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Flashcards in AAA: Case Presentation Deck (25):
2

How do you set up the OR for a AAA? (5)

Large ETT

Transducers (double or triple)- Art, Swann, Central lines

Fluid warmers

NG tube

Albumin available?

3

What drugs do you need during a AAA?

Uppers (3)
Downers (3)

Uppers: Norepi, Epi, Vasopressin

Downers: NTG, Nicardipine, Esmolol

4

What does high creatinine indicate?

Renal insufficiency

5

For patients with a pacemaker, what do you need to do?

Need magnet to place on the device.

6

What is the normal diameter of the abdominal aorta?

2-3 cm

7

What do you need to ensure regarding blood prior to surgery?

type and cross

8

What lab value is important because end organ issues can become a major complication during surgery?

Creatinine!

9

What induction drugs do you use for renal/heart patients?

Etomidate 20mg

Fentanyl 250 mcg

Cisatracurium 8mg

10

What are the 3 phases of an AAA?

Dissection

Clamping/Surgical Repair

Unclamping

11

What hemodynamic effects does clamping present?

Increased BP!!

12

What hemodynamic changes does surgical repair present?

Increased BP!

13

PEARL

How do you quickly calculate PaO2?

FiO2 * 5

14

What does clamping do to afterload?

Increases it.

15

During clamping phase, what do you need to do? (2)

Check urine output often to ensure renal perfusion!

Turn off lower body Bair hugger to decrease metabolism/O2 requirement!

16

What is normal urine output?

0.5 - 1.5 cc/kg/hr

17

When clamping, what 2 drugs should be in line?

NTG--reduces preload

Nicardipine

18

What lab value can you expect to change when giving albumin?

Calcium decreases.

Note: Also occurs with cell saver.

19

What does a (-) BE indicate?

Acidic state

20

When unclamping, what should you do? (3)

Take downers out of line!

Pressors in line.

Give fluids-- use pressurized bag.

21

What should you do if the pt becomes unstable during unclamping?

Reclamp and reassess.

22

During closing, what should we do? (6)

rewarm;

give protamine (SLOWLY)

check ABG;

fluid & urine status;

call & give ICU report;

BP control for suture lines 

 

 

 

23

What are common post-op complications? (7)

MI, arrhythmia (50% of complications)

Renal failure/insufficiency

Ileus

Ventilation problems (TRALI related)

Pain

Bleeding

Multiorgan failure

24

what can be a major complication of AAA surgery?

renal failure

25

what is SIRS and what causes it?

Systemic Inflammatory Response Syndrome

-reperfusion injury: tissue damage when blood returns to previously underperfused areas

26

name 4 factors that can increase the risk of post-op complications

 >74 years

> clamp time

emergency status

heart history