exam 1 Flashcards
(512 cards)
1
Q
ENT goal:
Balance ______ relaxation with _______ recovery
A
DEEP relaxation
RAPID recovery
painful/very stimulation (deep)
short cases (rapid)
2
Q
ENT
muscle relaxation ___________ paralytics
A
withOUT
3
Q
Goals of ENT
A
preventing fire
minimize blood loss (highly vascular)
specialized techniques
relax the muscle withOUT paralytics
deep but rapid
maintain CV stability
preventing postop airway obstruction
4
Q
3 types of ET tubes for ENT surgery
A
RAE
anode
laser tube
5
Q
ENT
ET tube
Cuffed, uncuffed (rare)
Sometimes difficult to fit, due to BEND
Helps make it less obstructed for the surgeon
The bigger the tube, the further out from the mouth
Nasal tube is good for dentists
A
RAE (oral or nasal)
6
Q
ENT
ET tube
Flexible, good at bending, can create knots, resists kinking
However, can be occluded easily with biting (without mouth block)
A
anode (armored, reinforced)
7
Q
ENT
ET tube
Metal impregnated tube, reduces risk of fire
However, markings are covered if you wrap it, so need to line it up with another tube; use breath sounds
A
laser tubes
8
Q
Most LAs are _______-based
A
amide
9
Q
3 drugs used for ENT
A
LAs
anticholinergics (secretions)
steroids (prolong LA, reduce edema + PONV)
10
Q
ENT have a high risk of _______
A
PONV
11
Q
which ENT case has the highest risk of PONV
A
middle ear procedures
8th cranial nerve
12
Q
to decrease blood loss by reducing MAP, while STILL MAINTAINING cerebral and systemic autoregulation
A
deliberate hypotension
13
Q
deliberate hypotension
Maintain MAP ≥ greater than or equal to ___
A
60
14
Q
true or false
deliberate hypotension
patients with HTN may need HIGHER MAP
A
true
could need 65 or 75
15
Q
true or false
deliberate hypotension can be done without aline, unless using nipride
A
true
16
Q
2 surgeries for deliberate hypotension
A
o Extensive dissections
o Functional endoscopic sinus surgery (FESS)
17
Q
drugs used for deliberate hypotension
A
Nipride (always use an a-line)
o Dexmedetomidine
o Esmolol
o Nitroglycerin (NTG)
o Nicardipine
o Remifentanil
o Propofol
18
Q
risk of deliberate hypotension
A
postop vision loss (irreversible)
19
Q
laser surgery types (4)
A
CO2
Nd: YAG
Ho: YAG, KTP
argon
20
Q
laser surgery drawback
A
most surgical fires are related to this
21
Q
What are the 3 biggest concerns with laser surgery)
A
1) Eye protection (patient + staff)
2) Plume dispersion (viral papillomas); can cause ETT to be dislodged
3) Fires
22
Q
which ETT is best for fires
A
laser tube, metal impregnated
23
Q
safety with laser surgery
A
matte finish
inflate cuff with methylene blue
shield tissue with wet gauze
suction plume
24
Q
if patient needs O2 AND needs to respond to verbal commands, do this for O2
A
deliver minimum amount of O2 (30% or less)
if needed above 30%, deliver 5-10L/min of air under drapes to washout excess O2
stop O2 >1 min before laser use
use adherent incise drape
keep towel edges far away
coat facial hair with jelly
use bipolar
do not use electrocautery to cut into trachea
25
complications of endoscopy
Eye trauma
o Epistaxis
o Laryngospasm
o Bronchospasm
o Adverse effects to LAs from epi, etc. (LAST)
26
bronchs require vocal cord ___________*
relaxation
avoid paralytics!
27
true or false
ONLY use AWAKE extubation with someone who has bleeding in their airway*
true
28
No ETT involved! It is from an independent source
unprotected airway
High Frequency Jet Ventilation
29
HFJV, always use lowest ____ possible
O2
<30%
30
CONTRAindication to HFJV
full stomach
obese
pulm disease (difficult to maintain O2)
31
difficulties of HFJV
air trapping
SQ emphysema
PTX
32
type of anesthesia to use for HFJV
TIVA
33
what bronchus is most common with children for aspiration
Right
34
gold standard for foreign body aspiration
rigid bronch with GA
35
foreign body:
inhalational induction with ______________ ventilation
spontaneous
36
avoid ______ with foreign body
PEEP
37
postop foreign body
steroids
breathing treatment
mask on face, chin lift
Avoid ETT unless necessary
38
what 2 drug classes are CONTRAindicated for nerve monitoring/preservation/stimulation
NMBs
LAs
nitrous (avoid >15 min before closing)
39
2 indications for nerve preservation
parotid glands
mastoidectomies
40
how long should nitrous be turned off for
>15 min before closing
41
myringotomy
ear procedure
usually does NOT require IV access
nitrous is okay to use (short procedure)
nasal fentanyl/dex for calmness
42
most common ped surgery
tonsillectomy and adenoidectomy (T+A)
43
true or false
LMAs are NOT recommended for tonsil surgery
true
44
contraindicated drug for tonsils
NSAIDS (however, studies have not proven they cause worse bleeding)
45
when are the ONLY times you can use DEEP extubation for ENT cases
"dry field" or VERY NORMAL cases
otherwise, always WAKE them
46
2 risk factors of bleeding tonsil complication
>15 years old
within 6 hours (SLOW onset, swallowing blood)
47
true or false
bleeding tonsils extubate fully AWAKE*
true
48
true or false
ALL bleeding tonsils are “full stomachs”: MUST HAVE TRUE RSI*
true
49
thyroid procedures
Increased incidence of myasthenia gravis (increased ____________ to muscle relaxants!)
