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CV Exam Flashcards

1
Q

PPO FEV1 tell you

A

Airflow

If <40 = increased risk

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2
Q

VO2 max tell you what ?

A

Cardiopulmonary reserve
VO2max < 15 ml/kg/min = increased risk
>15ml/kg/min = average risk

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3
Q

What does DLCO max tell you

A

Parenchymal function
Small amount CO, hold breath 10 seconds, measured

Low sensitity good specificity
PPOP ( predictive post operative product )

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4
Q

5 flights of stairs = VO@ max

A

> 20 ml/kg/min

Favorable

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5
Q

What must be evaluated to anticipate the patient’’s intra operative and post op needs

A

Respiratory function

Post resection lung

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6
Q

Average risk patient , may be extubated immediately post op

A

VO2max >15 ml/kg/min

PPO FEV1 > 40 %

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7
Q

High risk patients will struggle to get off vent , what are the values

A

VO2max < 10

PPO FEV1 < 30 %

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8
Q

INtermediate risk patients , need to assess the patients on an individualized basis , what are the values

A

VO2 Max between 10 -15 ml/kg/min

PPO FEV1 30% -40 %

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9
Q

What are the principal advantages of double lumen tubes

A

Easy to place
Ability to ventilate one or both lungs
Ability to suction either lung

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10
Q

What are the disadvantages of double lumen tubes : ( 4)

A
  1. Size selection
  2. Difficult to place w/ difficult airways
  3. Not optimal for post op ventilation ( must be change out if pt to remain intubated )
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11
Q

All DLTs share what characteristics (4)

A

LONGER BRONCHIAL LUMEN that enters the right or left main bronchus and another shorter tracheal lumen that terminates in the lower trachea

A preformed CURVE that when properly aimed allows preferential entry into a bronchus

Bronchial cuff

Tracheal cuff

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12
Q

Distance from right upper lobe to baring bifurcation is

A

1.5- 2 cm

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13
Q

Carina bifurcation to left mainsten is

A

4- 5 cm

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14
Q

Contraindication for left sided tube

A

Lesions of the airway
Compression of the trachea
Main bronchus by external mass

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15
Q

Right DLT can malposition more than left , so for that reason which DLT is used more ?

A

Left , even for right thoracotomy

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16
Q

MC complication with DLT is

A

Malpositioning

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17
Q

Larger size DLT is probably responsible for what ?

A

Responsible for the slightly increased incidence of hoarseness and vocal cord lesions ( following DLT vs Bronchial blocker )

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18
Q

Table

A

Inflate tracheal cuff
Verify bilateral breath sounds
Inflate endobronchial cuff
Clamp Y pice to endobronchial lumen and open at atmosphere

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19
Q

A bronchial Blocker just be

A

Advanced , positioned and inflated under visualization via flexible bronchoscope

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20
Q

Patient has a diff airway or tracheostomy chose DLT or Bronchial Blocker , already intubated , pediatric lung separation needed ,
?

A

BB.

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21
Q

Doe bronchial blockers allow suctioning ?

A

No

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22
Q

Which has a greater indidence of malposition?

A

BB

Also requires more time than DLT

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23
Q

When is pediatric lung separation needed ?

A

Infection absolute indication of one lung ventilation

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24
Q

During two lung ventilation blood flow to the dependent are averages how much ?

