Exam 3 Flashcards
(141 cards)
1
Q
what is the order of process for initial temporary platelet plug
A
adhesion, activation, and aggregation
2
Q
the blood vessel contraction in response to bleeding is a result of what 2 things
A
autonomic nervous system and expression of thromboxane A2 and ADP
3
Q
platelets release alpha granules containing what
A
ADP, thromboxane A2, serotonin, calcium
4
Q
Factor 1
A
Fibrinogen, synthesized in liver
5
Q
Factor II
A
prothrombin, synthesized in liver
6
Q
Factor III
A
tissue factor or thromboplastin, synthesized from vascular wall
7
Q
Factor IV
A
Calcium, synthesized from diet
8
Q
Factor V
A
proaccelerin, synthesized from liver
9
Q
Factor VII
A
proconvertin, synthesized from liver
10
Q
Factor VIII
A
antihemophiliac, synthesized from liver
11
Q
Factor vWF
A
von Willebrand, synthesized from endothelial cells
12
Q
Factor IX
A
Christmas, synthesized from liver
13
Q
Factor X
A
Stuart-Power, synthesized from liver
14
Q
Factor XI
A
plasma thromboplastin antecedent, synthesized from liver
15
Q
Factor XII
A
Hageman, synthesized from liver
16
Q
Factor XIII
A
Fibrin stabilizing, synthesized from liver
17
Q
Extrinsic pathway begins when
A
when Factor III is exposed
18
Q
what is the steps of the extrinsic pathway
A
Factor III (thromboplastin) activates Factor VII (proconvertin) which forms Factor VIIa which activates Factor X (stuart-power)
19
Q
is the extrinsic pathway fast or slow
A
fast, 15 seconds to be activated
20
Q
what lab test assesses extrinsic pathway
A
prothrombin test (PT)
21
Q
when is the intrinsic pathway activated
A
when damage occurs to the blood vessels themselves
22
Q
what are the steps for intrinsic pathway
A
Factor XII (Hageman) is activated into XIIa which activates Factor XI (plasma thromboplastin) into XIa, XIa activates Factor IX (christmas) to IXa, IXa binds with VIIIa (antihemophilic factor) to activate Factor X (stuart-prower)
23
Q
what are the steps for the common pathway
A
Factor X (stuart-prower) converts to Xa which converts Factor II (prothrombin) to IIa, IIa converts Factor I (fibrinogen) to Ia (fibrin) which forms a clot
24
Q
what does plasminogen do
A
breaks down fibrin
25
Fibrin is broken down into what
fibrin degradation products and d-dimer
26
Protein C and S inhibit what factors
III, V, and VIII
27
Antithrombin inhibits what factors
XII, XI, X, and IX
28
normal platelet
150-300k
29
normal PT and what it measures
12-15 seconds, measures extrinsic and common pathway
30
normal aPTT and what it measures
25-32 seconds, intrinsic and common pathway
31
normal INR and what it measures
1.5-2.5, extrinsic and common pathway
32
normal D Dimer
<500
33
normal fibrinogen
>150
34
normal ACT
90-150, guides heparin dosing
35
what is an autologous transfusion
reinfusion of patient's native blood
36
what is cell savage
collection of blood from surgical field that is filtered and reinfused to patient
37
what are contraindications for cell savage
contaminants in operating field
malignant tumors
thalassemia
sickle cell
anticoagulant drugs
disinfectant irrigation
synthetic resins
38
what is the CPDA in blood products
Citrate (anticoagulant)
Phosphate (acid-base buffer)
Dextrose (energy source for RBC)
Adenine or Adsol (extends shelf life)
39
how long can plasma be stored
one year, once thawed 24 hours
40
what is in cryo
100 units of Factor VIII, 200mg of fibrinogen, fibronectin and vWF
41
when is LR safe to give blood
within 60 minutes of initiation or at rapid rates 540cc/hr
42
what is the most common bacterial contamination of blood storage
cytomegalovirus
43
what products are a higher risk to cause lung injury
FFP or platelets
44
estimate amount of adults/children that experience malignant hyperthermia
1:100,000 1:30,000 children
45
who is more likely to experience MH
<15 years old, male
Midwest area
46
Gene responsible for MH
RYR1 gene (70% of cases)
47
pathophysiology of MH
