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PMI > OR Concepts > Flashcards

OR Concepts Flashcards

1
Q

pressure receptors that detect pressure of blood flowing through the arteries

A

baroreceptors

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2
Q

where are baroreceptors located?

A
  1. ) carotid sinuses

2. ) aortic arch

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3
Q

how does the brain try to correct for a low blood pressure?

A

the brain stimulated the ANS to increase the heart rate (increases cardiac output)

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4
Q

vasoconstriction causes the heart rate to decrease

A

reflex bradycardia

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5
Q

vasodilation causes the heart rate to increase

A

reflex tachycardia

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6
Q

contains baroreceptors that adjust heart rate to maintain normal cardiac output/blood pressure?

A

carotid sinus

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7
Q

cluster of cells that primarily sense hypoxia and stimulate faster respirations

A

carotid body

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8
Q

refers to sudden brain cell death caused by inadequate blood flow

A

cerebral vascular accident; stroke

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9
Q

possible causes of stroke (4)

A
  1. ) blood clot
  2. ) intracranial hemorrhage
  3. ) prolonged hypotension
  4. ) hypertension
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10
Q

refers to blood clot in a vein (usually in the legs)

A

deep vein thrombosis

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11
Q

Examples of pts at risk for developing blood clots:

A
  1. ) bedridden pts that cant ambulate

2. ) heart arrhythmias that decrease the blood flow through heart

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12
Q

when a DVT becomes dislodged from the legs it can move to the heart and lungs causing ____.

A

pulmonary embolism

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13
Q

How to prevent DVT? (3)

A
  1. walking/movement/ ambulation
  2. blood thinners ( medication)
  3. sequential compression stockings during surgery (squeeze the legs and promote blood flow)
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14
Q

excess fluid in the interstitial space

A

edema (“swelling”

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15
Q

excess fluid in the alveoli; caused by some degree of heart failure ( which causes some blood to back up into the lungs)

A

pulmonary edema

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16
Q

refers to “venous return” or VOLUME of blood that is returning to the right ventricle and available for the heart to pump on the next contraction

A

preload

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17
Q

refers to the RESISTANCE the left ventricle has to pump against

A

afterload

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18
Q

True/False: pt with a low blood volume (bleeding pt) will have a decreased venous return or low preload

A

true

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19
Q

how does a pt’s position in Trendelenburg affect preload?

A

it will INCREASE preload

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20
Q

how can you measure preload?

A

central venous pressure (CVP)

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21
Q

what is central venous pressure?

A

blood pressure within the superior vena cava (5-12 mm Hg)

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22
Q

If pt is supine…a low CVP indicates ___ ____

A

low preload

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23
Q

if pt is supine a high CVP indicates ____ ____

A

fluid overload (usually in heart failure and renal failure pts)

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24
Q

vasoconstriction = ___ afterload

A

high afterload

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25
Q

vasodilation = ___ afterload

A

low afterload

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26
Q

example of patient with high afterload yet low blood pressure

A

exsanguinating patients (bleeding to death)

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27
Q

refers to the difference in pressure between two sides of a wall or equivalent separator

A

transmural pressure

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28
Q

clinical example of transmural pressure is ___ ___

A

pulmonary edema

29
Q

explain how pulmonary edema affects transmural pressure

A

pressure in the lungs on one side of the membrane becomes drastically reduced; means pressure on the other side of the membrane is relatively much higher which can lead to blood entering the lungs from the pulmonary capillaries

30
Q

occurs when a patient tries to breathe while their airway is obstructed

A

negative pressure pulmonary edema

31
Q

2 examples of negative pressure pulmonary edema

A
  1. the pt bites down on their ETT tube during emergence

2. the patient experiences a laryngospasm

32
Q

Explain what happens when pts bite down on their ETT tube and experience larygospasm and how that contributes to pulmonary edema

A

intrathoracic pressure becomes more and more negative as the patient breathes (b/c air from the atmospher cannot enter the lungs); the negative pressure inside the lungs will “suck” blood into the alveoli from the pulmonary capillaries causing pulmonary edema

33
Q

refers to resistance that the left ventricle must pump against and it is affected by peripheral arterial vascular tone

A

systemic vascular resistance

34
Q

arterial vasoconstriction= ____ SVR

A

high SVR

35
Q

arterial vasodilation = ___ SVR

A

low SVR

36
Q

refers to the resistance that the right ventricle must pump against, and is affected by the vascular tone in the pulmonary arteries

A

peripheral vascular resistance (PVR)

37
Q

pulmonary artery vasoconstriction = ___ PVR ; while pulmonary artery vasodilation= ___ PVR

A

high PVR; low PVR

38
Q

True/False: PVR is usually much higher than SVR.