sensitivity
50
* Vocal Cords Motor Innervation (2)
o Recurrent laryngeal
o EXTERNAL branch of SUPERIOR laryngeal
51
gold standard thyroid surgery monitoring
intraop nerve monitoring
ETT with 4 electrodes
NIM tube (neuro inegral monitoring)
52
NIM electrodes
red: _______
blue: _____
red: RIGHT
blue: LEFT
electrodes should be in contact with vocal cords
53
thyroid surgery
treat hypotension with _______-________
direct-acting
(phenylephrine)
54
what can occur following thyroid surgery
HYPOcalcemia
(numb/tingling, laryngospasm, seizures, CV arrest)
55
treatment for HYPOcalcemia (2)
calcium gluconate or chloride
56
thyroid hematoma
Post-op hematoma
leads to
ER airway obstruction
leads to
emergent to the OR
57
true or false
cleft LIP is more difficult
true
difficult to mask and to intubate
done first
58
facial trauma
assume ___________ injury
cervical spine
use c-collar, F/O
59
Le Fort fracture
Horizontal, nose/palate, septum, posterior pterygoids
Usually, no issues
Oral or nasal ETT GOOD TO USE
I
60
Le Fort fracture
Triangular, nose, orbit, below zygoma, lateral maxilla + pterygoids
II
61
Le Fort fracture
Complete separation of midface from the cranial base across nose, ethmoid, orbit, sphenopalatine fossa
AVOID NASAL ETT without F/O guidance if basilar skull fracture suspected
III
62
basilar skull fracture signs (4)
o CSF from nose or ears
o Blood behind tympanic membrane (ears)
o “Raccoon eyes”: ALWAYS BILATERAL
o Bruising behind ears: “battle signs”
63
basilar skull fracture signs are delayed ___-___ days
2-3 days
64
facial fractures
true or false
ALL are full stomachs
Wire cutters must be available and stay at the bedside throughout the postop course
usually, not an emergency procedure
extubate AWAKE (need to be able to clear the airway)*
true
65
with any nerve thing, what do we avoid
NMBs or muscle relaxants
66
radical neck dissection (3)
difficult intubation (due to radiation, movement issues)
LONG procedure
AVOID fluid overload
risk of VAE (due to head-up position
67
opthalmic surgery
anesthesia type
LAs "epidural"
a little propofol
EXCEPT young children
they cause less PONV
68
most common + effective for profound analgesia/akinesia (no movement) of eye and eyelids (2)
RETROBULBAR LA*
peribulbar LA
Sub-tenon, infraorbital, supraorbital
69
which nerves are anesthetized with opthalmic
III, IV, V, VI, VII (3-7)
70
young children opthalmic surgery anesthesia type
GA
71
true or false
okay to use anticoags with eye surgery
true
72
opthalmic surgery
Sch causes transient ____________ IOP
increased
still considered safe
73
opthalmic surgery
decreases IOP + maintains akinesis
NON-depolarizers
74
opthalmic surgery
extubate ______
DEEP
75
2 risks from eye muscles
MH
PONV
76
opthalmic surgery
Prolonged PONV may be sign of increased ____!
IOP
77
For FULL stomach, OPEN-EYE INJURY patient
easy airway =
difficult airway =
easy = roc
difficult = Sch
(if sugg is available, use roc, less risk of increased IOP)
78
Oculocardiac Reflex
Afferent/towards = *
trigeminal (V)
five and dime
79
Oculocardiac Reflex
Efferent/away = *
Vagus (X)
five and dime
80
stimulus (4) of Oculocardiac Reflex
Globe pressure
optic nerve pressure conjunctival pressure
muscle traction
81
true or false
oculocardiac reflex occurs in children more
true
82
o Sudden, profound bradycardia, asystole, etc
Oculocardiac Reflex
83
treatment for Oculocardiac Reflex
stop stimulus
84
Oculocardiac Reflex
If unresolved (the second time it happens) = use ________ (2)
atropine or glycopyrrolate
85
* CN ____ nerve block = Bell’s Palsy
VII (facial)
86
Max SQ lidocaine
35 mg/kg
87
Max SQ epi
70 mCg/kg
88
1L SQ of tumescent solution
700ml absorbed
89
max amount of SQ tumescent solution
5L
90
tumesecent solution (3)
saline + epi + lidocaine
91
risks with liposuction
VTE*
abd wall perf
sepsis
fluid overload; pulm edema (from tumescent)
hypothermia
LA toxicity
92
o Highest incidence of death is d/t VTE
abdominoplasty "tummy tuck"
93
GREATEST risk of VTE
combined procedures
abdominoplasty + liposuction
94
biggest cause of VTE
smoking
95
VTE increased risk
long procedures
>__ hr GA
>__hr sedation
>1 hr GA
>2 hr sedation
96
facial cosmetic surgery
cocaine increases SNS
avoid ____, _________/_________
avoid HTN, swelling/bleeding
97
fiO2 <30% is =
150-200ml
98
safety checklist for office based surgery is from
ISOBS (institute for safety in office based surgery)
99
most common cause of death from OFFICE/PLASTICS based anesthesia
PE
(abdominoplasty)
100
Only ___ states have guidelines, policies, or position statements regarding office-based surgery and anesthesia (OBA)
33
101
true or false
standardization of safe practice with adequate safety protocols and practice standards are NOT legal guidelines*
true
102
true or false
Only 24 states have at least one law that regulated OBA
true
103
true or false
Heavy/deep or moderate MAC or deep sedation techniques require ETCO2*
however, this is NOT state/legal regulation, this is a standard of practice*
true
104
* DECREASED cost
* Increased patient and surgeon convenience and satisfaction
* Consistent staffing
* Efficiency
* Patient privacy
* Increased autonomy of practice
* DECREASED risk of infection
* Aging population + drive for cosmetic surgery
advantages of OBA
105
* Absent or inconsistent state regulations (someone who is not credentialed can perform)
* Lack of peer review and credentialing
* Logistical limitations
* Lack personnel support (solo provider)
* Possible poor quality/amount of equipment
* Lack organizational resources and human infrastructure
disadvantages of OBA
106
OBA facilities must have
positive pressure ventilation device (bag valve mask)
2 H tanks of oxygen
monitor/defibrilator
107
* What is the most common cause of death in OBA
inadequate ventilation and oxygenation
108
what should you keep in mind when monitoring fluids for liposuction
70% of tumesecent is absorbed (so calculate that into the number!)
do not overhydrate
109
true or false
If a bad trauma event happens, get them to a Level 1 trauma center; it does NOT matter how far it is!
true
110
modern trauma system has replaced the ________________ _____ ________
community care model
111
ATLS PRIMARY Survey:
ABCDE’s of trauma care
Vitals
Making sure the patient is stable
112
o ATLS Secondary Survey
Resuscitation and stabilization in progress
Complete head-to-toe assessment, including neuro exam!
