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Quarter 4 > Principles Final > Flashcards

Principles Final Flashcards

1
Q

Risk Factors of CAD

A
  • genetics
  • diet
  • environment
  • hypertension
  • smoking
  • diabetes
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2
Q

(3) Factors increasing myocardial oxygen demand

A

wall tension, contractility, and heart rate

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3
Q

(4) Factors affecting myocardial oxygen supply

A

coronary blood flow

diastolic time

oxygen saturation

myocardial oxygen extraction

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4
Q

Which part of the heart is most vulnerable to ischemia?

A

left ventricular subendocardium

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5
Q

(3) methods for monitoring Ischemia

A

ECG, pulmonary artery catheter, and TEE

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6
Q

(3) disadvantages of using Agents with CAD

A
  • myocardial depression
  • systemic hypotension
  • lack of post-op analgesia
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7
Q

drug of choice for coronary vasospasms

A

Nitroglycerin

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8
Q

Nitroglycerin

A

treats coronary vasospasm

  • venodilator
    • decreases venous return and filling pressures
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9
Q

Phenylephrine

A

increases myocardial oxygen requirements, but increases coronary perfusion pressure

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10
Q

Verapamil

A

CCB for treating SVT

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11
Q

Normal pulmonary wedge pressure

A

12

(above 18 is too high)

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12
Q

How would you treat decreased BP and increased PCWP in a patient with CAD?

A

phenylephrine, NTG and an inotrope

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13
Q

An ejection fraction less than ____ indicates myocardial dysfunction

A

0.4

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14
Q

LVED pressure greater than _____ indicates myocardial dysfunction

A

18 mmHg

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15
Q

“LAMPS” before CPB

A
  • Labs
    • ACT and HCT
  • Anesthesia
  • Monitor
    • BP, CVP, and PACWP
  • Patient
  • Support
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16
Q

(7) Components of Cardiopulmonary Bypass

A
  • circuit
  • oxygenator
  • pump
  • heat exchanger
  • primer
  • anticoagulants
  • myocardial protection
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17
Q

In CPB, blood is drained form the _____ and returned to the ____

A

right atrium

ascending aorta

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18
Q

(2) Types of CPB Oxygenators

A

bubble and membrane

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19
Q

(3) Types of CPB Pumps

A

roller, centrifugal, and pulsatile

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20
Q

CPB primer decreases HCT to ____

A

< 30%

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21
Q

ACT goal during CPB

A

> 400 seconds

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22
Q

Hypothermia during CPB

A

10 - 15 oC

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23
Q

Systemic BP decreased to _____ before aortic cannulation during CPB

A

80 - 100 mmHg

(reduces risk of aortic dissection)

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24
Q

Most likely cause of neurologic injury after CPB

A

emboli

(with hypotension being a contributing cause)

