Final Exam Flashcards
(133 cards)
1
Q
What conditions cause R ventricular hypertrophy?
A
COPD, pulmonary stenosis, tricuspid insufficiency, posterior MI
2
Q
What EKG findings will you see with R ventricular hypertrophy?
A
Tall R wave in V1, progressive decrease in amplitude in V4, shifting QRS vector to right with increased R precordial waves
3
Q
What are some causes of secondary T wave abnormalities?
A
conduction disturbances, ventricular hypertrophy, CNS ischemia
4
Q
What EKG findings would you see with left ventricular hypertrophy?
A
deeper right precordial S waves and taller left precordial R waves
5
Q
How do you calculate MAP?
A
(SBP + 2 DBP)/3
6
Q
For every 10 cm change, the BP changes by
A
7.4 mm Hg
7
Q
For every inch change, the BP changes by
A
2 mmHg
8
Q
What is the calculation for allowable blood loss?
A
ABL = EBV x [(starting Hct-target Hct)/starting Hct]
9
Q
What should your Hct be in relation to your Hgb?
A
3x
10
Q
How do you calculate EBV?
A
premies: 90-100 ml/kg, full term neonates: 80-90 mL/kg, infants 80 ml/kg, adults 70 ml/kg
11
Q
When should you transfuse?
A
healthy patients 7-8 g/dl and Hct of 21-24%; elderly or CV/pulmonary dz Hgb 10 d/dL or Hct 30%
12
Q
How much does one unit of pRBCs raise Hgb and Hct?
A
1 and 2-3%
13
Q
What is the ideal BP cuff size?
A
ideal length 80% of extremity circumference, 40% of extremity circumference
14
Q
Deflation of the IABP should occur at what point?
A
Before QRS complex
15
Q
How do you calculate maintenance fluid rate?
A
4,2,1 rule (or if over 20 kg, just take weight and add 40)
16
Q
How do you calculate TBW deficit?
A
(0.6 x kg) x ](Na-140)/140]
17
Q
What are some causes of decreased SvO2?
A
hyperthermia, shivering, seizures, reduced pulmonary transport of O2, hemorrhage, decreased CO
18
Q
What are some causes of increased SVO2?
A
hyperdynamic conditions, sepsis, L-R shunts, cyanide poisoning increased CO, unintentional PA wedge, L shift in O2Hgb curve
19
Q
What does hyperkalemia do to your EKG?
A
narrow peaked T wave, arrhythmia, wide QRS, heart block
20
Q
How do you calculate NPO status replacement?
A
hrs NPO x maintenance rate
21
Q
What is considered a minimally invasive procedure and what is the fluid requirements?
A
lower abdomen, hernia repair, small plastics - 2 ml/kg
22
Q
What is considered a moderately invasive procedure and what is the fluid requirements?
A
upper abdomen, appy, chole, uncomplicated ortho procedures- 4 ml/kg
23
Q
What is considered a severely invasive procedure and what is the fluid requirements?
A
upper and lower abdomen, total hip, bowel resection- 8 ml/kg
24
Q
What is the fluid replacement in the first hour of surgery?
A
1/2 NPO deficit + 3rd space loss + maintenance
25
What is the fluid replacement in the 2nd and 3rd hours of surgery, each?
1/4 NPO deficit + 3rd space loss + maintenance
26
What is the fluid replacement in the 4th hour of surgery and beyond?
3rd space loss + maintenance
27
What EKG changes will you see with hypercalcemia?
shortened ST and QT interval
28
What are the goals of ERAS?
decrease LOS and morbidity, faster recovery, decreased readmission rates, decreased cost
29
What are pre-op considerations for ERAS?
optimize pre-op conditions, educate pt and family to set realistic expectations, and emphasize fasting period
30
What are the fasting guidelines for ERAS?