Example: turning on the side, pupils, breath sounds, neuro assessment
113
Most common type of blunt trauma
MVAs and falls
114
blunt trauma
Always assume ___________, until confirmed otherwise
unstable C-spine
115
o What is the worst blunt trauma
thoracic (MVA/steering wheel)
116
most common symptom of blunt trauma
PTX (40%)
many times, it does NOT show up on x-ray
117
Tension PTX signs (6)
* HYPOtension
* SQ emphysema
* Unilateral ↓ BS
* ↓ chest wall motion
* Distended neck veins
* Tracheal shift to opposite side
118
treatment for tension PTX
* Emergent needle aspiration
2nd ICS (above 3rd rib, MCL)
119
* Beck’s Triad is associated with
pericardial tamponade
120
Beck’s Triad (3)
PERICARDIAL TAMPONADE
"beck was heart sick"
1) HYPOtension
2) increased CVP
3) jugular distention/muffled heart tones
121
what is NOT included in becks triad, but IS a symptom of pericardial tamponade
pulsus paradoxus (decreased SBP on inspiration)
122
what 2 drugs can be given for pericardial tamponade during INDUCTION
ketamine*
etomidate
AVOID PROPOFOL
123
hemothorax treatment (2)
1st fluid resuscitation
2nd chest tubes
124
What are common signs of tracheal injury
SQ emphysema
crepitus
125
most airway injuries occur _______ the carina
below
126
FAST stands for
Focused Assessment with Sonography in Trauma
great, highly sensitive, 4 views
127
lethal triad is for what
penetrating trauma, death
128
lethal triad**
PENETRATING TRAUMA
"lethal trauma"
1) acidosis
2) HYPOthermia
3) coagulopathy
129
Damage control surgery (DCS) with Damage Control Resuscitation (DCR)
prevent ________ triad
lethal
130
DCS and DCR
trauma
Limit/decrease _____________, but increase blood products
crystalloids
131
* DCS examples (2)
abd packing
external fixator
132
3 things used in Damage control resuscitation (DCR)
POC testing (TEG + ROTEM)
RAPTOR
REBOA
133
what is RAPTOR
resuscitation with angiography, percutaneous techniques and operative repair
(IR)
134
what is REBOA
Resuscitative endovascular balloon occlusion of the aorta
135
3 major assumptions with AIRWAY trauma
1) full stomach
2) c-spine issue
3) hypotensive + hypoxic
136
what NMBs for patients with AIRWAY trauma
Sch or Roc for RSI
137
Manual in-line stabilization (MILS)
after front of C-collar removed
* Many people helping!
138
true or false
AIRWAY trauma
NO outcome difference between DL (miller), VL, and FOB (provider dependent)!
true
you can use any!
139
what is the LAST resort (avoid it!) for airway trauma
front of neck access (FONA) with crichotomy
140
what is a dilemma for BREATHING trauma
↓ Decreased compliance (and need for ↑ increased PIP)
vs
barotrauma (with worsening disease)
141
protected lung ventilation (6)
1) LOW Vt
2) PEEP
3) Permissive HYPERcapnia (hypoventilating) ***
4) Limited fluids
5) Prone positioning
6) NMBs (can help with ventilating)
142
3 GOALS for breathing trauma
LOW Vt
LOW PIP (<32 cmH2O)
SpO2 90-94% (avoid O2 toxicity!)
143
excessive oxygen leads to
atelectasis
free radicals, ROS
cellular necrosis/apoptosis
however, ROS is also caused by oxygen toxicity
144
Current theory: “Golden Hour” is __________ _____ that is age and health status dependent
nonspecific time
145
Stages of Hemorrhagic Shock
* Blood volume normalized by shifting fluids
Stage I
NONprogressive or compensated
146
Stages of Hemorrhagic Shock
CV depression due to ISCHEMIA thrombosis, toxins, cellular damage
Stage II
Progressive
147
Stages of Hemorrhagic Shock
ATP depleted, cellular death with toxins released
o 1) Acute Irreversible: massive hemorrhage death FAST
o 2) SUB-Acute Irreversible: significant shock and cellular ischemia multi-organ failure/death over time/SLOW
Stage III
Irreversible
will die!
148
treatment of hemorrhagic shock
minimal bleeding:
<2 L crystalloid
(too much fluid can worsen it)
149
"Hypotensive Resuscitation"
when bleeding is UNCONTROLLED, minimize bleeding by maintaining SBP of ____-____ mmHg
* Controversial; primarily for penetrating trauma
SBP of 85-90
150
what is the exception to "Hypotensive Resuscitation"
TBI
151
"Hypotensive Resuscitation"
when bleeding is CONTROLLED, maintain SBP of >____ mmHg and HR <____
>100 SBP
<100 HR
152
for CVLs, access ______ the diaphragm when possible
ABOVE
153
replace EBL with __:__:__
1:1:1 (PRBCs, FFP, PLTs)
154
IV fluids resuscitation
________ cause rapid restoration but ↑ increased risk of pulmonary edema and bleeding
colloids
155
IV fluids resuscitation
Avoid ________, except for documented hypoglycemia + peds
glucose
156
Evidence: BG >____ mg/dL lead to adverse neuro outcomes
>170
157
trauma
maintain glucose at ____-____
140-180
158
trauma
majority of initial injury survivors are _______________ at death
coagulopathic
159
trauma
elevated ___ on admission = massive injury, hemorrhage, poor perfusion state
PT
prothrombin
160
(4) Trauma-Induced Coagulopathy (TIC) *
Dilution (too many fluids)
HYPOthermia*
Acidosis
TBI + Shock (coagulopathy)
161
When labs ARE available/have resulted, transfuse accordingly*
INR <____
PLT >_______
until then, use targeted transfusion (1:1:1)
1.5
PLT >50,000
162
hypothermia can result in _______
dysfunctional CLOTS
163
during resuscitation, ______ everything
WARM
164
acidosis with pH of <____ + hypothermia can result in significant clots
<7.1
165
true or false
bicarb is NOT effective for clotting issues
true
166
theory:
TBI + shock releases tissue factor, leading to __-__ complex
T-T complex
167
T-T complex leads to
activated protein C (APC) pathway
168
APC pathway inhibits ___ and ____,
+
promotes fibrinolysis
V and VIII
169
net result of T-T complex and APC pathway
systemic ANTI**coagulation
170
treatment for TBI and shock
EARLY FFP
171
assessment of blood consumption score (ABC)
and
trauma-associated severe hemorrhage score
(4)
penetrating injury
SBP <90
HR >120
positive FAST
172
ABC score of > or = ___
increased RISK of needing massive transfusion (may not be necessary)
2
173
keep PT level ____
low
174
TXA
> 12 years = ___ gm bolus over 10 min, then ___ gm over 8 hrs
1 gm over 10 min, then 1 gm over 8 hr
175
TXA
< 12 years = ___mg/kg bolus, then ___ mg/kg/hr over 8 hours
15 mg/kg
2mg/kg
176
* TXA should be administered less than < ___ hours post-injury
< 3
177
what is the up-to-date coagulation pathway
initiation, propagation
178
intubate with a GCS < __
8
179
for patients with low GCS score (neuro injury), use ______ IN*tubation
DEEP
180
