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Things to Know 2 Flashcards

1
Q

Anaphylaxis vs. Anaphylactoid

A

Anaphylaxis –> Type 1 hypersensitivity reaction, due to antigen-specific IgE antibodies, causes increased capillary permeability, peripheral vasodilation, bronchoconstriction, negative inotropy, coronary artery vasoconstriction

Anaphylactoid –> Triggered by mast cells and basophils direct interaction with certain allergens rather than interaction with IgE antibodies, dose dependent, doesn’t require prior sensitization

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2
Q

How to treat anaphylactic reaction

A

1) Call for help
2) 100% O2
3) 1-2 L fluid bolus
4) EPI
5) steroids, histamine blockers (H1, benadryl), H2 blockers (ranitidine, famotidine, etc.)
6) Inhaled b2 agonist
7) Supportive care

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3
Q

How does epi work for anaphylaxis?

A

alpha agonism causes vasoconstriction
beta agonism relaxas bronchial smooth muscle

increased cAMP restores vascular permeability
give IV if hypotensive and subQ if normotensive

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4
Q

Risk factors for latex allergy?

A

1) Spina bifida
2) Congenital urinary tract abnormalities
3) Undergoing multiple surgeries or medical procedures
4) Working in healthcare or rubber industry
5) Allergy to certain foods such as avocados, bananas, chestnuts, kiwis and passion fruit

basically repeated exposure to healthcare setting and fruits

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5
Q

Reasonable BP cut off for elective surgery

A

SBP > 180 or DBP > 110 if no end organ dysfunction

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6
Q

Causes of HTN

A 
CKD
Renovascular disease
Chronic steroid use
Sleep Apnea
Drugs
Alcohol Abuse
Obesity/metabolic syndrome
Thyroid or parathyroid disease
Pheo
Coarctation of the aorta
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7
Q

How to perform an axillary block?

A

Patient in a supine position with arm abducted and elbow flexed 90 degrees
Use US to locate the axillary artery and the nerve sheath next to it
Insert needle under US guidance into the nerve sheath and after negative aspiration inject 15-20 cc of local anesthetic
Block the musculocutaneous nerve within the coracobrachialis with additional 5 cc of local

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8
Q

What does the musculocutaneous nerve do?

A

Motor to the biceps

Sensory innervation to the lateral forearm

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9
Q

Differential for ACT not rising with heparinization for bypsas

A

1) AT3 deficiency
2) ACT machine broken
3) IV infiltrated
4) Insufficient dose of heparin

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10
Q

Types of protamine reactions

A

1) brief hypotension
2) anaphylactic/anaphylactoid generalized reaction
3) Severe pHTN with noncardiogenic pulmonary edema with cardiopulmonary collapse

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11
Q

What are the types of TEF?

A

Type A: Isolate esophageal atresia
Type B: Proximal fistula
Type C: Distal fistula
Type D: Both proximal and distal fistulas
Type E: H type, isolated fistula no atresia

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12
Q

What are VACTERL deformities?

A 
Vertebral
Anal
Cardiac
TracheoEsophageal
Renal and radial
Limb
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13
Q

What percentage of infants with TEF have cardiac defect?

A

Up to 20%, pre op echo is very important

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14
Q

Airway/induction for infant with TEF?

A

Many options, but basically you are trying to reduce aspiration but also reduce positive pressure ventilation

Would plan on inhaled induction after suctioning blind pouch to reduce chance of aspiration, this leaves infant spontaneously ventilating to reduce gastric distention

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15
Q

What type of TEF is most common?

A

80+% are Type C (c for common!)
Blind proximal pouch with a distal fistula
Try to position ETT past the fistula but above the carina

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16
Q

FHR variability

A

Indicates intact autonomic system
Minimal is < 5 bpm
Moderate is 6-25 bpm
Market is > 25 bpm

Over 2 cycles/min

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17
Q

What decreases FHR variability?