2 hours for clear liquids, 2 glasses of water before bed and morning of, carb rich drink 2 hours prior
31
What are common premedications for ERAS?
acetaminophen, celecoxib, gabapentin, heparin
32
What medications should you avoid giving routinely preop according to ERAS?
benzos
33
What does ERAS recommend for induction?
propofol, intermediate acting NMBA (roc) or succs, antibiotic prophylaxis 30-60 min before incision
34
What are mechanical ventilation optimal parameters for ERAS?
tidal volume 6-8 ml/kg IBW, PEEP 5 (10 for lap procedures), FiO2 50%, 8 RR to maintain ETCO2 40
35
Describe TRALI
Transfusion related lung injury- caused by transfusion of antibodies that interact with pt's WBCs- aggregate in pulmonary circulation and damages alveolar capillary membrane
36
What is TACO?
transfusion associated circulatory overload
37
What's the difference between type, screen, and crossmatch?
type- 5 minutes, tests for ABO and Rh antigens; screen- 45 minutes, tests for antibodies; crossmatch- 45 min, tests compatibility between recipient serum and actual blood to be transfused
38
What should you do for an emergency transfusion?
2 pRBCs of uncrossmatched O- blood and continue until anti a/b titers are determined
39
What are PAC indicated for?
impaired cardiac function (CAD, valvular dysfunction, HF), evaluation of response to fluids/drugs (shock/sepsis, renal failure, severe burns, cont iontropic support), cross clamping of thoracic aorta, suspected or diagnosed pulmonary emboli, pulmonary disease (acute resp failure, COPD, pulmonary HTN)
40
What procedures are PAC indicated for?
CABG, valve replacement, pericardectomy, aortic surgery requiring cross clamping, sitting crani, portal systemic shunts, major pulm procedures, high risk OB
41
What are contraindications to PAC?
absolute- tricuspid or pulmonic valve stenosis, RA or RV masses, tetralogy of Fallot
relative- severe dysrhythmias, coagulopathies, new pacemaker or LBBB
42
How do PAC monitor CO?
based on Fick principle- measures concentration difference in fluid stream over time using thermodilution technique
43
Describe thermodilution technique
injection of known quantity and temp bloused through proximal port of PAC at end expiration- average of 3 injections used
44
CO value is derived from the ? (thermodilution technique)
total area under the waveform
45
What is CVP?
measures fluid pressure entering R side of heart
46
What is the a wave on CVP and where is it on EKG?
RA contraction; just after P wave
47
What is the c wave on CVP and where is it on EKG?
ventricular contraction, tricuspid closing and bulging; just after QRS
48
What is the v wave on CVP and where is it on EKG?
atrial filling; just after T wave begins
49
What is the x descent on CVP and where is it on EKG?
atrial relaxation/ventricular systole; ST segment
50
What is the y descent on CVP and where is it on EKG?
tricuspid opens and blood fills ventricle; after T wave ends
51
What is the risk when using L IJ approach?
thoracic duct damage
52
What is the distance from the L IJ insertion site to vena cava- RA junction?
20 cm
53
Where should the PAC tip be?
zone 3- uninterrupted blood flow
54
What are s/s of hypermagnesemia?
lethargy and loss of DTRs, decreased BP/HR, decreased RR, increased PR interval, wide QRS, prolonged QT
55
What are causes of hypernatremia?
loss of water in excess to Na or retention of large quantities of Na- osmotic diuresis, diarrhea, perspiration, DI, nephrogenic diabetes, hypertonic saline, hyperaldosteronism/Cushing's
56
What is a significant electrolyte imbalance that can occur from massive transfusion?
hypocalcemia- Ca binding by citrate preservative
57
What is an acid/base imbalance from massive transfusion?
metabolic alkalosis (citrate and lactate are converted to bicarb by the liver)
58
What is hetastarch and what can it cause?
colloid; coagulopathy
59
What is the distance from PAC insertion to RA, and what does the waveform look like?
20-30 cm, small amplitude waveform
60
What is the distance from PAC insertion to RV, and what does the waveform look like?