A

FALSE; lower than SVR

39
Q

what must be placed in order for a bovie to work?

A

grounding pad

40
Q

where is ground pad usually placed to dissipate heat?

A

thigh

41
Q

advantages of bipolar cautery (2)

A
  1. less current flow through the body

2. the surgeon can control cautery in delicate areas

42
Q

Why doesnt a patient get electrocute with a cautery?

A

because the cautery is set on a ultra high current frequency (> 200,000 Hz) which allows the current to pass through the body w/o electrocution

43
Q

8 implications of pneumoperitoneum (CO2 insufflation)

A
  1. ) intubation is required
  2. ) atelectasis is more likely
  3. ) hypercarbia is more likely
  4. ) a vagal response is somewhat common
  5. ) cardiac output decreases
  6. ) blood pressure can go up or down
  7. ) pts can get referred pain in the shoulder
  8. ) partial pneumothorax (collapsed lung)
44
Q

When would you use a larger diameter ETT tube?

A

obese pt in trendelenburg with abdomen insufflated with CO2

45
Q

how does a larger diameter ETT help with an obese pt in trendelenburg with/ abdomen insufflated with CO2?

A

decreases the resistance of ventilation and lower the peak inspiratory pressure required to effectively move the patient’s diaphragm

46
Q

can occur with accidental infusion of CO2 into an injured vein or artery and results in blockage of the right ventricle

A

CO2 gas embolism

47
Q

refers to trapped air underneath the skin and can occur during laparoscopic sx as CO2 diffuses into the subcutaneous space

A

subcutaneous emphysema

48
Q

factors that can cause subQ emphysema (6)

A
  1. multiple attempts of abdominal entry
  2. improper cannula placement
  3. increased intra-abdominal pressure
  4. procedures lasting >3.5 hours
  5. gas flow rate
  6. high total gas volume
49
Q

“safe” range for pneumoperitoneum

A

0-20 mmHg; RECOMMENDED: 12-14 mm HG

50
Q

When is extubation contraindicated during subQ emphysema? (3)

A
  1. ETCO2 is elevated
  2. airway swelling
  3. crepitus (crackling, crinkly, or grating feeling or sound under the skin)
51
Q

purpose of OG/NG tubes (4)

A
  1. can decompress the stomach
  2. can vent gases if pt has a bowel obstruction
  3. can deliver tube feedings directly to the stomach
  4. can empty the stomach of poison or drug overdose
52
Q

indications using a OG tube

A

intubated pts w/ full stomach or undergoing laparoscopic surgery

53
Q

indications for NG tube

A

most open abdominal procedures, b/c abdominal sx increases the risk of a pt developing postoperative ileus

54
Q

defined as gastroparesis and can lead to abdominal distention

A

ileus

55
Q

When do NG usually stay in ?

A

postoperatively

56
Q

when should you avoid using an OG/NG tube? (2)

A
  1. ) for pts who have had prior gastric surgery; if it needs to be done need to use radiology
  2. ) pts with liver failure (cirrhosis ) b/c they can develop esophageal varices which can rupture with an OG/NG tube
57
Q

caused by excess histamine release

A

anaphylaxis

58
Q

2 main problems associated with anaphylaxis

A
  1. vasodilation (hTN)

2. bronchoconstriction (wheezing)

59
Q

tx for anaphylaxis (4)

A
  1. subcutaneous epinephrine
  2. bronchodilators (beta 2 agonists)
  3. histamine blockers
  4. steroid (100 mg hydrocortisone)
60
Q

refers to decrease in blood flow to a bodily compartment due to an increase of pressure inside the compartment and which compressed blood vessels

A

compartment syndrome

61
Q

tx for compartment syndrome

A

surgical fasciotomy

62
Q

causes of compartment syndrome (3)

A
  1. fracture
  2. infiltrated IV
  3. tight cast
63
Q

sudden onset of bradycardia and/or hypotension

A

vagal response

64
Q

when are vagal response commonly seen?

A
  1. CO2 insufflation for laparoscopic sx
  2. eye surgery
  3. abdominal or uterine surgery
65
Q

if vasopressor therapy is not as effect what should you consider?

A

stress dose of steroids

66
Q

what steroids are used for “Stress dose”

A

solu-medrol or solu-cortef

67
Q

hypoventilation that is caused by the pain of breathing

A

abdominal splinting

68
Q

how to prevent splinting? (3)

A
  1. dosing pain med
  2. supplementing anesthetic w/ nerve blocks
  3. local anesthetic injection at the surgical site

PMI (21 decks)

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