diagnosis of ICP
>10 mmHg
181
when do you treat ICP
>25 mmHg
182
until ICP monitoring is available,
maintain MAP >____ to maintain CPP >____
maintain PaCO2 ___-___
MAP >80
CPP >60
PaCO2 30-35 (HYPO**carbic)
183
o ACS 3-Tiered Approach
(neuro)
ICP 10 – 20 mmHg
Tier 1
184
o ACS 3-Tiered Approach
(neuro)
ICP > 20 - 25 mmHg
Tier 2
185
o ACS 3-Tiered Approach
(neuro)
UNRESOLVED
ICP > 20 – 25 mmHg
Tier 3
186
o ACS 3-Tiered Approach
(neuro)
* Surgical evacuation, med-induced coma, HYPO**thermia
Tier 3
187
o ACS 3-Tiered Approach
(neuro)
EVD, mannitol or hypertonic saline, neuromonitoring, CT, NMBs
Tier 2
188
o ACS 3-Tiered Approach
(neuro)
Elevate HOB 30 deg, short acting sedation/analgesia, monitor ventricular drainage, repeat diagnostics
Tier 1
189
cushing's triad is for what
impending herniation
190
cushing triad (3)
BRAIN HERNIATION
"you want some cushion for your brain"
1) HTN**
2) BRADYcardia
3) irregular respirations
191
what 2 drugs should you AVOID with increased ICP
nitrous
ketamine
192
increased ICP, BEST choice for neuro protection, unless myocardial depression is a risk
propofol
193
drug treatment for ICP (3)
propofol
mannitol (0.25-1gm/kg)
lasix
194
true or false
Steroids are NOT effective for ↑ ICP
true
195
Signs of spinal cord injury (6)
1) Paralysis
* 2) Pain
* 3) Position
* 4) Parasthesias
* 5) Ptosis
* 6) Priapism (erection)
196
Sch
fasciculations can _______ spinal cord injuries
worsen
197
>____ hours until forever, AVOID Sch with spinal cord injury
>24 hours
UP-regulation, hyperkalemia
198
Be aware of spinal cord injury withOUT radiographic abnormality (_________) and vertebral artery injury (VAI)
this can occur in up to 88% of patients
CIWORA
199
what is needed for c-spine injury intubation
MILS, c-collar, halos
200
what 2 drugs do you avoid for spinal injury
Sch
nitrous
201
spinal cord injury
intra op evoked potentials
maintain _____ anesthetic
LOW
202
spinal cord perfusion
have MAP at ____-____
85-90
203
spinal shock triad (3)
1) HYPOtension (dilation)
2) BRADYcardia
3) HYPOthermia (heat loss)
"warm shock"
204
spinal cord
___ and above leads to major CNS impairment
T6
205
spinal cord SHOCK
true or false
aline is required to avoid pulm edema and guide pressors
true
206
Massive SNS response due to stimulus BELOW the spinal INJURY
autonomic dysreflexia
207
autonomic dysreflexia is most common with injuries above ___
T6
208
causes of autonomic dysreflexia (3)
bladder distention
fecal impaction (constipation)
nitrous/opioid GA or regional anesthesia (NOT with VOLATILES)
209
symptoms of autonomic dysreflexia (6)
* HTN*
* Seizures
* Pulm edema
* MI
* Acute renal injury
* Cerebral hemorrhage
210
treatment for autonomic dysreflexia (5)
* Nitrates
* Nifedipine
* Hydralazine
* Labetalol
* Foley*
211
what surgery is a major risk for fat emboli, PE emboli, hemorrhage, shock
orthopedics
212
symptoms of bone fractures (3)
Hypoxic respiratory failure due to continuous fat emboli syndrome (FES)
ARDS
HIGH morbidity and mortality (with pelvic fractures)
213
treatment for bone fractures (4)
REBOA (occlusion of aortic artery)
repair it early
treat as FULL stomach, RSI
regional? depends
214
what is the cause of death for junctional trauma
life-treatening hemorrhage
they are NON-compressible**
treatment: junctional tourniquets
215
what are most INTRAop deaths for trauma patients from (3)
HYPERkalemia
HYPOcalcemia
acidosis
NOT hemorrhage/exsanguination
216
what are POSTop deaths for trauma patients
multiorgan failure
early:
later:
early: CV failure*
later: PIICS (persistent inflammatory, immunosuppressed catabolic syndrome)
217
peds burns are mostly due to
scalding (NAT? possible abuse)
218
burns
main causes of EARLY death < 48 hours (2)
shock or inhalational injury
219
burns
main causes of LATE death
> 48 hours (2)
multiorgan failure + sepsis
220
true or false
rule of nines
The difference in % for the head in children is MORE severe*
true
head is 18%
adults it is only 9%
221
major burn:
>10% TBSA (adult) or 20% (age extremes): ___degree
>10% TBSA (adult: ___ degree
2nd degree
3rd degree
222
true or false
electrical burn or inhalational injury
are considered major burns, regardless of degree
true
223
burn**
If
patient age + % TBSA
is >____,
that means the patient has a
> 80% mortality
>115
224
mortality ________ with added inhalation injury
doubles
225
burns
Suspect ____________ injury until ruled out
inhalation
226
burns
true or false
heat in UPPER airway is dissipated, reflex laryngospasm occurs, which CLOSES the airway, so the LOWER airway damage is uncommon
true
227
burns
what is LOWER airway damage due to
toxins
NOT the hot air/steam
228
gold standard for airway exam for burn
fiberoptic
229
true or false
with upper airway damage, EARLY intubation is required, even if asymptomatic
true
230
burns
if swelling/obstruction is present, ________ intubation is the best choice
AWAKE
231
burns
Progressive air leak around ETT indicates airway swelling is ___________
subsiding
232
burn AIRWAY
treatment (3)
topicals, ketamine, dex
233
burn AIRWAY
avoid this class of drug
avoid NMBs (we want spontaneous ventilation)
234
CO binds to Hgb with 200x the affinity of O2 (______ shift), decreased SaO2 & metabolic acidosis
LEFT shift
235
true or false
pulse ox does NOT detect carbon monoxide
true
it will be falsely high
236
treatment for carbon monoxide poisoning
100% O2 until CoHgb <___% for ___ hours
100% O2 until CoHgb <5% for 6 hours
237
cyanide (HCN) causes metabolic __________
acidosis
238
symptoms of cyanide (HCN) toxicity
o Changes in LOC
o Seizures
o DILATED pupils
o HYPOtension
o Apnea
o High lactate levels
239
treatment for cyanide (HCN) toxicity
Hydroxocobalamin (vitamin B12a)
240
burns
fluid loss is greatest in the FIRST ___ HOURS
12 hrs
241
burns
HYPERmetabolism
highest stress response is 1st ___ days after injury
3 days
242
burns
HYPERmetabolism
plasma catecholamines are ___-___x higher than usual
10-50x higher
243
burns
when does the PRONOUNCED hypermetabolic phase set in
___ hrs post injury
48 hours post-injury
lasts up to 2 years following
244
burns
treatment for hypermetabolic phase
abx
beta-blockers
warming devices
anti-hyperglycemia
nutrition
245
fluid resuscitation
Parkland***
__ ml LR fluid x TBSA % x kg
over the first ___ hours
4ml
example: 70 kg pt with 30% TBSA burn = 8,400 mL
over 1st 24 hours = average of 350 mL/hr
(a lot of fluid!)
