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Flashcards in Orals Deck (31):
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Tachycardia

Primary: SVT, ventricular arrhythmia Secondary: hypoxemia, hypercapnia, decreased O2 output (anemia, low CO), pain (somatic, visceral, sympathetic), hypovolemia (absolute - dehydration, hemorrhage & relative - tamponade, pneumo, PEEP) Unusual: inotrope, pheo, carcinoid

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Bradycardia

Primary: sick sinus, complete heart block Secondary: (vagal stim/supp) drug induced - digoxin, narcotics, anticholinesterase, beta blockers, dexmedetidine [alpha2 stim], CCB & vagal stim - oculocardiac reflex, traction on viscera, laryngoscopy, baroreceptor [carotid]

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Hypertension

Primary: Long standing, associated with disease (pre-e, kidney failure) Secondary: hypoxemia, hypercapnia, decreased O2 output (anemia, low CO), pain (somatic, visceral, sympathetic), hypovolemia (absolute - dehydration, hemorrhage & relative - tamponade, pneumo, PEEP) Unusual: inotrope, pheo, carcinoid

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Hypotension

Preload - not enough or blocked from getting to heart (tamponade, PEEP, tension pneumo, aorto-caval compression, pinched vessel, CABG bent/twisted heart) & heart itself - muscle not strong (cardiomyopathy, MI), bradycardia/tachycardia/valvulopathy & afterload - too low (spinal shock, anaphylaxis, meds) & blood - low hematocrit and not enough to generate pressure

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Hypoxemia (1)

Wall to ETT: wrong gas composition, no has delivery; ETT to lungs: endobronchial/esophageal intubation, kink/clog/aspiration, disconnect, subQ tube

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Hypoxemia (2)

Thorax (out to in): weak chest wall from NMB, kyphoscoliosis/flail chest/phrenic nerve, pleura (fluid/air), parenchyma (aspiration, PNA, ARDS, CHF, atelectasis, V/Q mismatch), pulm vasculature (emboli), cardiac R-L shunt

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Hypercapnia

Making too much: MH, thyrotoxicosis, sepsis Eliminating too little: hypoventilation Rebreathing: CO2 absorber, valve, flows

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High risk procedure

Risk > 5% - aortic and other major vascular surgery, peripheral vascular surgery

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Intermediate risk procedure

Cardiac risk ~ 1-5% - intraperitoneal and intrathoracic, carotid endarterectomy, head and neck surgery

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Low risk procedure

Cardiac risk < 1% - endoscopic procedures, superficial procedure, cataract surgery, breast surgery, ambulatory

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Major clinical risk conditions

Unstable coronary syndromes, decompensated heart failure, significant arrhythmias, severe valvular disease

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Intermediate clinical risk conditions

h/o ischemic heart disease, h/o compensated or prior heart failure, h/o CVA, DM, renal insufficiency

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Minor clinical risk conditions

Abnormal EKG, rhythm other than sinus, uncontrolled systemic HTN

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CAD risk factors

Age, male, heredity, tobacco, cholesterol, sedentary, overweight/obese, DM, stress, alcohol, diet and nutrition

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Beta blockers and pregnancy

Bradycardia, hypoglycemia, respiratory depression, intrauterine growth retardation

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Rapid shallow breathing index

ratio of respiratory frequency to tidal volume (f/VT), <105 for extubation

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Postoperative pulmonary complications risk factors

Preexisting pulmonary disease, thoracic or upper abdominal surgery, smoking, obesity, age >60, prolonged GA >6 hours

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Normal FEV1 values

>3L men, >2L women

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Normal FEV1/FVC percentage

>70%

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Preop thoracic evaluation

FEV1 >800ml then postoperative FEV1 = % blood flow to remaining lung x total FEV1; FEV1 40mm Hg or PaO2 <45mm Hg means not a pneumonectomy candidate)

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High risk preop lab criteria for pneumonectomy

ABG (PaCO2 >45, PaO2 <10 ml/kg/min

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One lung maneuvers

100% O2, periodic inflation of collapsed lung, CPAP (5-10), early ligation/clamping of ipsilateral PA (pneumonectomy), position, PEEP, continuous insufflation of O2 to collapsed lung, changing tidal volume and RR

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Nitrous

35x more soluble than nitrogen in blood so it diffuses into air containing cavities more rapidly than nitrogen is absorbed by the bloodstream

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Hypothermia effects

<36 C, reduces metabolic requirements, increasing O2 consumption x5 2/2 shivering, cardiac arrhythmias an ischemia, increased peripheral vasc resistance, left shift hemoglobin-O2, reversible platelet dysfunction, postoperative protein catabolism and stress response, AMS, renal dysfunction, decreased drug metabolism, poor healing, increased infection

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Cardiac tamponade etiologies

Blood (postcardiotomy, chamber perforation, dissecting aortic aneurysm, trauma, anticoagulation), exudate (malignancy, infective/idiopathic pericarditis), non exudate (uremia, SLE, RA, idiopathic, radiation), air

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Tamponade pressures

CVP= pulmonary artery diastolic pressure = pulmonary artery occlusion pressure

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ETT mm newborn? 1 yr? 2 yr?

3mm, 4mm, 5mm

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ETT secure newborn? 1yr? 2 yr?

10cm, 11cm, 12cm (16 + age)/4

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Peds airway differences

Narrowest part is sub glottic

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Peds fluid

4:2:1; deficit - 50% 1st hour, 25% 2nd hour, 25% 3rd hour

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ROP goals

PO2 60-90, sat 94%