ECMO

Question 1

what is ecmo

Answer 1

provides prolonged cardiac and respiratory support to sustain life and give gas exchange/perfusion

Question 2

what does veno venous support

Answer 2

lung

Question 3

what does veno arterial do

Answer 3

heart, but also lung

Question 4

does single lumen or bi caval allow mobility

Answer 4

bi caval

Question 5

where does a patient need to be on RASS as a screen to mobilize on ECMO

Answer 5

-1 to 1 , conscious, orientated, responsive

Question 6

what is considered a major adverse event

Answer 6

cannula movement
bleeding
fall

Question 7

what is considered a minor event

Answer 7

hypotension
arthrymia
persistent drops in flow

Question 8

difference analgesia anesethetic

Answer 8

analgesia - pain relief

anesthetic - blocking sensation (including pain)

Question 9

Acetaminophen

onset
peak
duration

Answer 9

onset: 30-1 hr
peak : 1-2 hrs
duration: 4-6 hr

Question 10

NSAIDS
onset
peak
duration

Answer 10

onset: 30min-1 hr
peak : 1-2 hrs
duration: 4-6 hours

Question 11

Gabapentin
onset
peak
duration

Answer 11

onset: 1 hr
peak : 2-4 hrs
duration: 6-8 hrs

Question 12

morphine
onset
peak
duration

Answer 12

onset 5-10 mins
peak 30 mins
duration 4 hrs

Question 13

Hydromorphine
onset
peak
duration

Answer 13

onset 5-15 mins
peak 30-60 mins
duration 4-5 hrs

Question 14

Fentanyl
onset
peak
duration

Answer 14

onset 1-2 mins
peak 15 mins
duration 1 hr

Question 15

opioid side effects

Answer 15

decreased LC, respiration, gut mobility, rash, decreased cardiac status

Question 16

if someone has prior substance abuse do you give them sedative

Answer 16

yes its a pre disposing factor

Question 17

if someone has severe hypoexemia and shock do you give them sedative

Answer 17

yes

Question 18

benzodiazepines, propofol ,and dexmedetomidine are examples of

Answer 18

sedatives

Question 19

sedative side effects

Answer 19

decreased LOC, decreased respiration, decreased cardiac status

Question 20

RASS -5/-4 what do you do

Answer 20

PROM

Question 21

RASS -3/-2 what do you do

Answer 21

PROM sit

Question 22

RASS -1/0/1 what do you do

Answer 22

AROM
active exercise
sit stand walk
ADL

Question 23

when are paralytics used

Answer 23

endotracheal intubation
decrease shock state
manage ICP

Question 24

do paralytics have analgesics

Answer 24

no so they better be sedated properly

Question 25

which drug can cause renal failure

Answer 25

NSAIDS

Question 26

iontropes do what

Answer 26

increase CO

Question 27

vasopressors do what

Answer 27

increase vasoconstriction, increase MAP

Question 28

why treat low BP or hypotension

Answer 28

blood to vital organs restore tissue perfusion reduce mortality

Question 29

dopamine is a vasopressor or inotrope

Answer 29

mixed but primary increases inotrophy

Question 30

whats dobutamine do

Answer 30

increase CO (inotropic), vasodilator

Question 31

whats milrinone do

Answer 31

inotrophy and vasodilator, but longer therapeutic effect than dobutamine

Question 32

name three vasopressors

Answer 32

norepinephrine epinephrine midodrine

Question 33

what are vasopressors and iodtropes used for

Answer 33

hypotension

Question 34

side effects of vasopressors and iodtropes

Answer 34

hypo perfusion (blood to vital organs, you could amputate digits) cardiac dysrhymias myocardial ischemia

Question 35

activity mobility guidelines

Answer 35

no increased dose of vasopressor for 2 hours no evidence of MI 24 hours no new artiarthymic agent 24 hours HR <75% predicted max HR at rest less than 20% variability of BP on low dose of inotrope support <10

Question 36

heparin is an example of what kind of drug

Answer 36

anticoag

Question 37

is heparin brief onset brief duration

Answer 37

yes

Question 38

T/f heparin is used over the counter

Answer 38

hospital only

Question 39

difference warfarin and heparin

Answer 39

slower onset, longer duration

Question 40

physio considerations for anticoags

Answer 40

they could bleed or clot | could be on specific bed rest

Question 41

with low INR they __ with high INR they

Answer 41

clot bleed

Question 42

how to assess for delrium

Answer 42

confusion assessment method

Question 43

common anti psychotics

Answer 43

haloperidol methotrime loxapine quetiapine

Question 44

can transplant patients be on EMCO

Answer 44

yes

Question 45

signs symptoms of transplant rejection

Answer 45

``` pain at site of transplant ill, flu like symptoms fever weight change swelling decreased urine output ```

Question 46

side effects of immunsuppression

Answer 46

mm weakness, tremors peripheral neuropathy, myopathy increased likelihood of CAD

Question 47

t/f early post transplant failure has high mortality rate

Answer 47

true

Question 48

heart transplant peak HR

Answer 48

only 80% of normal

Question 49

do heart transplant patients get angina

Answer 49

no

Question 50

difference transplant heart ECG

Answer 50

2 p waves | first P wave not followed by QRS

Question 51

Pt considerations in heart transplant

Answer 51

there tacky all the time longer warm up cool down heart can't respond quickly (orthostatic hypotension)

Question 52

lung transplant consideration for PT

Answer 52

decreased mucus clearance ineffective cough decreased strength increased reliance on anaerobic metabolism

Question 53

considerations for liver transplant

Answer 53

hemorrhage mm weakness tacky