complications Flashcards
(143 cards)
1
Q
Hypothermia is defined as temp below what?
A
96.8 (36)
2
Q
What is normothermia?
A
98.6 (37)
3
Q
What are 6 prevention strategies for hypothermia?
A
- core temps referred (98.6/37C)
- Patients lose 3-5 degrees under anesthesia - bc of vascular changes, we are going to cool to match our external environment
- use approved warming devices according to manufacturer’s instruction
- intermittent use is safest
- warm irrigation solutions and blood products
- room temp in procedure areas should be 68-75 degrees; humidity 20-60%
4
Q
We can exceed 75 degree upper limit for what?
A
for one at risk patient
5
Q
Post op shivering increases o2 consumption by how much?
A
400%
6
Q
What are 6 complications of hypothermia?
A
- post op shivering increases 02 consumption by 400%
- myocardial ischemia
- cardiac arrhythmias below 90 degrees F (32 C)
- increased surgical site infections
- acidosis
- increased bleeding - hypothermia and acidosis interrupt clotting cascade
7
Q
There are some scenarios where what is true regarding hypothermia and bleeding?
A
there is decreased bleeding (usually for open hearts)
8
Q
What are 4 considerations for head and neck procedures?
A
- keep trach tray nearby in case of swelling
- wire cutters if jaw is wired closed
- anticipate dizziness and N/V after ear surgery
- send obturator home with trach patients
9
Q
What 2 things are important to remember with wire cutters for wiring jaws shut in head and neck procedures?
A
- The wire cutters go home with the patient not just to PACU, because if they need to be emergently intubated we can
- there should be a picture and drawing of wire cutters
10
Q
For ortho procedures, casts should be removed where?
A
outside of the OR
11
Q
Wet casts in ortho procedures are handled with what?
A
palms only
12
Q
Do what with patients who have casts?
A
elevate cast higher than the level of the heart and keep open to air while it is drying
13
Q
What are 3 considerations for cement (methyl methacrylate)?
A
- avoid vapors use scavenger system
- let anesthesia know when placing cement into the canal - bone is very vasculature, so it can cause a dip in the blood pressure
- dry time for cement effected by room temperature
14
Q
Can pregnant personnel be in the room when using methyl methacrylate?
A
NO; it crosses placental barrier
15
Q
What can cause the cement to dry more slowly?
A
making the room extra cold
16
Q
What can cause the cement to dry more quickly?
A
heating up the room
17
Q
What is the biggest concern with flap procedures?
A
vasoconstriction
18
Q
Monitor what with flap procedures?
A
monitor circulation with doppler
19
Q
Protect a flap site from what?
A
protect site from sharing or pressure
20
Q
We want to keep the patient what for flap procedures?
A
keep warm
21
Q
Highest risk of emboli are what?
A
fat emboli
22
Q
What kind of emboli risk is there after long bone procedures?
A
fat emboli
23
Q
Prevent what during orthopedic procedures?
A
prevent DVT’s
24
Q
What are 3 things we can do to prevent DVT’s in ortho procedures?
A
- SCD’s - on and running before induction
- coumadin/heparin or lovenox
- early ambulation - muscle contraction in lower extremities
25
What additional emboli do we monitor for during ortho procedures?
pulmonary emboli
26
What are 3 symptoms of pulmonary emboli?
painful, short of breath, sudden onset
27
what are 3 components of virchow's triad?
1. venous staisis
2. hypercoagulability
3. endothelial injury
28
What is virchow's triad?
trifecta of DVT formation
29
What is venous stasis in virchow's triad caused by?
immobility during surgery
30
what is one way we can aid venous stasis from immobility during surgery?
SCD's
31
Why do we have endothelial injury in virchow's triad?
surgery interrupts vascular endothelium
32
Why do we have hypercoagulatibility in virchow's triad?
clotting cascade triggered
33
How do we interrupt virchow's triad?
we make sure scd's are on and running before induction
34
What are 7 patients at risk for fluid imbalances?