A

fetal hypoxia, sleep, prematurity, neurologic abnormalities, fetal tachycardia, betamethasone, opioids, benzos, mangesium

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18
Q

Adequate fetal accelerations

A

Adequate accelerations are defined as:
<32 weeks’ : >10 BPMabove baseline for >10 seconds
>32 weeks’ : >15 BPM above baseline for > 15 seconds
Twice in a 20 minute period = reactive

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19
Q

Normal FHR

A

110-160 bpm

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20
Q

Normal pressure differential for raising the transducer

A

10 cm = 7.5 mm Hg

A vertical difference of 10 cm between the pressure transducer and the artery of interest results in a pressure difference of 7.5 mmHg due to hydrostatic pressure

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21
Q

At what gestational age is LUD indicated?

A

18-20 weeks

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22
Q

What is rhesus isosensitization?

A

When blood from an Rh+ baby gets into the circulation of an Rh- mother and she develops IgG antibodies against the Rhesus D antigen. Can cross the placenta and lead to anemia, hemolytic dz of the newborn, hydrops, etc.

Can happen 2/2 delivery, miscarriage, abortion, amnio, ectopic pregnancy, abdominal trauma etc.

Can be prevented by administering anti-Rh antibodies (RhoGAM) within 72 hrs of event, destroying fetal D+ RBCs

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23
Q

Kleihauer-Betke Test

A

To detect and quantify the extent of fetomaternal hemorrhage to determine dose of RhoGAM

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24
Q

When to avoid NSAIDs in a pregnant patient and why?

A

2nd half of pregnancy due to possibility of closure of the fetal ductus arteriosus

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25
Q

When does FHR variability develop?

A

25-27th week of gestation, suggestive of normally functioning autonomic nervous system

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26
Q

Most significant intrapartum sign of fetal compromise?

A

Absent or minimal FHR variability

*but remember can be affected by opioids, benzos, steroids, etc

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27
Q

Effect of maternal hyperventilation on a fetus?

A

Leads to reduced maternal cardiac output, decreased BP, increased uteroplacental vasoconstriction –> all can result in compromised blood flow to the baby

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28
Q

Spina bifida occults vs. cystica

A

Occulta: abnormal or incomplete formation of midline structures over the back without herniation of meninges or neural elements

Cystica: Failed fusion of the neural arch, associated with herniation of the meninges (meningocele) or both meninges and neural elements (myelomeningocele)

Often associated with hair or dimple on the skin, can be associated with tethered cord

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29
Q

What is an omphalocele

A
  • Herniated abdominal viscera through the abdominal wall at the base of the umbilicus
  • Occurs when gut fails to return to the abdominal cavity during gestation
  • Has a membranous covering around the herniated viscera
  • Normally functioning bowel
  • Associated with other congenital defects such as CDH, trisomy 21, bladder exstrophy, cardiac abnormalities
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30
Q

What is gastroschisis?

A
  • Defect in the abdominal wall with herniated viscera lateral to the umbilicus
  • Exposed viscera and intestines with no covering
  • Inflamed and functionally abnormal bowel
  • Less likely associated with congenital abnormalities
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31
Q

What is Beckwith-Wiedemann?

A
  • Congenital syndrome
  • Macrosomia (weight & length > 90th percentile)
  • Macroglossia
  • Midline abdominal wall defect (omphalocele, umbilical hernia)
  • Ear creases/pits
  • Neonatal hypoglycemia and polycythemia
  • There is a potential for difficult airway
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32
Q

What is Pierre Robin Sequence?

A

underdeveloped jaw, backward displacement of the tongue and upper airway obstruction. Cleft palate is also commonly present, large tongue, natal teeth

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33
Q

Carcinoid triad

A

Diarrhea, flushing and cardiac involvement (pulmonic stenosis or tricuspid regurgitation)

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34
Q

What is carcinoid syndrome?

A

Signs and symptoms when a carcinoid tumor releases excessive amounts of histamine, kallikrein and serotonin into systemic circulation

Most tumors do not result in symptoms because they enter portal circulation and are inactivated by the liver but liver mets of head/neck/lung/breast tumors can also result in symptoms

Symptoms include: flushing of the upper body, bronchoconstriction, diarrhea, right sided heart disease, hypotension and hypertension

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35
Q

How to diagnose carcinoid?

