38. Embolism

Question 1

VAE requirements

Answer 1

open vein
pressure in vein > subatmospheric pressure

Question 2

VAE surgical position

Answer 2

can occur in any position

Question 3

higher incident rate of VAE

Answer 3

sitting craniotomies

Question 4

VAE presentation is dependent on

Answer 4

volume entrained
rate of air entrainment
presence of R-to-L shunt

Question 5

as rate of air entrainment increases, what happens?

Answer 5

incr PAP
decr CO
RV overload
decr LV preload

Question 6

nitrous and VAE

Answer 6

rapidly increases severity of VAE

Question 7

VAE definitive diagnosis

Answer 7

Echo

Question 8

VAE signs/symptoms

Answer 8

decr EtCO2 (stair step)
decr O2
tachycardia
hypotension

Question 9

monitors to detect VAE

Answer 9

TEE
precordial doppler over RA

Question 10

precordial doppler placement for VAE

Answer 10

over RA
between 3rd and 6th ribs

Question 11

VAE treatment

Answer 11

prevent further entrainment
stop N2O
100% FiO2
aspirate air bubbles from CVC
give crystalloid to incr CVP
give vasopressor to correct htn
incr PEEP
head down/left tilt (durant’s)

Question 12

polymethymethacrylate

Answer 12

exothermic
expansion
intramedullary pressures > 500mmHg

Question 13

bone cement can cause embolism of

Answer 13

fat
bone marrow
cement
air

Question 14

bone cement signs/symptoms

Answer 14

hypoxia
hypotension
arrythmias
PHTN
decr CO

Question 15

bone cement embolism treatment

Answer 15

incr FiO2
euvolemia
adequate BP

Question 16

rhabdo is associated with tourniquet inflation over _____ hrs

Answer 16

> 2hrs

Question 17

pt experiences tourniquet pain after

Answer 17

60 mins

Question 18

inflate tourniquet to _____

Answer 18

100mmHg above SBP

Question 19

when are fat embolisms common

Answer 19

with long bone fractures

Question 20

fat embolism signs/symptoms

Answer 20

dyspnea
confusion/coma
petechia
clotting dysregulation
hypoxia
resp failure
ST changes
decr EtCO2

Question 21

signs/symptoms of RV strain

Answer 21

acute incr PHTN
pulm vasodilators
milrinone

Question 22

fat embolism treatment

Answer 22

stabilization of frature
O2 therapy
hypotension correction

Question 23

ARDS

Answer 23

disruption of cap-alveolar membrane
albumin leak into alveolar space resulting in fluid in the lungs causing inflammation

Question 24

Acute lung injury

Answer 24

PaO2/Fio2 ration < 300

Question 25

ALI causes

Answer 25

trauma sepsis aspiration

Question 26

ARDS

Answer 26

PaO2/FiO2 ratio < 200 more severe than ALI

Question 27

ARDS treatment

Answer 27

fix the cause

Question 28

ARDS mgmt: Plat P

Answer 28

< 27 cmH2O

Question 29

ARDS: TV

Answer 29

4-6 mL/kg

Question 30

ARDS: FiO2

Answer 30

< 50%

Question 31

ARDS: RR

Answer 31

< 30 breaths per min

Question 32

ARDS: PEEP

Answer 32

<15 cmH2O

Question 33

ARDS: drugs

Answer 33

NO prostacyclin PGE1

Question 34

DVT

Answer 34

blood clot in vein that becomes thrombotic more common in lower extremities

Question 35

DVT risk factors

Answer 35

obesity Age > 60 sx > 30 mins tourniquet use LE fracture immobilization > 4 days blood clotting disorders (Factor 5)

Question 36

LE orthopedic risk of DVT

Answer 36

40-80% without prophylaxis

Question 37

DVT pharmacological prophylaxis

Answer 37

LUFH warfarin LMWH (lovenox 40 mg)

Question 38

DVT mechanical prophylaxis

Answer 38

IPC SCD compression stockings

Question 39

what might lower risk of DVT

Answer 39

neuraxial anesthesia

Question 40

DVT treatment

Answer 40

anticoags thrombotics IVC filter thrombectomy/embolectomy

Question 41

AFE incidence rate

Answer 41

1:20,000

Question 42

AFE mortality

Answer 42

86%

Question 43

AF composition

Answer 43

fetal debri prostaglandins leukotrines

Question 44

____ indicates severity of AFE

Answer 44

volume of entrainment

Question 45

AFE is a _____ response

Answer 45

immune

Question 46

AFE signs/symptoms

Answer 46

tachycardia cyanosis shock generalized bleeding

Question 47

AFE phase 1

Answer 47

pulmonary vasospasm hypoxia resp acidosis

Question 48

AFE phase 2

Answer 48

LV failure pulm edema uterine atony DIC

Question 49

AFE phase 3

Answer 49

seizure coma

Question 50

AFE treatment: pulm embolism

Answer 50

aspirate max PaO2 CPR

Question 51

AFE treatment: hemodynamics

Answer 51

aggressive fluid resuscitation direct vasopressor (phenylephrine) milrinone after adequate resuscitation

Question 52

AFE treatment: uterine atony

Answer 52

oxytocin methergine prostaglandin hemabate misoprostol

Question 53

AFE treatment: DIC

Answer 53

transfusion

Question 54

AFE treatment: seizures

Answer 54

benzos