1. burns
2. congestive heart failure
3. pediatrics
4. neuro patients
5. liposuction
6. diabetes insipidus
7. renal patients
35
Day 1 and 2 of having a burn is characterized by what kind of fluid shift?
fluid shifts cause hypovolemia. Fluid is moving out of the vasculature and into the tissue, otherwise known as third spacing
36
What would a patient look like day 1 and 2 of having a burn?
edematous, puffy, wet weeping wounds, juicy
37
What would a patient need on day 1 and 2 of having a burn?
give IV fluid
38
Day 3 of having a burn is characterized by what kind of fluid shift?
fluid shifts back to vascular causing hemodilution
39
CHF patients are prone to what?
fluid overload
40
CHF patients tend to become what under anesthesia?
tend to become vasodilated
41
Pediatrics have small what which leads to small what?
small volumes equates to small margin of error
42
Fluid overload in neuro patients can cause what?
increase ICP
43
Dehydration in neuro patients decreases what?
cerebral perfusion
44
Autonomic dysfunction from cord injury causes what?
loss of vasomotor tone
45
Why are neurogenic or cord injury patients prone to fluid imbalances?
the area below the injury down does not have any vascular tone at all, so they vasodilate. If the vascular system expands, pressure goes down and they look hypovolemic
46
What does neurogenic mean?
reason neuro
47
Liposuction patients are prone to what kind of volume change?
prone to hypovolemia, because if you take a bunch of adipose tissue a bunch of fluid wants to go into that area.
48
What medications do we give to help with fluid shifts in liposuction patients?
lidocaine and epi for tumescence. The lidocaine for pain, epi for post op patient control. Since it shrinks the vasculature, it helps with the fluid shift
49
What is diabetes insipidus?
trauma/surgery to pituitary gland or hypothalamus causes decrease in ADH
50
What do we treat diabetes insipidus with?
1. treat with vasopressin or DDAVP
2. ML/ML urine output of fluid resuscitation
51
What is DDAVP?
synthetic analog of ADH
52
What is more commonly given vasopressin or DDAVP?
DDAVP
53
Renal patients are prone to what with fluid imbalances?
prone to fluid overload
54
What is a question we want to ask our renal patients?
when was the last time you went to dialysis
55
What are 7 signs of fluid overload?
1. edema
2. dyspnea
3. rales
4. weight gain - couple of kg over nigh
5. neck vein distention
6. increased CVP and BP
7. bulging fontanelle***** - fluid overload bulging fontanelle if they are dehyrdated they have a sunken fontanelle
56
What are 7 signs of hypovolemia?
1. postural hypotension
2. decreased BP
3. increased pulse
4. dry mucous membranes
5. decreased urine output
6. dizziness or fainting
7. sunken fontanelle
57
What is normal range of sodium?
135-145
58
What are 4 causes of hyponatremia?
1. irrigation fluid absorbed into venous sinuses
2. results from fluid overload
3. hysteroscopies and TUR procedures
4. glycine and sorbitol leave behind free water after metabolism
59
What are 2 actions you want to take with hysteroscopies and TUR procedures?
1. monitor I and O of irrigation on these cases
2. report to anesthesia and surgeon if defiicency occurs
60
Hyponatremia causes fluid to shift into or out of tissues?
into
61
What are s/sx of hyponatremia?
1. N/V, irritability (cerebral edema)
2. slowed breathing
3. headache, blurred vision (cerebral edema)
4. edema
5. muscle twitching, cramping
62
what are 3 hyponatremia treatments?