enhanced calcium release from sarcoplasmic reticulum --> elevated intracellular Ca results in muscle contraction and abnormal metabolism --> O2 use, CO2 production, heat production, and lactic all go up --> acidosis and hyperthermia destroys sarcolemma increasing K+, myoglobin and CK
48
succs increase risk of MH by how much
20x
49
Signs of MH
unexplained sudden ETCO2 increase above 55, tachycardia, masseter rigidity, rising temp, cola-colored urine, decreased SaO2, labile BP, mottled skin
50
Labs with MH
ABG - mixed acidosis
K+ >6
CK >20k
myoglobin >170
urine myoglobin >60
blood lactate 10-20x
51
treatment of MH
dantrolene 2.5mg/kg bolus q5-10
hyperventilate with 100% FiO2
Cool patient
treat arrhythmias
DO NOT GIVE Ca channel blockers
52
what is the most accurate test for determining MH
caffeine halothane contracture test (CHCT)
53
continuous infusion of dantrolene dose
.25mg/kg/hr
54
what does cell mediated immunity target
intracellular pathogens
these are T cells
55
what does humoral immunity target
targets extracellular pathogens
these are B cells
56
what is an antigen
any toxin or foreign substance that causes an immune response in the body
57
complete antigens common in anesthesia
blood products
protamine
dextran/volume expanders
Latex
NMR
58
incomplete antigens common in anesthesia
PCN
low molecular weight anesthesia drugs
59
4 functions of T cells
T-Helper
Suppressor
Cytotoxic
Killer
60
type 1 hypersensitivity
anaphylaxis
61
type 2 hypersensitivity
cytotoxic reactions
62
type 3 hypersensitivity
immune complex reactions
63
type 4 hypersensitivity
delayed hypersensitivity
64
which immunoglobin is responsible for anaphylaxis
IgE
65
which immunoglobin is responsible for cytotoxic reactions
IgG or IgM
ex. ABO transfusion incompatible reactions, HIT
66
which immunoglobin is responsible for immune complex reactions
IgG or IgM
ex. snake bite
67
what are examples of delayed hypersensitivity reactions
TB test, poison ivy
68
CV signs of anaphylaxis
hypotension, tachycardia, arrhythmia, cardiac arrest
69
Respiratory signs of anaphylaxis
low ETCO2, low SaO2, increased PIP, laryngeal edema
70
what are the most common causes of anaphylaxis in anesthesia
muscle relaxants (70%)
latex (12%)
Abx (8%)
71
epi doses for anaphylaxis
5-10 mcg for hypotension
.1-1mg for CV collapse
72
what antibiotics are most common to have allergic reaction
beta lactams (penicillin)
73
H1 receptor antagonist dose and agent for anaphylaxis
diphenhydramine .5-1mg/kg
74
H2 receptor antagonist dose and agents for anaphylaxis
ranitidine 50mg or famotidine 20mg
75
steroid dose for anaphylaxis
hydrocortisone 250mg
76
absolute contraindications of regional anesthesia
Patient refusal
coagulopathy
increased ICP
severe hypovolemia
infection at site
allergy
severe aortic stenosis
77
C7 landmark
most prominent spinal process
78
T7 landmark
opposite the inferior angle of the scapula
79
L1 landmark
rib margin
80
L4-L5 landmark
line connecting the iliac crests
Tuffier's line
81
S2 landmark
Posterior superior iliac spine
82
curvature of cervical spine
convex anteriorly
83
curvature of thoracic spine
concave anteriorly
84
curvature of lumbar spine
convex anteriorly
85
curvature of sacrum
concave anteriorly
86
in supine, what are the 2 high points (lordosis) of spine
C5 and L3-L5
87
in supine, what are the low points (kyphosis) of the spine
T4-T7 and S2
88
where does the spinal cord start and stop
foramen magnum to L1-L2
89
what are the target sites for neuraxial anesthesia
spinal nerve roots and spinal cord
90
what is the outer most part of the spinal meninges
dura mater, tough sheath
91
what is the intermediate membrane of the spinal meninges
arachnoid mater, thin weblike
92
what is the innermost layer of the spinal meninges
pia mater, vascular fibroelastic tissue
93
what is the average skin to epidural space
5cm
94
what is the subarachnoid space
lies between pia and arachnoid
contains spinal cord, CSF, nerves, and blood vessels
95
specific gravity of CSF
1.004 - 1.009
96
with midline approach what is the order of layers of anatomy that will be pierced
skin
subq fat
supraspinous ligament
interspinous ligament