30-40 cm, high amplitude waveform
61
What is the distance from PAC insertion to PA, and what does the waveform look like?
40-50 cm, high amplitude waveform with higher diastolic trough than RV
62
What is the distance from PAC insertion to PCW, and what does the waveform look like?
45-55 cm; similar waveform to RA but higher pressure
63
What are the 4 variables of mixed venous oximetry? (What is the equation?)
SvO2 = SaO2 - [VO2/(Q x 1.34 x Hgb x 10)]
64
What is the purpose of PACU?
critical assessment, stabilization, prevention and detection of complications
65
What are the benefits of MAC?
Quicker recovery in OR, shorter PACU time, less N/V, less cost, high patient satisfaction
66
Goals of operative positioning
optimum surgical exposure, access for monitoring, prevent complications and injuries, maintain body integrity and physiological function
67
Describe brachial plexus nerve injury
prevents muscles of arm and hand from working properly, loss of feeling
68
Describe ulnar nerve injury
numbness/tingling of 4th and 5th fingers
69
Describe radial nerve injury
drooping of wrist and fingers
70
Describe suprascapular nerve injury
pain in shoulder, weakness and loss of shoulder function
71
Describe sciatic nerve injury
weakness of knee flexion, foot movements, difficulty bending food inward and down
72
Describe common peroneal nerve injury
inability to dorsiflex toes
73
Describe posterior tibial nerve injury
flattening of foot, inward rolling of ankle, turning out of toes and foot
74
Describe saphenous nerve injury
loss of sensation over medial aspect of lower leg
75
Describe obturator nerve injury
difficulty with ambulation, unstable leg
76
Describe pudendal nerve injury
phantom pain of lower regions of pelvis
77
Describe femoral nerve injury
affects ability to walk, problems with sensation of leg and food
78
What are common nerve injuries in lithotomy?
common peroneal, femoral nerve
79
What surgical position can cause compartment syndrome from occlusion of the femoral artery?
lithotomy
80
What are some useful pieces of information from previous anesthesia record?
induction drugs/doses used, tube size used, history of MH, pseudocholinesterase deficiency
81
What is the purpose of Murphy eye, and should your stylet pass it?
allows for release of pressure; no
82
How do you perform a Mallampati?
sit upright, extend neck, open mouth wide, stick out tongue, do NOT phonate
83
What are the components of the preop assessment?
name, DOB, verify procedure, indication for procedure, med history, prior anesthetic history, H&P (airway), lab results, consults, pt eduation, informed consent
84
What changes flow from laminar to turbulent?
change in direction >20 degrees, increased velocity, corrugated tubing
85
What are required components of vaporizers?
concentration calibrated, interlock system, liquid level present, keyed filler device, no discharge of liquid anesthetic
86
Describe variable bypass vaporizer
splits gas into vaporizer above and through liquid agent- uses bimetallic strip
87
Describe electronic vaporizer
computer calculates volume of gas to get concentration- heated and pressurized
88
Which way do the vaporizer knobs move?
counter clockwise
89
What is the Tec 6 heated and pressurized at?
39 C and 2 atm
90
All the muscles that move the VC (abductors, adductors, tensors) are supplied by the ? except the cricothyroid muscle, which is supplied by the ?
RLN; SLN
91
For sensory, above the VC, the larynx is supplied by the ? and below the VC by the ?
ILN (branch of SLN); RLN
92
What does the internal branch of SLN do?
sensory input above VC
93
What does the external branch of SLN do?
motor to cricothyroid muscle
94
Where is the R RLN?
branches from vagus, loops around brachiocephalic artery
95
Where is the L RLN
branches from vagus and recurs around aorta
96
What is the only motor branch of the glossopharyngeal nerve?
stylopharyngeus
97
What do the posterior cricoarytenoids do?
abducts cords
98
What do the lateral cricoarytenoids do?
adducts cords
99
What muscles close the glottis?
aryepiglottic and oblique arytenoid muscles
100
What muscles open the glottis?
thyroepiglottic muscles
101
What is the ideal gas law?