1. restrict fluids
2. diuretic
3. hypertonic salines
63
what is the rule of thumb for electrolyte and muscle?
any electrolyte that doesn't start with letter p, then the muscle and electrolyte are going in the opposite direction. I.E. hyposodium - hyper muscle twitching and cramping
64
What is the main cause of HYPERnatremia?
hypovolemia - dialysis, dehydration, burns, diurectis, DI
65
What is the main cause of hypernatremia?
hypovolemia - dialysis, dehydration, burns, diuretics, DI
66
Hypernatremia causes the fluid to shift where?
out of tissues and into the vascular system
67
What are the main signs and symptoms of hypernatremia?
thirst, concentrated urine, muscle weakness, seizures, coma
68
Treat hypernatremia with?
treat with fluid
69
What are the 5 causes of hypokalemia?
1. lost by diuretics
2. bowel prep
3. vomiting or diarrhea
4. laxative abuse
5. alkalosis
70
What are the 4 s/sof hypokalemia?
1. abdominal distention
2. loss of bowel sounds
3. weakness or paralysis
4. hypotension****
71
What do we treat hypokalemia with?
treat with potassium replacement
72
What is the order in which electrolytes leave the body?
1. potassium
2. calcium
3. magnesium
73
What are 2 main causes of hyperkalemia?
1. too much in IV fluid
2. intracellular potassium - meds, MH, crushing syndrome
74
What is normal range of potassium?
3.5-5.0
75
What 3 things are huge pals when it comes to electrolytes?
potassium, hydrogen ion and glucose are pals
76
What 3 systemic issues do you see where potassium, hydrogen ion and glucose are noticeably friends?
1. diabetic ketoacidosis
2. burns
3. addison disease
77
What are s/sx of hyperkalemia?
1. intestinal cramping
2. elevated T wave
3. hypertension
4. spastic paralysis
5. cardiac standstill
78
What is one of the treatments for hyperkalemia if we gave too much?
kayexalate
79
How is kayexalate given?
NG, PO, enema - it is going through the GI system
80
How long does kayexalate take to work?
several hours
81
What is the ideal treatment for hyperkalemia? but with what condition
D50 with insulin, but only works if it is hyper within the cell
82
Regardless, we want to treat what with hyperkalemia?
acidosis
83
what is the normal serum value for calcium?
8.5-10.5
84
What is normal ionized value of calcium?
4.5-5.6
85
What is serum calcium?
bound calcium to albumin
86
If we have a low albumin, what electrolyte do we disregard?
calcium
87
What are the 4 causes of hypocalcemia?
1. multiple banked blood transfusion - citrate (keeps blood fresh while in storage) but citrate binds with calcium
2. hypoparathyroidism
3. parathyroid regulates ca and phos levels - so if you have hypoparathyroid you will have hypocalcemia
4. diuretics
88
You can only find ionized calcium on what 2 tests?
CMP or a blood gas with electrolytes
89
What are s/sx of hypocalcemia?
1. twitching
2. laryngospasm
3. cramping
4. arrthythmias
5. positive chvotstek's sign and trousseau's sign
90
What is chvotstek's sign?
when you tap the facial nerve that is right in front of the nerve, and the whole side of the face twitches up
91
What is trousseau's sign?
a BP cuff is left on too long but their thumb starts twitching
92
Treat hypocalcemia with what?
replacement
93
What are 4 causes of hypercalcemia?
1. medically - TPN
2. hyperparathyroidism
3. bone cancer/multiple myeloma
4. sarcoidosis
94
What does sarcoidosis do to calcium?
increases GI absorption of dietary Ca++
95
What are symptoms of hypercalcemia?
neuromuscular depression and arrhythmias
96
What are 2 treatments for hypercalcemia?
1. mithramycin - anti-tumor drug
2. most common - phosphate replacement
97
What is normal value of phosphorus?
1-2 mEq/L
98
What are 4 causes of hypophosphatemia
1. hypercalcemia
2. hyperparathyroidism
3. bone cancer/multiple myeloma
4. sarcoidosis
99
What are symptoms of hypophosphatemia?
neuromuscular depression and arrhythmias
100
What are 2 treatments for hypophosphatemia?