ligamentum flavum
dura mater
subdural space
arachnoid mater
subarachnoid space
97
with the paramedian approach, what layers are avoided
supraspinous ligament, interspinous ligament
98
what is spinal anesthesia
consists of injecting local anesthesia into the CSF within subarachnoid space
99
what is the primary site of action for local anesthetics in spinal anesthesia
nerve roots
100
what is the secondary site of action of local anesthetics in spinal anesthesia
spinal cord
101
what is differential sensitivity
difference in how local anesthetics affect different nerve fibers
102
what is differential blockade
the temporary blocking of nerve fibers using local anesthetics
103
what factors affect differential sensitivity
fiber type, fiber size, local anesthetic used
104
are myelinated or unmyelinated fibers more resistant to local anesthetics
unmyelinated
105
are small fibers or large fibers more susceptible to local anesthetics
small fibers
106
in spinal anesthesia, sensory blockade occurs how many dermatomes above motor block
2 dermatomes above
107
in spinal anesthesia, autonomic blockade occur how many dermatomes above sensory blockade
2 - 6 dermatomes above sensory block
108
in epidural anesthesia, sensory and ANS block are how many dermatomes above motor block
2 - 4 dermatomes above motor block
109
what is the order of nerve fiber types being blocked
B (most sensitive)
C/A delta
A gamma
A beta
A alpha (most resistant)
110
recovery of nerve fibers is in same order of onset or opposite
opposite
111
what is the sequence of neural blockade
loss of sympathetic function
Pain
sensations of cold, warmth, touch
Proprioception
motor function
112
what is the dermatome for perineal and anal surgery
S2 - S5
113
what is the dermatome for foot and ankle
L2 (L2-L3)
114
what is the dermatome for thigh and lower leg
L1 (L1-L2)
115
what is the dermatome level for turp, vaginal delivery, hip
T10
116
what is the dermatome level for lower extremity with tourniquet
T8
117
what is the dermatome level for lower abdominal (appy, intestinal, gynecologic, urologic)
T6
118
what is the dermatome level for upper abdominal (C-section, cystectomy)
T4
119
what dermatome corresponds to umbilicus
T10
120
what dermatome corresponds to xiphoid
T6
121
what dermatome corresponds to nipples
T4
122
what are the 3 factors affecting block distribution
Baricity, patient position, and dose
123
what is an epi amount added to spinals to increase duration of action
.1 - .2mL of 1:1,000 (1mg/1mL)
124
how much fentanyl and morphine can be added to increase duration of action
Fentanyl 10-25mcg
Morphine .1 - .5 mg
125
how much clonidine and precedex can be added to increase duration of action of spinals
Clonidine 150mcg
Precedex 5mcg
126
is a high block or low block cause a complete sympathectomy
high block
127
what pressor is the preferred choice for hypotension for spinal
ephedrine
128
what are the physiologic responses to sympathectomy
arterial vasodilation
decreased SVR
venous pooling
reduction venous return
if T1 - T4, bradycardia
129
what systems are autoregulated
cerebral and renal
130
epidural insertion site for mastectomy
T1
131
epidural insertion site for thoracotomy
T4
132
epidural insertion site for upper abdominal surgery
T7-T8
133
epidural insertion site for lower abdominal surgery
T10
134
epidural insertion site for lower extremity above knee
L1-L2
135
epidural insertion site for lower extremity below knee
L3-L4
136
epidural insertion site for perineal
L4-L5
137
what are the significant factors affecting spread of epidural
dose and site of injection
(not effected by baricity)
138
for initial dosing of epidural, how many mLs are given
1-2mL per segment needed to be blocked
ex. epidural at T7, need T4 - T10 block, give 6 - 12mL
139
epi's effect on locals
reduces absorption which enhances block and duration of action
140
bicarb's effect on locals
increases pH which speeds onset, increases potency, and reduces pain on injection
141
what level block is known to cause urinary retention
S2-S4
