Pre-Test (Pre and Post Op, Critical Care) Flashcards Preview

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Flashcards in Pre-Test (Pre and Post Op, Critical Care) Deck (54):
1

Earliest clinical indication of hypermagnesemia

Loss of DTR (High Mg generally leads to states of neuromuscular depression)

2

Initial management of hyponatremia

Free water restriction

3

FeNa of less than 1% in oliguric setting indicates

Pre-renal etiology - aggressive Na resorption in the tubules (look urine Na)

4

Hypomagnesmia effects

paresthesia, hyperreflexia
Prlonged QT and PR intervals

5

Normal EKG in pre-op pt with hx of MI

Still do stress test (normal EKG wouldn't preclude further workup)

6

When should mix acid-base abnormalities be suspected

When pH is normal, but pCO2 and Bicarb levels abnormal OR
If compensatory responses appear to be excessive

7

Whenever significant bleeding is noted in early post-op period, first presumption should be

Error in surgical control of blood vessels in the operative field

8

Goldman's index risk #1

Recent MI (Up to w/in 6 mo)

9

In absence of peritoneal signs, dx test of choice for acute mesenteric ischemia

Angiography

10

Pre-op period tx for vWD

Desmopressin

11

What do you give with PRBC

FFP - transfusions lead to dilutional thrombocytopenia w/ def in factors V and VII

12

When do you start enteral nutrition post op

After bowel function if PO
If tube that passes stomach, can start w/in 24 hours

13

1st step in massive bleeding from retroperitoneal hematoma in post op pt

Immediate reversal of Heparin w/ protamine sulfate

14

What is referring syndrome? Major Complication?

IV glucose after chronic malnutrition leads to inc insulin levels --> electrolytes shifted back into cells
Hypophosphatemia (also hypokalemia and hypomagnesemia)

15

Sepsis vs Adrenal insuff

Similar presentations, but sepsis generally associated with hyperglycemia and normal K+
(Adrenal insuff -> hypoglycemia and hypokalemia)

16

When should FFP to replenish Vit K deep clotting factors be administered prior to OR? Why?

On the call to the OR
Factor 7 half-life is 4-6 hours (most stable clotting factor)

17

DIC after blood products likely?

Transfusion reaction (hemolytic)

18

What do you give a hemophilia A pt before surgery

Desmopressin and Aminocaproic acid (inhibitor of fibrinolysis)
*FFP has F VIII but not in high enough levels to prevent bleeding in hemophiliacs*

19

Most common cause of Zinc def? Symptoms

Excessive diarrhea
Alopeica, poor wound healing, night blindness, skin rashes

20

Ratio of NS or LR to replace blood loss

3:1 (3x fluid for 1ml blood lost)

21

Fluid replacement formula per hour

4 ml/kg/h for first 10 kg
2 for second 10
1 for every additional kg

22

Non-anion gap acidosis management

Fluid replacement and stool bulking agents

23

Patients with large ileostomy outputs at risk for?

Dehydration with accompanying hyponatremia, hypokaelmia, and non-anion gap metabolic acidosis

24

Hemolytic tranfusion reaction treatment

Fluids and mannitol
*Indwelling catheter can help and diagnose by showing oliguria and hemoglobinuria*

25

Metabolic rate during starvation

Decreases by 10%

26

Stress factors relative to basal metabolic rate for routine operation? multiple organ failure or severe injury? >50% burns?

Routine operation: 1.1
Multiple organ failure or severe injury: 1.5
>50% burns: 2

27

First step if trach starts bleeding bad

Intubate or stop the bleeding before going to OR for median sternotomy

28

Indications for extubation

-Rapid shallow breathing index b/w 60-105 (ratio of of RR to tidal volume)
-Neg insp force >-20
-PEEP of 5 or less

29

Major serious complication of hemolysis

Renal damage caused by precipitation of hemoglobin in renal tubules

30

Anesthetic to avoid in SBO surgery

Nitrous oxide (more absorbable, can increase distention)

31

3 major physiologic altercations of ARDs

1) hypoxemia unresponsive to elevations in O2 conc
2) Dec pulmonary compliance
3) Dec FRC

32

3 major things that shift the O2 curve to the right

Acidosis, rise in PaCO2, and elevation of temperature
*Also 2,3-BPG*

33

How does TRALI manifest

Respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload

34

Agent of choice in cardiogenic shock

Dobutamine

35

Cardiac index formula

Cardiac output / Body surface area

36

Tx for acalculous cholecystitis

Percutanous drainage of gallbladder

37

Hemodynamics of septic shoc

Hyper dynamic state with increase in CO and decrease in peripheral vascular resistance
*relatively normal central pressures*

38

How does PEEP improve oxygenation

Increases FRC by keeping alveoli open at the end of expiration

39

Tx for neurogenic shock

IV fluid bolus followed by presser (Phenylephrine or dopa)

40

Prolonged paralysis after intubation likely from? Don't use what drug?

Pseudocholinesterase def
Don't use succinylcholine or Mivacurium

41

3 criterion for acute transfusion reactions

1. Haptoglobin levels 5
3. + Coombs test (but takes 2-10 days)

42

O2 content variables

Hb, O2 sat, and PaO2 (in that order for contribution)

43

Highly reliable indication of alveolar ventilation

PcO2 (inc means not good alveolar ventilation)

44

Ideal respiratory quotient

0.75-0.85

45

What do you give pre-op pt's w/ VWD (besides desmopressin)

Cryoprecipitate (Has vWF and Factor VIII)

46

Who is not a candidate for ECMO

Babies with hypoplastic lungs --> not enough surface area for gas exchange

47

What is indicated for aspiration pneumonitis if there is particulate matter in tracheobronchial tree

Bronchoscopy

48

Tx for malignant hyperthermia besides dantrolene

Hyperventilate with 100% O2

49

Lab values for cholesterol atheroembolism

Eosinophilia
Microscopic hematuria or proteinuria
FeNa >1

50

Metabolite abnormality that succinylcholine can cause

Hyperkalemia (worse in burn patients)

51

Warfarin factors

II, V, VII, X, C and S

52

What does thrombin time measure

Qualitive abnormalities in fibrinogen and presence of inhibitors to fibrin polymerization

53

What can measure both amount of and nature of hypotesion

Pulmonary artery cath

54

Measurement of HTN after CEA

Art line for beat to beat measurement