1. mithramycin - anti-tumor drug
2. most common - phosphate replacement
101
What are 4 causes of hyperphosphatemia?
1. hypocalcemia
2. hypoparathyroidism
3. parathyroid regulates ca and phosphate levels
4. diuretics
102
What are signs and symptoms of hyperphosphatemia? or hypocalcemia
1. twitching
2. laryngospasm
3. cramping
4. arrhythmias
5. positive chvotstek's sign and trousseau's sign
103
Treat hyperphosphatemia with?
calcium replacement
104
What is normal value of magnesium?
1.5-2.5
105
Magnesium deficiency (hypomagnesemia) can be due to what things?
1. poor nutrition (diagnostic of malnutrition), alcoholism, pancreatitis, diurects
106
What are clinical s/sx of hypomagnesemia?
muscle spasms and twitching
107
Magnesium excess (hypermagnesemia) has what kind of effect on the CNS?
sedative
108
Magesium is used for what?
premature labor and preeclampsia
109
You want to monitor what 2 patients with giving magnesium in obstetrics?
mom and baby
110
Magnesium is a treatment for what 2 things cardiac wise?
v-fib and torsade's de pointes
111
What are monitoring mom for with magnesium?
rapid onset pulmonary edema (STOP mag drip), hypotension - episodes of low BP, poor deep tendon reflexes - APGAR scores are low
112
What is normal range for RBC's in men?
4.3-5.9
113
What is normal range for RBC's in women?
3.4-5.5
114
What is RBC's job?
contains hemoglobin
115
What is normal range of hemoglobin for men?
13.2 to 17.5
116
What is normal range of hemoglobin for women?
11.5-16
117
What does hemoglobin carry?
oxygen
118
Can hemoglobin be low even with a normal RBC?
yes
119
what is a normal range of hematocrit for men?
42-52
120
What is normal range of hematocrit for women?
37-47
121
What is low hematocrit also called?
anemia
122
Ideally treat low H&H with what?
iron preoperatively
123
If you a patient with rheumatoid arthritis and low hematocrit what do you need to do?
send them home
124
What is thrombocytopenia?
low platelet count
125
What is a normal range of platelet count?
150,000-450,000 uL
126
low platelet count is not a problem for most surgeries above what?
50,000 uL
127
What is normal range of WBC's?
normal value: 5000-10,000 cells/nm3
128
What conditions do you see an increase in WBC?
1. infection
2. autoimmune
3. leukemia
129
What conditions do you see a decrease in white blood cell?
1. prolonged infection
2. bone marrow suppression
3. chemotherapy
4. radiation
130
What is normal PT?
Normal value 11-12.5 seconds
131
What does PT measure?
A PT test evaluates the coagulation factors: extrinsic and common pathways
132
What is the extrinsic pathway?
VII
133
What is in your common pathway?
X (5), V (10), II (2) and I (1)
134
What does it mean if your PT is out of whack?
1. bleeding or clotting disorder
2. liver disease - vitamin k to synthesize factor 2, 7, and 10 (measured by PT)
3. warfarin therapy
135
If you want to know if you are in normal range for coumadin you want to draw what?
PT
136
INR measures what?
measures the same thing as the PT. If you have a patient who is anticoagulated on coumadin or warfarin, or apixiban or elequis you can draw INR as well.
137
What is a normal INR if you are anticoagulated?
2-3
138
What is normal INR if you are not anticoagulated?
1
139
What is normal range for PTT?
30-40 seconds
140
What does PTT measure?
evaluates coagulation factors:
- intrinsic: XII, XI, IX, VIII
- common: X, V, II, and I
141
What does PTT mean?
1. Bleeding or Clotting disorder (intrinsic like DIC)
2. Heparin therapy
3. hemophilia
4. shortened in early DIC - trend bc you are clotting faster and faster and faster
142
What may you do with surgery if unsuspected PTT?
cancel case
143
What may you do with surgery if unsuspected PT?
cancel case