A

60%

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25
What happens to blood flow when one lung is deflated and one lung ventilation is started ?
Any blood floe to the deflated lung becomes shunt flow, causing the PaO2 to decrease A 40% shunt would be anticipated w/o Autoregulation. But the lung have a compensatory mechanism of increasing vascular resistance in hypoxic areas of the lungs , and this diverts some blood flow to areas of better ventilation and oxygenation .
26
What is HPV
A reflex intrapulmonary feedback mechanism in inhomogeneous lung that improves gas exchange and arterial oxygenation Hypoxia causes pulmonary arteries to vasoconstrict opposite of what happens in the rest of the body ( vasodilation ) with hypoxia.
27
HPV can increase PVR to what %?
50 to 300 %
28
What meds inhibit HVP
``` NTG Nitroprusside Dobutamine Isopreterenol ( some B2 agonist ) CCB Volatiles Mac >1.5 Hypocapnia ```
29
Vasoconstrictive drugs preferentially constrict well oxygenated arteries = reestablishing shunt flow = opposing the HPV effects .
Phenylephrine Epinephrine Dopamine
30
Factors that reduce effective of HPV
1. Alkalosis 2. Hypocapnia 3. Excessive Vt or PEEP 4. Hemodiluation 5. Hypervolemia 6. Hypothermia 7. Prostacyclin 8. Shunt fraction <20% or >80% 9. Vasodilators , Phosphodiesterase Inhibitor 10.calcium channel blocker 11. Volatile anesthetic >1.5 MAC
31
PaO2 from highest to lowest post various lung surgery
Pneumonectomy>Lobectomy> Segmentectomy
32
Smoking is not only a major risk factor for chronic lung disease but also a strong predictor of preop complication . True or false ?
True
33
The neurological innervation to the heart originates from
the autonomic nervous system, as well as from sensory fibers
34
Efferent impulses are transmitted from the _____and ______ to numerous body systems, including the heart
Brainstem and hypothalamus
35
Increased sympathetic nervous system increases what ?
Heart rate Inotropy Rate of AV node discharge ( dromotropy )
36
Preganglionic sympathetic nervous system fibers originate from
The cells in the INTERMEDIOLATERAL COLUMNS of the higher thoracic segments of the spinal cord and SYNAPSE at the 1st Through 4th or 5th thoracic paravertebral ganglia. ( T1-T4/T5)
37
Postganglionic fibers then travel as the ___,___,and ____ cardiac nerves and the ______nerves
Superior, middle and inferior cardiac nerves and throracic visceral neves = Epi cardiac plexus >> distributed over the entire ventricular myocardium
38
Postganglionic sympathetic fibers + Postganglionic parasympathetic fibers from cardiac plexus to primarily innervation
SA and AV nosed and the atrial myocardium .
39
WHERE DO preganglionic parasympathetic fibers originate ?
In the dorsal motor nucleus of the medulla
40
______primarily innervation the SA and AV nodes and the atrial muscle fibers
Short postganglionic fibers
41
Function of the parasympathetic nervous system is primarily to slow HR and secondarily to decrease contractility. True or False ?
True
42
Main NT of PNS is
Ach
43
PNS makes SA node and AV node less excitable ( bradycardia etc...) why ?
Bc it increases Potassium permeability = hyperpolarization
44
Where does sensory innervation of the heart come from ?
Nerve endings in the walls of the heart, the coronary artery adventitia and the pericardium They synapse with the posterior gray columns of the spinal cord . >>second order neurons >>ascend spinothalamic tract >> and terminate in the postventral nucleus of the thalamus
45
Preganglionic parasympathetic fibers originate in the
Dorsal motor nucleus of the medulla
46
Alpha stimulation = decrease in bronchial secretion. True or false ?
True
47
Effects of Isoproterenol in bronchial and pulmonary system
Potent bronchial dilator and pulmonary vasodilator
48
Dissecting aortic aneurysm and mitral stenosis place traction on the _____ causing hoarseness
RLN
49
Does injury to SLN cause respiratory distress?
No
50
Stridor means
Acute phase of bilateral RLN damage by unopposed addicted vocal cords, may progress to Resp distress and even death
51
The larynx begin with the ____ and extends to the ______
Epiglottis and extends to the cricoid cartilage
52
Adult Larynx begins at what vertebrae and end at which ?
CC3-C4 ends at C6 | C3- C6 or C4-C6
53
Blood supply to larynx is
External carotid which branches into superior thyroid artery Superior thyroid artery gives rise to the superior laryngeal artery while inferior thyroid artery =infraglottic region of the larynx
54
Endodermis-derived epithelium and the mesoderm contribute to the development of what ?
The lungs
55
Development of alveoli until year ____after birth | Lung growth until year ____after birth
3 years | 2 years
56
Tracheal extends from
Cricoid cartilage to the carina
57
How long in the trachea in adult
10 to 20 cm | Has 16 to 20 C shaped rings
58
Which is the only cartilage in the trachea that has a comple cartilaginous ring ?
Cricoid cartilage
59
When the cartilages disappear it is not called
Bronchioles
60
Angle of the right mainstem bronchus is
25 to 30 degrees
61
Angle of the left mainstem bronchus is
45 degrees
62
Bifurcation of the Right upper lobe is approximately ____cm from the carina
2.5
63
C3, C4 C5 innervates the
Phrenic nerve
64
Most modern PM are _____and their lead configuration exhibit smaller spikes on the surface of ECG
Bipolar
65
Right atrium PM lead = spike in front of which wave form , and area paced ?
Spike in front of P wave , | Atrial depolarization
66
Right ventricle PM lead = spike in front of which wave form , and area paced ?
Spike in front of QRS | Ventricular depolarization
67
Spike in front of both P wave and QRS where are the leads ?
Leads are both in right atrium and ventricle
68
Indication for Pace,maker
``` Sinus Node AV Node Long QT HOCM DCMP ```
69
Electrical output
Measured in mA | It’s the electrical out the PM delivers with each charge
70
Threshold
The minimum output that will cause the myocardium to consistently contract or capture
71
Sensitivity
The lowest amplitude P or R wave that the pacemaker will recognize as an electrical signal
72
Capture
Depolarization of a hear chamber in response to pacemaker electrical outlet
73
Failure to capture
When the pacemaker electrical I’ll put fails to cause Myocardial depolarization
74
Failure to sense
The pacemaker fails to recognize intrinsic cardiac electrical activity
75
The first letter in the cold identifies
the CHAMBER where the pacing electrolytes placed 1= CHAMBER PACED
76
If the first letter is a= The first letter is V= If the first letter is D =
``` A= Right Atrium V = Ventricle D= Both , Dual ```
77
The second leather identifies the
The chamber where the sensing electrode is placed 2= Chamber sensed
78
If the second letter is O what does that mean
No sensing | Pacemaker will paste at asynchronous rate
79
The third letterIdentifies the
The pacemaker response to the detection of spontaneous cardiac depolarization and its effect on subsequent pacing stimuli The device will either inhibit or trigger a piercing stimulus
80
If the third letter is I, T, O or D
I= inhibit T= TRIGGER O=no sensing , asynchronous D= inhibit and Trigger in response to sensed intrinsic stimuli
81
The fourth letter represents
Rate modulation
82
Fort letter: R represents—- and O represents ——
``` R = presence of rate modulation O= It’s absence ```
83
Fifth letter in final letter identifies
Multi site pacing

Advanced Principles III (11 decks)

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