PV=nRT or PV=T
102
Boyles law
T constant, P and V inversely proportional
103
Charles law
P constant, T and V directly proportional
104
Gay Lussac law
V constant, T and P directly proportional
105
How do you calculate the contents of an O2 cylinder?
2000 psi/660 L, cross multiply with current pressure
106
when should you change your O2 cylinder?
1000 psi or less
107
What is Fick's law?
diffusion is directly proportional to surface area and gradient and inversely proportional to membrane thickness
108
How do you calculate TV delivered if your machine does NOT decouple and does NOT account for compliance?
(TV+FGF)-compliance
FGF- TV in mL divided by I:E ratio divided by RR
compliance- compliance x PIP
109
How do you calculate FiO2?
divide actual oxygen by total amount of liters
ex) 1 L of O2 and 1 L of air- 1.21/2= about 60%
110
What is the purpose of a diaphragm valve and where is it found on the machine?
reduces pressure- first and second stage regulator (decreases pressure from cylinder)
111
What are some examples of active cardiac conditions?
unstable coronary syndromes (unstable angina, severe angina, recent MI), decompensated HF, significant arrhythmias (high grade AV block- mobitz 2 and 3rd degree, SVT or Afib RVR, symptomatic ventricular arrhythmias or bradycardia, new onset VT), severe valvular disease (AS, MS)
112
EKG findings with posterior MI
R wave >0.04 seconds in V1 and V2 and R/S >1 posterior, depressed ST
113
What artery is affected in posterior MI?
posterior descending
114
What EKG findings would you see in RBBB?
V1- rSR (triphasic, wide QRS, inverted T
| V6- small q wave, broad S wave, upright T
115
What EKG findings would you see in LBBB?
V1- broad negative QRS
| V6- positive QRS, broad R wave, no Q wave or S wave
116
EKG changes with inferior wall infarct
ST elevation in II, III, aVF; ST depressions in I and aVL; abnormal Q waves in II, III, aVF
117
What are re-entry or circus movements?
re-excitation of cardiac tissue from same cardiac impulse- mechanism of most tachydysrhythmias
118
What are requirements of re-entry/circus movements?
imbalance between conduction and refractoriness, unidirectional block
119
What are some causes of re-entry/circus movements?
elongation of conduction pathway (chamber enlargement), decreased velocity of conduction of cardiac impulse (after MI), shortened refractory period (toxic doses of antidysrhythmics)
120
What lead is best for detecting ischemia?
V5
121
The ? represents the combination of all the instantaneous vectors during ? into a single vector that we call ?
mean cardiac vector; systole; axis
122
Limb leads determine the axis in the ? plane and provide information about the position of the electrical activity of the heart as it rotates around an ? axis. This is the axis we will deal with as it is the most commonly reported on EKGs
frontal; anteroposterior
123
Intersection of leads ? and ? divide the precordium into 4 quadrants
I and aVF
124
What is a normal axis?
0 to 90 between positive poles of leads I and aVF- QRS is upright in both
125
What is R axis deviation?
90 to 180- QRS is negative in I and positive in aVF
126
What is L axis deviation?
0 to -90- QRS is positive in I and negative in aVF
127
What is indeterminate axis deviation?
-90 to -180 QRS is negative in both leads
128
What leads monitor the lateral wall of the LV?
V5-6
129
What leads monitor the anterior LAD?
V1-V6
130
In lead I, left arm is ? and right arm is ?
positive; negative
131
In lead II, right arm is ? and foot is ?
negative; positive
132
In lead III, left arm is ? and foot is ?
negative; positive
133
Name the 9 cartilages of the larynx
single- cricoid, thyroid, epiglottic
| paired- arytenoid, corniculate, cuneiform