246
2 types of fluid resuscitation
parkland
modified brooke
247
what type of fluid for parkland resuscitation
heavy isotonic crystalloid (LR)
248
parkland resuscitation
children require ________ additionally
glucose
249
burns
CV
hypovolemia
hypotension
decreased CO
then, hypermetabolic
HTN
tachycardiac
250
burns
pulm
decreased function (even with no inhalational injury)
acute lung injury
decreased FRC
decreased compliance
increased capillary permeability, pulm edema, ARDS
251
burns
pulm treatment
use low Vt
use low PIP
252
burns
renal
myoglobinuria
hemoglobinuria
AKI
253
burns
AKI categorized by RIFLE
Risk
Injury
Failure
Loss
End-stage kidney disease
254
burns
immune
sepsis
pneumonia
255
what is the leading cause of death for burns
sepsis
256
burns
GI/nutrition
metabolic rate 2x normal
insuline RESISTANCE (hyperglycemia)
ileus
use RSI
257
burns
true or false
if intubated, do NOT stop enteral feedings (transpyloric)/TPN
continue them intraop*
use RSI
true!
otherwise, patient will get hypoglycemic fast
258
burns
common guidelines for when to stop debridement (3)
1) no more than 20% body surface at a time
2) core temp < 35 C
3) 10 units PRBCs given (approx 3500ml)
259
burns
true or false
even if Hct is normal (30), the patient could be dehydrated, so the Hct would be FALSELY HIGH
a number is just a number, until you put it into perspective of the patient; it doesn’t matter if their Hct is 35 or 45*
true
260
burns
anesthesia implications
thorough assessment
MINIMALLY safe NPO orders
2 large IVs/CVLs
labs/blood available
INCREASED opioids/NMBs due to hypermetabolic state
warm everything
postop ventilation
261
burns
absolute CONTRAindication
Sch
262
burns
fluid/blood replacement
start blood _________
as SOON as blood loss begins
KEEP UP AND STAY AHEAD OF THE GAME
263
burns
true or false
they require INCREASED amount of NMB
true
due to up-regulation
264
burns
true or false
anesthetic effects may be EXAGGERATED if hypovolemic
true
265
burns
true or false
regional should be AVOIDED
true
(sympathetic blockade, needle through burned tissue, coagulopathy)
266
burns
when is regional the ONLY good choice (otherwise, avoid it!)
children with caudal (lower extremity) burns
267
burns
utilize _______ extubation*
AWAKE
268
burns
avoid _________ due to oozing
NSAIDS
269
burns
which drug might be a good choice for postop/emergence
dex
270
what is the majority of MH from gene ______
chromosome _________
RyR1 gene
chromosome 19q13.1
271
MH
true or false
you can have the RyR1 variation, but not have MH
true
272
MH
true or false
Up to 50% have had 2 or more UNEVENTFUL GAs in the past!
true
273
MH
only < __% have positive family history
< 7%
274
causes of MH
volatiles (NOT nitrous)
Sch
275
explain MOA of MH
depolarization,
opens RyR1,
SUSTAINED calcium release,
cannot be re-uptake into SR fast enough,
sustained muscle contraction,
anaerobic metabolism,
acidosis, hyperthermia,
ATP is depleted
hypoxia, cell death, rhabdo
massive hyperkalemia (cause of death)
276
what is the cause of death for MH
massive hyperkalemia
277
MH peak age of incidence
3 years old
278
true or false
black box warning for Sch with children
true
279
what is the 1st sign of MH
hypercarbia
280
what are the EARLY signs of MH
hypercarbia (first)
hyperthermia
tachycardia
281
MH
hyperthermia occurs __ degree C every 10 minutes
1 degree every 10 min
282
when does MH occur
intraop (98%) of the time
or
1st hour postop
283
dantrolene MOA
BINDS to RyR1 receptor
promotes closing state
and
calcium reuptake
284
MH
skeletal muscle relaxant properties of dantrolene occur at the ______________ level
INTRAcellular (not the NMJ)
285
dantrolene pH
9.5
286
dantrolene reduces mortality of MH from >40% to ___%
1.4%
287
dantrium
____mg per vial
____ml per vial sterile water
20mg per vial
60ml per vial
contains mannitol
288
ryanodex
____mg per vial
____ml per vial sterile water
250mg per vial
5 ml per vial
small amount of mannitol (drawback)
289
MH
what 2 types of patients do you use non-triggering anesthetic*
For patients with blood relative with known MH
or
a myopathy with high association to MH
290
what are the 3 core myopathies for MH*
1) central core
2) multi-minicore
3) king-denborough
291
MH
flush machine with ___ L/min O2
10 L/min
292
MH
some machines need up to ____ min of flush time!
120
293
anesthesia type for MH patients
TIVA
propofol, opioids, non-depolarizer, nitrous
294
what type of thermometer is needed for MH risk patients
esophageal
axillary
nasopharyngeal
NOT skin temp
295
1st thing to do when MH is suspected
discontinue the agent
296
treatment for MH*
discontinue agent
hyperventilate 100% O2 or 10 L/min flow
get help
dantrolene
cooling measures
propofol/benzos
foley
lab tests
bicarb, hyperventilate, insulin (for hyperkalemia)
297
dantrolene BOLUS/LOADING dose
_____ mg/kg
repeat every ___-___ min
2.5 mg/kg
5-10 min until symptoms abate
298
dantrolene
dose to prevent reoccurence
___ mg/kg
repeat every ___ hours
for ____-____ hours
1 mg/kg
every 6 hours
24-48 hours
299
MH
true or false
NO direct ice on skin
true
300
MH
for NON-RESPONSIVE hyperthermia:
invasive/internal cooling (chilled NS)
301
MH
stop cooling measures at ___C*
38C
302
MH
INSERT FOLEY
keep UOP >__ml/kg/hr*
>2
303
what is CONTRAindicated with dantrolene
calcium channel blockers
-pine
304
MH
bicarb dose for acidosis
___-___mg/kg
1-2mg/kg
305
MH
gold standard diagnostic test (ONLY ONE)
Caffeine Halothane Contracture Test (CHCT)
post-pubescent
306
MH
For a pregnant patient not believed to be at risk for MH, but whose partner is susceptible to MH, which of the following is “Best Practice" *
Treat as MHS until delivery of fetus (OKAY TO GIVE Sch**** for RSI)
307
Dantrolene ___ mg/kg should be accessible within ___ minutes of the first MH signs*
10mg/kg
within
10 min
308
true or false
masseter muscle rigidity after Sch administration could be a sign of MH
true
309
true or false
MH can still occur in neonates
and
starting symptoms for children may be different (such as hyperkalemic cardiac arrest)!
