CLINICAL SCENARIOS Flashcards Preview

Board Review CRNA (Sweat Book) > CLINICAL SCENARIOS > Flashcards

Flashcards in CLINICAL SCENARIOS Deck (31):
1

A medianstinoscopy is most useful for _______.

right lung cancers

2

What is the first and second most common complication during a medianstinoscopy?

1) hemorrhage
2) pneumothorax (primarily on right side)

3

Where should a BP cuff be placed during a medianstinoscopy?

left arm

4

Where should an a-line be placed during a medianstinoscopy?

right radial to assess for compression of innominate and right brachiocephalic arteries

5

Where should the pulse oximeter be placed during a medianstinoscopy?

right hand--> to assess vascular compression

6

Where is the incision made for a medianstinoscopy?

transverse incision just above suprasternal notch or in the 2nd or 3rd rib interspace

7

What arteries may be compressed during a medianstinoscopy?

innominate and right brachiocephalic arteries

8

What tissues can a pheochromocytoma be found in?

found in the abdominal cavity 95% of the time and originates in the adrenal medulla about 90% of the time

9

What is the diagnostic triad for pheochromocytoma?

1) diaphoresis
2) tachycardia
3) headaches

10

If a pheochromocytoma is not diagnosed and treated in a timely manner, the patient may die from _______. (3 main things)

1) CHF
2) myocardial infarction
3) intracerebral hemorrhage

11

What is the treatment (pre-operative preparation) for pheochromocytoma?

- alpha before beta
-alpha block with phenoxybenzamine 20-30mg/day and increase to 60-250mg/day in order to control BP
-prazosin is also an alpha blocker
-beta block primarily for treatment of tachycardia
-also need to check fluid status and assess for hypovolemia prior to surgery

12

What are some anesthetic considerations for pheochromocytoma surgery?

-DO NOT stimulate SNS
-Must have anesthesia in place before any stimulation occurs
-control tachycardia with esmolol, labetalol, and propanolol

13

What is the goal of one-lung ventilation?

to optimize arterial oxygenation

14

Name 2 absolute indications for one-lung ventilation.

1) prevent contamination of healthy lung
2) control distribution of ventilation

15

Name 1 relative indication for one-lung ventilation.

1) surgical exposure

16

What is the most common DLT used?

Robertshaw--> available in left or right and does not have a carinal hook like the Carlens (left DLT) or White tube (right sided Carlens DLT)

17

What is a description of Class 1 ASA?

healthy patient, no organic, physiologic, biochemical, or psychiatric disturbance

18

What is a description of Class 2 ASA?

patient with mild systemic disease (disturbance) that may or may not be related to the reason for surgery
EX) essential HTN, heart disease that only slightly limits activity, diabetes, anemia, extremes of age, morbid obesity, and chronic bronchitis

19

What is a description of Class 3 ASA?

patient with severe systemic disease (disturbance) that limits activity but is not incapacitating and may or may not be related to the surgery
EX) heart disease that limits activity, poorly controlled essential HTN, diabetes with vascular complications, chronic pulmonary disease that limits activity, history of prior MI and angina pectoris

20

What is a description of Class 4 ASA?

patient with an incapacitating systemic disease that is a constant threat to life with or without surgery
EX) CHF, persistent angina pectoris, any advanced kidney, liver, or pulmonary disease

21

What is a description of Class 5 ASA?

moribund patient not expected to live 24 hours with or without surgery; submitted to surgery as resuscitative effort
EX) pulmonary embolus, cerebral trauma or ruptured AAA (uncontrolled)

22

What is a description of Class 6 ASA?

a brain dead patient whose organs are being harvested
EX) organ donation

23

What is a description of Class E ASA?

any patient requiring emergency surgery (not elective)
EX) appendicitis, D&C for bleeding, etc.

24

A painless degeneration and atrophy of skeletal muscles (associated with mental retardation) is called ______.

muscular dystrophy
*hereditary disease

25

What is the most common and most severe neuromuscular disease?

Duchenne's muscular dystrophy
*X-linked recessive
*Early childhood

26

What are some ECG changes seen with Duchenne's muscular dystrophy?

prolonged QRS and PR interval; ST segment abnormalities, bundle branch block, Q waves, tall R waves

27

Why should you avoid succinylcholine with patients having Duchenne's muscular dystrophy?

increased incidence of malignant hyperthermia

28

Should you use neuromuscular monitor with a patient having Duchenne's muscular dystrophy?

neuromuscular monitoring is mandatory

29

______ is characterized by random and multiple sites of demyelination of corticospinal tract neurons in the brain and spinal cord, exclusive of peripheral neurons.

multiple sclerosis

30

What are some s\s of multiple sclerosis?

-visual distrubances
-ataxia
-limb paresthesia and weakness
-spastic paresis of skeletal muscles
-exacerbations and remission

31

With multiple sclerosis you should avoid marked ______ changes.

temperature