A

24 hour urine 5HIAA
Elevated serum chromogranin A

Also can use octreoscan, PET/CT, MRI

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36
Q

Why is left heart protected from carcinoid syndrome?

A

Pulmonary degradation of serotonin (except in cases of right to left intracardiac shunt)

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37
Q

How to reduce pre-op risk of carcinoid crisis?

A

1) Perioperative somatostatin analogue administration such as ocretotide - reduces tumor secretion of ocreotide
2) Optimize intravascular fluid status - probably depleted
3) Anxiolytic to present stress induced release of vasoactive substances
4) Alpha & beta blockers
5) H1 & H2 blockers
6) Steroids

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38
Q

When to avoid reglan pre op?

A

If there is a bowel obstruction

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39
Q

Vapor pressures of volatile anesthetics?

A 
Sevo = 160 mm Hg
Iso = 240 mm Hg
Des = 681 mm Hg
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40
Q

What happens if you put iso in sevoflurane vaporizer?

A

Delivered concentration will be higher than expected because the vapor pressure of iso is higher than that of sevo. Danger compounded by the fact that iso is more potent than sevo.

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41
Q

Chance of crossreactivity between PCN allergy and cephalosporin allergy?

A

About 0.5% 1st generation
Near 0 for 2nd and 3rd generation

Also incidence of TRUE PCN allergy with reported PCN allergy is less than 10%

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42
Q

How many times faster than air does nitrous oxide diffuse into abdominal cavities?

A

34x

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43
Q

Tricuspid regurgitation effecto on CVP tracing?

A

Prominent CV wave and absent x-descent

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44
Q

Pathophysiology of aspiration pneumonitis?

A

Damage to surfactant producing cells and pulmonary capillary endothelium by gastric contents, causes atelectasis, pulmonary edema, bronchospasm, tachypnea, tachycardia, increased pulmonary vascular resistance 2/2 hypoxic pulmonary vasoconstriction and increased WOB

Intense inflammatory response can lead to ARDS

Then can develop pnuemonia due to transmission of bacteria into the lungs from the oropharynx

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45
Q

Abx after aspiration as prophylaxis?

A

No not usually recommended unless there was feculant aspiration (bowel obstruction etc)

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46
Q

Differential of a normal PT and elevated PTT

A

Von Willebrand’s, Hemophilia A, B or C, lupus anticoagulant or low dose heparin administration

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47
Q

Hemophilias

A

A & B are both sex linked recessive disorders that are clinically indistinguishable

A - factor 8 deficient
B - factor 9 deficient

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48
Q

PT vs. PTT (extrinsic vs intrinsic)

A

PT - extrinsic & common pathway

PTT - intrinsic

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49
Q

When to give DDAVP for hemophilia?

A

When patient has mild hemophilia A with Factor VIII levels > 5%

Induces release of factor VIII and vWF from endothelial cells

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50
Q

What level of factor VIII prevents surgical bleeding?

A

Most think 30%, but would correct to 75-100% depending on bleeding risk

51
Q

Pros and cons of LMA for tonsillectomy

A

Pros: better protection of lower airway from blood, less bronchospasm, laryngospasm, bleeding and post-operative desaturation

Cons: ETT would be easier to place, occupies less space in the oropharynx and provides more reliable positive pressure ventilation

52
Q

What are contra-indications to deep removal of LMA?

A

OSA, obesity, difficult airway

53
Q

How to dose narcotics in patients undergoing tonsillectomy?

A

1/2 what you would normally give

There is a black box warning on codeine containing products in children undergoing tonsillectomy

54
Q

How to dose factor VIII after a surgery?

A

Continue to replace for up to 2 weeks or longer for bone or joint surgery

Half life is 6-10 hrs in adults and 6 hrs in children

55
Q

Benefits of induced hypotension in orthopedic surgery?

A

Decreased blood loss and operative time

56
Q

Interscalene nerve block distribution

A

Indications: Shoulder and upper arm surgery, surgery of the clavicle (combined with cervical plexus nerve block)
Transducer position: Transverse on the neck, 3–4 cm superior to the clavicle, over the external jugular vein
Goal: Local anesthetic spread around superior and middle trunks of brachial plexus, between the anterior and middle scalene muscles
Local anesthetic: 7–15 mL

Commonly ulnar sparing, inferior trunk (C8-T1) is spared.