true
310
later findings of neonate with MH
anasarca
mottling
anuria
creatinine kinase 2,900
DIC
311
symptoms of muscular dystrophy
muscle weakness
contractures
resp/CV weakness
possible:
learning disabilities
deafness
vision deficits
312
true or false
MH is NOT necessarily linked to musclar dystrophy
true
however, AVOID triggers and use TIVA to avoid hyperkalemia, etc
313
most common type of muscular dystrophy
myotonic
314
2nd most common type of muscular dystrophy
dystrophinopathy
(x-linked recessive)
315
what is the MOST severe phenotype of dystrophinopathy muscular dystrophy*
Duchenne Muscular Dystrophy (DMD)
316
what is the less severe phenotype of dystrophinopathy muscular dystrophy
becker MD
317
___% of muscular dystrophy has NO family history
30%
318
for muscular dystrophy, preop ___ should be drawn
CPK, it can be 100x normal
(however, always use TIVA, no matter the results)
319
wheelchair bound before adolescence
Duchenne Muscular Dystrophy (DMD)
320
if duchenne muscular dystrophy patient gets triggers, that can cause severe ______________ and _____________, leading to cardiac arrest (30% mortality!!)
rhabdomyolysis
hyperkalemia
321
What is a frequent 1st sign of DMD
cardiac arrest during inhalational induction
322
for DMD patients,
by ___ years old, serial ______ MUST BE DONE to evaluate cardiomyopathy*
8 years old, serial ECHOs
323
treatment for DMD (1)
glucocorticoid (prednisone)
324
with down syndrome, up to ___% have CARDIAC DEFECTS
50%
VSD, TOF, PDA, AV
325
what can occur upon induction with down syndrome*
BRADYCARDIA
326
true or false
downs syndrome
you MUST know cardiac status (ECHO) if non-emergency case
true
327
what are the 2 issues with patients with congenital defects*
intubation/mask difficulty
cardiac issues (have ECHO)
often have pacemakers, may need a magnet!!
328
what is the MOST DIFFICULT intubation for congenital defects
pierre robin
329
cystic fibrosis
symptoms
chronic inflammation/infection
hepatic dysfunction/clotting disorders*
OBSTRUCTIVE disease
INCREASED FRC
decreased FEV1
decreased expiratory flow
decreased VC
malnutrition
330
cystic fibrosis
true or false
do NOT dry the patient out
use humidity in the circuit
use SHORT acting agents (des, sevo, remi, prop, atracurium, nimbex)
true
331
cystic fibrosis
CONTRAindications (2) *
anticholinergics (glyco)
antagonists of NMBs (neostigmine)
332
cystic fibrosis
extubate ______*
AWAKE
333
sickle cell anemia
mutant Hgb ___
A
(recessive)
334
true or false
sickle cell TRAIT doesnt matter!
we only care about sickle cell DISEASE
true
335
sickle cell
acute chest syndrome (ACS) (1)
throwing clots/pulm emboli
more likely to occur after surgery, pregnancy, increased age
336
sickle cell
transfuse ONLY to Hct of ___%
avoid over transfusing
30%
337
sickle cell
WARM
WET
GREEN***
warm: keep them warm
wet: keep them hydrated
CANNOT BE NPO
green: keep them oxygenated
338
for craniofacial abnormalities, what is the best type of airway
LMA
339
when you dont know what you are dealing with, _________ the case
cancel
340
what are the 4 POTENTIALLY difficult airways for congenital disease***
turner's/noonan's
apert's
arthrogryposis
goldenhar
"TAAG"
341
what are the 6 KNOWN difficult airways for congenital disease***
pierre robin**
treacher collins*
down's syndrome
crouzon's
beckwith/gigantism
342
which 3 congenital diseases do NOT have heart issues
pierre robin
crouzon's
goldenhar
"PCG"
343
VSD heart issue
arthrogryposis
344
coarctation of AORTA=females
coarctation of PULM ARTERY=males
noonan's turner's
345
NORA
ambu bag must be able to inflate >___% O2
>90%
346
what is an important thing for NORA
dependable communication devices
347
NORA has _________ incidence of death compared to the OR
(conventional belief)
HIGHER death
however, the NACOR thinks NORA has a lower mortality rate!!!
348
>50% of NORA deaths are _______________
preventable, sub-standard care
349
what are most NORA claims related to
inadequate oxygenation/ventilation
OVER-sedation, resp depression
350
what is the most common anesthetic technique for NORA
MAC
351
for NORA claims related to over-sedation, what is the issue
limited ETCO2 monitoring or none at all
moderate and deep require ETCO2!
352
mean age of NORA patients is 3.5 years _________ than OR patients
OLDER
353
NORA patients are _______ medically complex than OR
more
(there are more ASA III-V)
354
NORA patients are _______ likely to be discharged earlier than OR patients
MORE likely to be discharged
355
MRI challenge:
distance between patient and anesthesia machine
>1 person needed for airway management
356
what is a difference in NORA and OR staff
uncertainty how to delegate during a crisis
357
MRI
Radiofrequency radiation emitted by MRI scanners is absorbed by the patient as heat energy, which can cause _____
burns
358
magnet strength is measured in ________
teslas (T)
359
most common teslas
1.5 and 3 T
360
true or false
teslas
the larger the number (T), the stronger the MRI, the clearer the pictures, but the higher the risks
true
361
MRI
4 zones: ____T - ___T
0.5T-4T
362
most common NORA adverse outcomes (minor) (3)
PONV
pain
hemodynamic instability
363
Highest NORA mortality categories (2)
cardiology and radiology
364
highest NORA adverse outcomes
GI endoscopy (might be related to sheer volume of cases though!)
