how to calculate O2 transport?
Hct/viscosity
how long can platlets be stored at room temp?
5 days
do platletse need to be ABO compattible?
No, but preffered
can platlets be warmed?
no
what size filter for platlets vs RBCs?
170micron for platlets and 20-40 for blood
effective coagulationc an occur with clotting factors as low as?
20-30% of normal
the four factors found in cryo?
fibrinogen
vWF
F 8
F13
waht is used for uremeic bleeding not responsive to DDVAP?
cryo
how fast does TRALI occur?
within 6hrs of transufsion
2 causes of acutue hemolytic reactions?
presence of antibodies from prior exposure
transfusion of white cells or white cell antibodies
main cause of sepsis from bacterial contamination with tranfusions?
platlets»_space; RBC > FFP & Cryo
1 unit of regular insulin lowers BG by how much?
25-30mg/dl
what rate for D5 infusion?
1.5ml/kg/hr
how much does 1ml of D50 raise BG?
by 2mg/dl