Anterior deltoid often received innervation from superficial cervical plexus so may not be blocked with interscalene

57
Q

Bezold-Jarisch reflex

A

Bradycardia, apnea, hypotension in response to shoulder surgery, spinal or epidural anesthesia, after an MI etc. Thought to be a cardiac productive response (induced bradycardia to avoid ischemia)

A cardiovascular decompressor reflex involving a marked increase in vagal (parasympathetic) efferent discharge to the heart, elicited by stimulation of chemoreceptors, primarily in the left ventricle.

This causes a slowing of the heart beat (bradycardia) and dilatation of the peripheral blood vessels with resulting lowering of the blood pressure.

58
Q

Horner’s Syndrome

A

ptosis, miosis (constricted pupil), anhydrosis

Many causes but iatrogenic from anesthesia include cervical plexus block, stellate ganglion or interscalene block

59
Q

Curling’s ulcers

A

Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa

60
Q

Cushing’s ulcers

A

from head injury/elevated ICP

61
Q

DPG & oxygen hemoglobin dissociation curve

A

Increased DPG –> right shift

Decreased DPG –> left shift

62
Q

Minimum UOP

A

0.5 ml/kg/hr

63
Q

GCS

A

Scoring system used to describe the level of consciousness of a person following TBI using eye opening, motor response and verbal response

From 3-15
Below 9 = severe brain injury
9-12 = moderate
> 13 = minor

64
Q

Definition of massive transfusion

A

1 blood volume in 24 hrs

50% blood volume in 4 hours

65
Q

Trauma product resuscitation ratio

A

1:1:1

66
Q

ARDS criteria

A

Acute Respiratory Distress Syndrome (ARDS)

acute onset
PaO2/FiO2 ratio < 200
bilateral infiltrates consistent with pulmonary edema
no evidence of LA hypertension

67
Q

Ventilation strategy in ARDS

A

Protective lung ventilation

  • low tidal volume (TV) ventilation (4-8 mL/kg)
  • Maintaining plateau pressures (Pplat) <30 cmH20
  • Permissive hypercapnia
  • 6 mL/kg PBW (predicted body weight, not actual body weight)
68
Q

Severity of ARDS

A

Mild 200 – 300
Moderate 100 – 200
Severe < 100

69
Q

Pathophysiology of ARDS

A

Acute lung inflammation, increased permeability of the lung endothelial and epithelial barriers, inhibition of surfactant function, impairment of alveolar fluid clearance mechanisms and systemic inflammation

70
Q

Pre-thoracotomy respiratory assessment

A

Evaluate:

1) Respiratory mechanics: FEV1, MVV, RV/TLC, FVC
2) Lung parenchymal function: DLco, PaO2, PaCO2
3) Cardiopulmonary reserve: Vo2 max, Stair climbing, 6 minute walk test, exercise SpO2

71
Q

What if a thoracotomy/pneumonectomy patient has a ppoFEV1 < 40%?

A
  • Order a VQ scan to assess contribution of lung to be resected
  • Get an echo to eval rRV function (high risk of RV function)
72
Q

What is pancoast’s syndrome?

A

Malignant involvement of the structures in the superior sulcus or thoracic inlet, referred shoulder pain or pain in the ulnar distribution, ipsilateral horner’s syndrome

73
Q

Cushing’s syndrome, secretion of excess ACTH causes potassium to do what

A

hypokalemia

74
Q

Stair climb correlation to VO2 max

A

5 flights - VO2 max > 20
2 flights - VO2 max of 12
< 2 flights = high risk

75
Q

Revised Cardiac Risk Index

A

History of:

  • Ischemic Heart Disease
  • IDDM
  • Stroke or TIA
  • Heart failure
  • Renal insufficiency with Cr > 2
  • Supra-inguinal vascular, intraperitoneal or intrathoracic surgery

0-1 predictors = low risk of MACE
> 2 = elevated risk of MACE

76
Q

Sequence to treat pedi laryngospasm

A

1) Call for help
2) Suction oral secretions
3) Larson’s maneuver (jaw thrust with pressure at the ascending ramus of mandible)
4) PPV using 100% oxygen
5) Deepen anesthetic & give lidocaine

77
Q

Age cut off for caffeine halothane contracture test?