365
NORA has a ________ amount of emergency procedures
greater
366
NORA
true or false
preop evaluation must occur
+
must check for proper equipment
true
367
NORA
prone or lateral positions (2)
GI procedures
ERCP
368
primary process leading to CAD, stroke, extremity ischemia, and aneurysms
atherosclerosis
369
where does atherosclerosis form
o Coronary arteries
o Carotid bifurcation (laminar flow changes to turbulent flow)
o Infrarenal abdominal aorta
o Iliac arteries
o Superficial femoral artery
370
atherosclerosis
What are the reasons for the ultimate injury (3)
plaque enlargement (reduced blood flow)
embolism of plaque (thrombi)
advanced plaque (occlusion)
371
risk factors for atherosclerosis
o Smoking (8x more likely)
o Hyperlipidemia
o Diabetes
o HTN (60%)
o Family history
o Male
o Advanced age
o Insulin resistance
o Physical inactivity
o Elevated C-reactive protein, elevated lipoprotein
372
3 types of Arteriosclerosis
infrarenal
thoracoabdominal
descending thoracic
373
1 type of cystic medial necrosis
degeneration of aortic media
(ascending aorta)
374
ELECTIVE AAA repair mortality rate ___%
5%
1-11%
375
surgery is recommended for AAA diameter
4 to >5.0!!! cm
376
RUPTURED AAA mortality rate ___%
75%
35-94%
377
PREhospital mortality rate of ruptured AAA
80-90%
378
AAA grow ___mm a year
4 mm
even with treatment
379
untreated mortality rate AAA
5 year
81%
380
untreated mortality rate AAA
10 year
100%
381
law of LAPLACE*
T = P x r
tension = pressure x radius
382
<4 cm rupture risk
0%
383
4-5cm rupture risk
0.5-15%
384
5-6cm rupture risk
3-15%
385
6-7cm rupture risk
10-20%
386
7-8cm rupture risk
20-40%
387
>8cm rupture risk
30-50%
388
Originates in the proximal ascending aorta and usually involves the ascending aorta, arch, and can go to abdominal aorta
DEBAKEY
Type 1
389
o Confined to the ASCENDING aorta
DEBAKEY
Type 2
390
o Confined to the DESCENDING thoracic aorta
DEBAKEY
Type 3a
391
DESCENDING thoracic aorta
May extend into the abdominal aorta and iliac arteries
DEBAKEY
Type 3b
392
o The ASCENDING aorta is involved, with or without the ARCH or the DESCENDING aorta
STANFORD
Type A
393
o The DESCENDING thoracic aorta is involved, with or without PROXIMAL or DISTAL extension
STANFORD
Type B
394
Where do aneurysms occur most commonly (2)
ascending thoracic aorta (close to aortic valve)
descending thoracic aorta (distal to L subclavian artery)
395
AAA major causes of death (4)
MI* (40-70%)
resp failure
renal failure
stroke
396
cross-clamping
hemodynamics depend on (3)
site of clamp
preop cardiac reserve (LV)
intravascular volume
397
during cross-clamping
cardiac
INCREASED
afterload
wall tension
MAP
SVR
preload
coronary flow
LVEDP (wedge): poor patients only
398
during cross-clamping
cardiac
UNCHANGED
HR
CO (good LV function)
LVEDP (wedge): good patients
399
during cross-clamping
cardiac
DECREASED
CO (lousy/bad LV!)
LVEDP
400
HTN occurs ______ the cross-clamp, hypotension occurs _________
HTN=above
hypotension=below
401
the longer the __________ of the cross clamp, the GREATER the INCREASE in SVR and DECREASE in CO
duration
time matters!
402
the ________/_________ the cross-clamp is placed, the GREATER the hemodynamic effect
HIGHER/MORE PROXIMAL
"the closer to the heart, the bigger the impact"
403
infrarenal __________ effect
suprarenal/infraceliac ____________ effect
supraceliac ___________ effect
infrarenal=LOWEST effect
suprarenal/infraceliac= MODERATE effect
supraceliac= GREATEST effect
404
proximal = ________ the cross-clamp
ABOVE
405
if splanchnic venous tone is HIGH, preload will _________
increase
406
if splanchnic venous tone is LOW, preload will _________
decrease
407
cross-clamp
increased pulm HTN/wedge + increased permeability =
pulm edema
408
cross-clamp
pulm damage related to (4)
hypervolemia
metabolites: prostaglandins, free radicals (bronchoconstriction)
activation of renin-angiotensin (BP rises)
complement cascade (inflammation)
409
INFRArenal cross-clamp:
renal blood decreased ____%
40%
410
INFRArenal cross-clamp:
renal vascular resistance increased ____%
75%
411
SUPRArenal and JUXTArenal:
renal blood flow is decreased ___%
80%
412
cross-clamp
renal failure is due to
reperfusion injury (acute tubular necrosis)
413
cross-clamp
where does damage occur for spinal cord
artery of adamkiewicz occlusion
414
cross-clamp
spinal cord: no collateral flow to _________ portion of spinal cord (_________)
ANTERIOR, MOTOR is injured
415
true or false
somatosensory evoked potential (SSEP) does NOT provide info about anterior spinal cord/motor
true
it is sensory/posterior ONLY
416
o Anterior Spinal Syndrome
Elective infrarenal ___%
0.2%
417
o Anterior Spinal Syndrome
Ruptures of the descending aorta ____%
40%
418
artery of adamkiewicz is found where
T5-L2
origin is unknown
419
spinal cord perfusion = _____ - _____**
MAP - CSF pressure
to help perfusion, you want to either:
INCREASE MAP
or
DECREASE CSF
420
how to prevent spinal cord injury
limit cross clamp time to ____ min
30 min
421
spinal cord injury
prevention:
drains (best option)
30 min or less
shunt (retrograde flow)
HTN
methylprednisone
HYPOthermia
AVOID hyperglycemia
mannitol
422
what temp do you want patient for reduced spinal cord injury
30-32 C
423
signs of spinal cord injury
(2)
motor function loss
pinprick sensation loss
preserved: vibration and proprioception
424
DURING the cross-clamp ______________ ALKALOSIS
central/proximal portion
RESPIRATORY
distal
425
DURING the cross-clamp ______________ ACIDOSIS
DISTAL/periphery portion
metabolic
426
cross-clamp
__________ total body O2 extraction
decreased
427
cross-clamp
___________ SvO2*
INCREASED
428
cross-clamp
____________ catecholamines
INCREASED
429
NTG (nitroglycerin) reduces __________ *
preload/venous
effects O2 consumption (improves supply/demand)
430
Nipride reduces ___________*
afterload
potentially improve CO
431
DURING cross-clamp, keep them _______volemic
normo (goal directed)
432
DURING cross-clamp, ___________ mV
DECREASE (due to ETCO2 being lower)
433
Milrinone decreases ___________*
afterload
434
DURING cross-clamp, you want the patient _____thermic
hypo
435
AFTER/RELEASE of cross-clamping
DECREASED:
afterload/SVR
MAP
preload
wedge (PCWP)
pH
temp
436
AFTER/RELEASE of cross-clamping
what can increase, have no change, or decrease?