A

Age 7 and 20 kg

78
Q

Starter jet ventilator settings

A

Pressure 5-10 psi for pedi, 15-25 psi for adult

Inspiratory time of < 1 second

79
Q

Extubation criteria in general terms

A

When the patient demonstrates adquate oxygenation and ventilation, minimal ventilatory support, normal lung compliance, stable hemodynamics. If any airway injury consider also making sure no airway edema and the presence of a cuff leak.

80
Q

Hepatopulmonary syndrome what is it?

A

Hepatopulmonary syndrome (HPS) is characterized by the triad of abnormal arterial oxygenation caused by intrapulmonary vascular dilatations (IPVDs) in the setting of liver disease, portal hypertension, or congenital portosystemic shunts.

Caused by increased perfusion at the lung bases with poor ventilation there. Worst in the upright position, better with laying flat.

81
Q

What causes ascites?

A

portal hypertension and renal retention of sodium and water, low oncotic protein intravascularly

82
Q

Criteria for hepatorenal syndrome

A

1) Presence of advanced liver disease and portal HTN
2) low GFR (serum Cr > 1.5)
3) Absence of shock, infection, flood losses or treatment with nephrotoxic agents
4) No sustained improvement in renal function with a 1.5 L fluid challenge
5) Absence of protenuria, urinary obstruction or parenchymal renal disease

83
Q

Pathophysiology of HRS?

A

Splanchnic arterial vasodilation, leads to reduction in effective blood volume sensed by juxtaglomerular apparatus which then leads to activation of RAAS and sympathetic nervous system, causes intra-renal arterial vasoconstriction

84
Q

Types of HRS?

A

Type 1 - rapidly progressive renal failure ( 2 weeks or less)
2) slower onset renal failure

85
Q

Classifications of portopulmonary hypertension

A 
Mild = mean PAP of 25-35
Moderate = mean PAP of 35-45
Severe = mean PAP > 45
86
Q

Aneurysm vs. dissection

A

Aneurysm: abnormal dilation of all 3 layers of an artery (intima, media, adventitia)

dissection: Blood has entered the arterial wall through a tear in the intima

87
Q

Craword Aneurysms

A

Type 1 - originate below the left subclavian and extend only to involve the celiac and mesentary axis
Type 2 - originate below the left subclavian and extend into the infrarenal abdominal aorta
Type 3 - Originate in the lower descending thoracic aorta and involve the remainder of the aorta
Type 4 - Originate at the diaphragm and involve the abdominal aorta only
Type 5 - Originate below the 6th rib and extend only to the renal arteries

88
Q

Perioperative concerns specific to aortic aneurysm

A

Aneurysm rupture, propogation of aneurysm, paraplegia 2/2 disruption of radicular arteries, hemodynamic instability, potential massive blood loss, post-op kidney dysfunction, stroke

89
Q

CSF target pressure via lumbar drain?

A

8-10 mm Hg

90
Q

Spinal cord preservation strategies

A 
Passive hypothermia
Avoidance of intra-op hypotension
Maintenance of normal hematocrit & PaO2
Neuromonitoring
Avoidance of hyperglycemia
ID and preservation of blood flow to critical intercostal arteries
91
Q

Types of endoleaks

A

Type 1: failure of seal between stent graft and aortic wall at the proximal or distal attachment site
Type 2: retrograde flow from intercostal arteries fills in the aneurysm sac
Type 3: Structural failure of the stent graft
Type 4: Stent graft too porous
Type 5: Unknown location of leak

Type 2 & 4 are benign, 1 & 3 require urgent intervention

92
Q

How to create a hemodynamically “still” field for endograft deployment in thoracic aneurysm

A
  1. adenosine 6-12 mg
  2. rapid pacing 150-180
  3. RA flow occlusion via occlusion balloon
93
Q

Renal protection during aortic surgery

A 
Adequate hydration
Minimize contrast use
Avoid nephrotoxic drugs
Renal protective drugs: statins, mannitol, loop diuretics, low-dose dopamine, fenoldopam
systemic or regional hypothermia
94
Q

How does mannitol protect kidneys?

A

Increases renal cortical blood flow, is a free radical scavenger, increases renal prostaglandin synthesis, decreases renin secretion, reduces cellular edema

(little evidence to support this)

95
Q

What is post-implantatoin syndrome?

A

Associated w/ endovascular aortic aneurysm repair, post-op complication

2/2 endothelial activation by the prosthesis

Fever, elevated inflammatory mediators, leukocytosis, usually mild and self limiting (2-10 days) and treated with NSAIDs

96
Q

Tetrology of fallot defects

A
  1. Overriding aorta
  2. RVH
  3. RVOT Obstruction (pulmonary stenosis)
  4. VSD
97
Q

Drugs that inhibit antiplatelet effect of clopidogrel and aspirin?

A

PPIs - don’t give in patients on DAPT

98
Q

Complication of TPN that causes difficulty with ventilator weaning?

A

Hypophosphatemia causing muscle weakness

Elevated Co2 from carb delivery which might require more ventilation than patient can perform on their own

99
Q

Treatment of cholinergic crisis

A

1) Intubation if necessary
2) D/c any anticholinesterase therapy
3) Give antimuscarinics (like atropine)
4) Supportive care
5) In most severe cases can consider plasmaphoresis or IVIG

100
Q

Complications of retrobulbar blocks

A

1) Direct trauma to the optic nerve
2) Retrobulbar hemorrhage
3) Increased IOP 2/2 globe compression
4) Globe perforation
5) Stimulation of oculocardiac reflex
6) Intravascular or intraneural injection
7) Spread of local to the CNS causing general anesthesia & apnea

101
Q

Pedi foreign body aspiration

A

Give metoclopramide & glyco
Ensure presence of ENT and rigid bronchoscope
Apply appropriate monitors
Inhalational induction and maintain spontaneous ventilation

PPV can push the foreign body further so I would not ventilate if at all possible

102
Q

Complications of foreign body aspiration

A

Obviously life threatening airway obstruction but also:

1) Chemical pneumonitis
2) Bronchial stenosis
3) PNA
4) Lung abscess
5) Tissue erosion/perforation
6) Pneumomediastinum or pneumothorax

103
Q

What is pseudotumor cerebri?

A

Benign intracranial hypertension
Normal CSF and absence of mass lesion
Headaches, visual disturbances, papilledema, etc

Treatment:

  • Carbonic anhydrase inhibitors: acetazolamide to decrease CSF production
  • Furosemide
  • Steroids
  • Serial LPs
  • VP shunt
  • Optic nerve sheath fenestration
104
Q

Avoid sux in male children

A

8 years

2/2 risk of undiagnosed muscular dystrophies

105
Q

FAST exam

A

focused assessment with sonography for trauma

Views:

  • Subxiphoid (pericardium)
  • RUQ (hepatorenal recess)
  • LUQ (perisplenic space)
  • pubic (retrovesical pouch)

However CT is better in a stable patient

106
Q

What is abdominal compartment syndrome?

A

When the abdominal pressures rise above the perfusion pressure of abdominal organs (20-25mm Hg), reduced perfusion to the liver, kidneys & bowel, impaired ventilation, cardiovascular depression 2/2 decreased venous return, increased SVR 2/2 compression of the aorta, increased ICP 2/2 decreased cerebral venous outflow

107
Q

How to diagnose abdominal compartment syndrome

A 
Triad of 
1) Elevated intra-abdominal pressures
2) Abdominal distension
3) End organ dysfunction
Don't need to have all but if have all 3 highly suggestive

Can measure pressure via NG tube with gastric pressure or intra-vesicular pressure with Foley

> 10 mm Hg can cause it but > 20-25 mm Hg are critical

108
Q

What is PRIS?

A

Propofol infusion syndrome

Primarily occurs in kids & critically ill adults
Continuous infusion of high dose propofol (4-5 mg/kg/hr) for > 5-6 hrs but usually > 24-48 hrs

Leads to metabolic acidosis, bradycardia, rhabdo, lipemia, hyperkalemia, hepatomegaly, fatty liver, renal failure, cardiomyopathy

Mortality > 80%

109
Q

Slit Ventricle Syndrome?