CO
dependent on LV
437
AFTER/RELEASE of cross-clamping
INCREASED
ETCO2
438
after unclamping, hypotension shock syndrome can involve myocardial ____________ factors
depressant
decreased myocardial contractility
439
what can happen to the lungs AFTER cross-clamp
pulm edema
(increased permeability, mediator washout)
440
Wedge (PCWP) should be ____________ by ___-___ mmHg from PRECLAMP values
INCREASED by 3-4 above PRE-clamp values
this is to help with hypotension
441
AFTER release of cross-clamp
intraop interventions:
Increase Mv
use bair hugger
decrease anesthesia/vasodilation
increase fluids
consider mannitol
bicarb
442
what is a big challenge with cross-clamp release
fluid management
potential for blood loss
443
cross-clamp AFTER
maintain UOP ___ml/kg/hr*
1
goal-directed
444
what is the best prevention of renal failure
preventing hypovolemia
445
___-___ min PRIORRRRR to cross-clamp, give mannitol ____GM/kg
20-30 PRIOR
0.5*** gm/kg
446
dopamine for cross-clamp dose
___-___ mCg/kg/min
3-5 mCg/kg/min
447
use ________-sided aline for DESCENDING THORACIC
RIGHT=descending
448
PA cath looks at the _____ side
LEFT
449
best leads for EKG
II, V5
450
which congenital disorder has "no chin" or micrognathia
pierre robin (most difficult intubation)
451
what is the best type of anesthesia for AAA
combined! general + regional
452
regional for AAA requires ______-______ml MORE IV FLUID
1600-2000ml more
453
what are the 3 high risk AAA
they will need ventilation/intubation postop!
1) ascending aorta
2) aortic arch
3) thoracic aorta
454
who is more at risk for RUPTURED AAA
older
women
non-white
comorbidities (CHF, renal failure, valve disease)
insurance status
455
what is the best fluid (to get volume in fast) for RUPTURED AAA
crystalloids
456
what 2 vascular repairs require CPB (cardiopulm bypass)
ascending aorta
aortic arch
457
use ______sided aline for ASCENDING aorta
innonminate (brachiocephalic artery) clamped
LEFT=ascending
458
avoid ________cardia with aortic regurgitation
bradycardia
we dont want it!
due to the slow diastolic time
459
aortic arch repair: use hypothermia ___-___ C
15-18 C
protects brain
460
true or false
DESCENDING thoracic surgery does NOT use CPB
true
461
true or false
DESCENDING thoracic has GREATERRR risk/effects of cross-clamp, ischemia, renal insufficiency
compared to abdominal (AAA)
true
462
____________ thoracic requires ONE LUNG ventilation (double-lumen tube)
descending
463
mesenteric traction syndrome
high concentrations of ____
symptoms (4)
F1a (prostaglandin)
decreased BP/SVR
tachy
increased CO
facial flushing
464
peripheral vascular disease
what is the best anesthesia option
regional (sympathectomy allows for better perfusion)
465
* What is the most significant factor predicting postop stroke incidence
PREop neuro dysfunction
466
CEA
PERIoperative strokes
___% in asymptomatic patients
___% in symptomatic patients (TIAs)
___% in existing strokes
3% in asymptomatic patients
5% in symptomatic patients (TIAs)
10% in existing strokes
467
CEA
OR mortality
___-___%
0.5-2.5%
468
what is mortality for CEA patients due to
myocardial infarction
469
increased risks CEA (6)
o Age >75
o Symptomatic lesions
o Uncontrolled HTN
o Angina
o Carotid thrombus
o Occlusions near the CAROTID SIPHON
470
you want _____tension for patients who are getting a CEA intraop
HTN! (for perfusion)
neo
471
cerebral protection for CEA drugs (3)
barbiturates
propofol
dex
passive HYPOthermia!
472
HTN shifts autoregulation to the _______
RIGHT (higher)
473
CPP =
MAP - ICP
474
gold standard monitoring for CEA
awake
EEG
475
indicator of neuro dysfunction:
loss of ____ wave activity
emergence of _____ wave
loss of BETA
emergence of SLOW
loss of amplitude
476
carotid stump pressure
< ___ needs a shunt!
< 50 mmHg
477
inhalational agents at >___ MAC interfere with assessment of EEG/SSEP
>1 MAC avoid this
478
best anesthetic choice for CEA
there is no difference in outcome!
479
CEA
carotid sinus _______________ causes HYPOtension
baroreceptor
480
CEA
drugs for HYPOtension (3)
LA
ephedrine
neo
481
CEA
carotid sinus _______________ causes HTN
(and decreased response to hypoxemia)
denervation
often, postop
482
CEA
while cross-clamp is ON, KEEP SBP >____
>150
483
CEA
after cross-clamp is OFF, KEEP SBP <____
<140
484
CEA
postop, SBP >____ is associated with higher incidence of stroke or MI
> 180
485
EVAR is most beneficial for _____-risk patients*
HIGH
486
where is EVAR performed
IR
OR
487
EVAR 1
criteria
____cm
>___years old
5.5cm
> 60 years old
488
DREAM
for EVAR
criteria
___cm
5cm
489
EVAR
patient criteria
renal arteries should be >___cm away from TOP of aneurysm
>1.5 cm
490
EVAR
patient criteria
aortic bifurcation should be >___cm away from DISTAL end of aneurysm
>1 cm
491
EVAR
femoral artery should be able to handle introducer or at least ___ Mm diameter
withOUT tortuosity
8 Mm
492
EVAR
ACT >____ seconds
Heparin ___-___ units/kg
___fr sheath
> 300 seconds
50-100 units/kg
12 fr sheath
493
EVAR
PRIOR to graph attachment/balloon expansion, REDUCEEE
the SBP to ____ mmHg and MAP to ___mmHg during balloon inflation
SBP 100
MAP 60
during balloon inflation
494
EVAR
where is ischemia most likely to occur
distal (check peripheral pulses)
495
EVAR
Persistence of blood flow outside the graft; or between the graft and the aneurysmic vessel wall
biggest complication*
endoleak
496
EVAR
endoleak
inadequate seal
Type __
Type 1
497
EVAR
endoleak
retrograde flow
Type __
Type 2
498
EVAR
endoleak
tear or defect, leak
Type __
Type 3
499
EVAR
endoleak
porous graft flow
Type __
Type 4
500
EVAR
you want normothermia, normotensive except when
inflating balloon (then reduce it)
501
EVAR
kidney damage is due to
contrast
(it is NOT a perfusion issue)
502
EVAR
_____ is CONTRAindicated with pulm comorbidities
GA
503
EVAR
what is the ONLY difference between GA and regional outcomes
length of hospital stay
longer for GA
504
parkland, how do you split up the fluid in 1st 24 hours
1/2 in the first 8 hours
1/2 in the last 16 hours
505
parkland
2nd 24 hours, what do you do
D5W at maintenance rate with colloid 0.5 mL/% TBSA/kg
506
avoid _________________ with CF
glycopyrollate
507
LOUSY LV = decreased CO =
decreased coronary flow, decreased heart contractility
508
cross-clamp = GOOD LV = increased CO =
increased coronary flow, increased heart contractility
509
cross clamp = ____________ venous capacitance
DECREASED
510
Pulm vascular resistance goes ____ when UNclamping
goes UP
511
CROSS CLAMP: ABG
respiratory ALKAlosis
512
AFTER cross clamp: ABG
metabolic acidosis