A

When excessive CSF shunting happens during brain growth, leads to irreversibly collapsed ventricles and decreased intracranial compliance

High risk of cerebral herniation

110
Q

Significance of LBBB

A
  • Significant association with ischemic heart disease, aortic valve disease, LVH, CHF, HTN
  • hard to diagnose MI because LBB hides ST & T wave segment changes
  • wide QRS can mistake SVT for VT
  • Placement of PA catheter can lead to complete HB bc of transient RBB during placement
111
Q

Contrast induced nephrology - how to diagnose

A

25% or 0.5 mg/dL increase in serum cr from baseline within 3 days of contrast injection, usually resolves within 7-14 days

112
Q

What is vWD?

A

Most common inherited coagulation disorder, caused by qualitative and quantitative defects in vWF. vWF mediates platelet adhesion to the surface of blood vessels and also paltelet to platelet aggregation. It also acts as a carrier for factor 8.

113
Q

vWD eval?

A

History: ask about bleeding, bruising, epistaxis etc.
Labs: CBC, plt, bleeding time, PT and PTT (all could be normal but severe dz has prolonged bleeding time and PTT)

114
Q

Blood products to have available for patient with vWF?

A

DDAVP
cryo
FFP
humate p (preparation of f8 and vWF concentrate)

115
Q

Which vWD type cannot get DDAVP?

A

Type 2B

116
Q

DDx for AMS after crani

A

1) hematoma
2) tension pneumocephalus
3) cerebral edema
4) Cerebral infarction/ischemia
5) hypoxia
6) hypercarbia
7) seizure
8) obstructive hydrocephalus

117
Q

Risk factors for peripheral nerve injury

A

Male, hospital stay > 14 days, hypotension, vascular dz, hx hypertension, dm, smoking, very thin or very obese

More than 1/2 regain full sensory and motor function within 1 year, most within 6-12 weeks

118
Q

Systemic effects of chronic renal failure

A
  • Metabolic derrangements such as hyperK, hypoNa, hypoCa, hyperMg, hyperphos, hypoalbuminemia, metabolic acidosis
  • peripheral & autonomic neuropathy
  • uremia with encepholopathy
  • delayed gastric emptying
  • insulin resistance
  • cardiac arrythmias or conduction blocks
  • accelerated atherosclerosis
  • renal osteodystrophy from secondary hyperPTH and decreased renal vitamin D
  • uremic pericarditis
  • HTN
  • CAD
  • cerebrovascular disease
  • anemia
  • bleeding
  • increased susceptibility to infections
119
Q

explain pathophys of HTN in renal disease

A

renal retention of sodium & water and activation of the RAAS system leads to HTN

120
Q

Hemodynamic goals in cardiac tamponade

A 
tachycardia = good
full = good

give fluid, 100% oxygen, treat bradycardia

121
Q

PACU discharge criteria

A

Postanesthesia Discharge Scoring System (PADSS) or ALdrete

Crtieria include:

1) Vital signs within 20% of baseline
2) Activity level steady gate no dizziness
3) N/V minimal and treated with PO meds
4) Pain acceptably controlled with PO meds
5) Surgical bleeding minimal no dressing changes required

OR

Activity
Respiration
Circulation
Consciousness
Oxygen Sat

need a score of 9

122
Q

Neonatal SLE?

A

Maternal autoantibodies cross the placenta and bind to fetal tissue - can cause heart block, cutaneous lupus and thrombocytopenia

123
Q

Interscalene block complications

A
  • Diaphragmatic hemiparesis from ipsilateral phrenic nerve block (100% incidence, 25% reduction in pulmonary function)
  • Pneumothorax
  • Permanent neurologic injury
  • Blockade of vagus, recurrent laryngeal, and cervical sympathetic nerves (Horner’s syndrome)
  • Epidural or subarachnoid injection
  • Vertebral artery injection
  • Severe hypotension and bradycardia (Bezold-Jarisch reflex)

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