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25
Laboratory tests during CPB
* ACT * HCT * ABG * potassium * glucose
26
Monitoring during CPB
* BP * CVP * ECG - flat line * urine output * temperature
27
Why should mixazolam be given before rewarming?
high risk of awareness 5 - 10 mg
28
dose of Protamine
1 mg/100 units of Heparin * administer slowly * double check with surgeon * Check ACT before giving
29
Intra-aortic balloon pumps ___ before systole to ____ afterload and ____ during diastole to ____ coronary blood flow
Intra-aortic balloon pumps **deflate** before systole to **decrease** afterload and **inflates** during diastole to **increase** coronary blood flow
30
(3) Side effects of Protamine
hypotension, allergic reaction, and pulmonary hypertension
31
normal Mitral valve area
4 - 6 cm2
32
Normal Aortic valve area
2.5 - 3.5 cm2
33
mitral stenosis area
\< 1 cm2
34
aortic stenosis area
\< 0.75 cm2
35
Murmur in Mitral stenosis
rumblic diastolic
36
Murmur in aortic stenosis
systolic ejection murmur | (right upper sternal border)
37
Pathophysiology of Mitral Stenosis
* increased left atrial pressure and volume overload * impaired blood flow from left atrium to left ventricle * right ventricular hypertrophy * pulmonary edema * increase in left atrial pressure reflected back to pulmonary circulation
38
most common cause of mitral stenosis
rheumatic fever
39
Anesthetic considerations in Mitral Stenosis
avoid increased HR or decreased SVR
40
Dysrhythmia that commonly occurs with Mitral Stenosis
atrial fibrillation
41
Mitral stenosis has impaired blood flow from _____ to \_\_\_\_\_
left atrium to left ventricle
42
(3) Symptoms of Aortic Stenosis
angina, CHF, and syncope
43
Murmur in mitral regurgitation
holosystolic (best heard at lower left sternal border)
44
Murmur in Aortic regurgitation
decrescendo diastolic
45
(3) symptoms of right heart failure
* hepatic congestion * peripheral edema * JVD
46
Diagnostic methods of Mitral regurge
ECHO and angiogram
47
Mitral Regurge Treatment
* cardiac glycosides * hydralazine * ACE inhibitor * CHF regimen
48
mangement goals in Mitral regurge
* small increase in HR * derease in SVR
49
Management goals in Aortic Regurgitation
* avoid overzealous fluid * decrease afterload * maintain contractility * slight increase in HR
50
(4) classic symptoms of CHF
dyspnea, fatigue, fluid retention, and edema
51
decompensated fluid retention due to CHF may manifest as:
* pulmonary rales * JVD * peripheral edema * ascites and hepatomegaly * S3 gallop
52
Acute treatment of CHF
* optimize preload and afterload * dobutamine, milrinone, and amrinone * vasodilators * acute beta blockers
53
(3) causes of CHF
* weakening of heart muscle * stiffening of heart muscle * disease that increase oxygen demand
54
Patients recieving ____ valves are required to begin anti-coagulaiton therapy
mechanical
55
CVP may significantly _____ LVEDP | (in aortic valve replacement)
underestimate
56
anticoagulation for mechanical valves should be started ___ days post-op
2 - 3
57
aortic stenosis generally has a ____ prognosis than aortic regurge
better
58
Total Cardiopulmonary Bypass
all venous return from superior and inferior vena cava and coronary sinus is drained * PA and systemic pressure tracings are non-pulsatile
59
Partial Bypass
some of the blood return is still pumped by the ventricles * example: femorofemoral bypass
60
Keep HCT higher than ____ during priming for CPB
18-20%
61
(3) Common priming solutions
Normosol, albumin, and mannitol
62
PA and CVP should be ___ during CPB
low or near zero
63
urine output rate during CPB
1 mL/kg/hr
64
Duing CPB, maintain MAP between ____ to ensure adequate tissue perfusion
50 - 100 mmHg
65
Treatment of Hypotension during CPB
increase flow rate phenylephrine
66
How do you treat hypertension during CPB?
inhalational agents via pump | (do not lower pump flow rate)
67
\_\_\_\_\_% of normal cardiac output is usually enough to maintain tissue oxygenation
70
68
normal pump flow
50 - 70 mL/kg/min
69
Do you give muscle relaxants during CPB?
yes * prevents diaphragmatic movement and shivering
70
How does CPB affect muscle relaxants?
* requires more * reduces renal excretion * prolonged onset
71
Normal mixed venous oxygen tension should be _____ during CPB
40 - 45 mmHg
72
How do you preserve myocardium during CPB?
cardioplegia and hypothermia
73
Components of Cadrioplegia
* potassium * magnesium * THAM or bicarbonate * steroids, calciu, and insulin * nitroglycerin
74
Aorta may be cross-clamped for ____ without perfusion
60 - 120 minutes
75
At what temperature can patients be weaned from CPB?
37 oC esophageal/naso 35oC rectal/bladder
76
How do you defibrillate the heart internally during CPB?
DC at 5 - 10 joules
77
platelet function returns to normal ____ hours post CPB
2 - 4 hours
78
Thrombocytopenia is more common with ____ oxygenators
bubble-type
79
What is the most common cause of bleeding post CPB?
platelet dysfunction
80
Laboratory tests for termination of CPB
* HCT 20-25% * potassium 4 - 5.5 * ionized calcium 1.1 - 1.2 * mixed venous oxygen more than 70%
81
IABP is used when LVEF is predicted to be less thatn \_\_\_
25%
82
If LVEF is between 25 - 35%, which inotropic drug should be used?
milrinone
83
Mechanism of action of protamine/heparin
heparin is a strong aid | (protamine a strong base)
84
(3) Types of Protamine reaction
* I - systemic hypotension from rapid injection * II - anaphylactic or anaphylactoid * III - catastrophic pulmonary vasoconstriction with sytemic hypotension
85
How do you treat hypotension after protamine administration?
rapid volume infusion and vasoconstrictors
86
Bystolic
beta blocker
87
Lamisil
treats fungal infections
88
Lipitor
treats high cholesterol
89
Transvalvular gradient
greater than 50 mmHg represents significant **aortic stenosis**
90
Gingko
increases blood flow through atherosclerotic vessels (may increase bleeding)
91
Aortic stenosis represents obstruction to ______ tract
left ventricular outflow
92
Pathophysiology of Aortic Stenosis
* concentric hypertrophy of LV * decreased ventricular compliance (contractility and ejection fraction usually maintained)
93
Hemodynamic goals of aortic stenosis
* adequate volume * maintain SVR, HR and normal rhythm * maintain contractility
94
Hemodynamic goals of Aortic Regurge
* adequate preload * increase HR * decreased afterload
95
Risks associated with cannulation of vein during PAC
bleeding, infection, air embolism
96
Risks associated with floating PA catheter
arrhythmias, PA rupture, failure to wedge
97
What should be done before sternal splitting?
additional narcotics and lung deflation
98
What are some causes of hypotension during CPB?
limited pump flow, aortic dissection, and low peripheral resistance
99
(3) types of burns
thermal, eletrical, and chemical
100
Most common type of burn
thermal
101
second degree burn
blisters
102
third degree burn
burn through dermis | (insensitive)
103
Pulmonary complications of burns within 24 hours
CO poisoning, inhalational injury, and edema
104
pulmonary complications days to weeks after burn injury
pneumonia, atelectasis, and pulmonary emboli
105
Problems with cabon monoxide poisoning
* tissue hypoxia * left shift of oxy-hemoglobin curve * cardiovascular depression * cytochrome inhibition
106
Intial cardiovascular effects of burns
* hypovolemia * depressed myocardial function * increased blood viscosity * release of vasoactive substances
107
Problems with renal function due to burns
* decreased function and GFR * increased ADH * acute renal failure * hemoglobinuria and myoglobinuria
108
How are hemoglobinuria and myoglobinuria treated?
fluid resuscitation and alkalinization with bicarb then osmotic diuretics
109
Rule of 9's
A. Head and Neck 9% B. Arms 9% each C. Anterior chest 9% D. Posterior chest 9% E. Abdomen 9% F. Lower Back 9% G. Legs 18% each H. Perineum 1%
110
(2) formulas used for fluid resuscitation in burn patients
Parkland and Brooke
111
Parkland forumla
LR 4 mL/kg/% BSA burn * 50% given in first 8 hours * after 24 hours, use colloids
112
Common procedures in burn patients
* escharotomies * burn excision and skin graft * reconstruction * tracheostomy
113
Drug resposnes in burn patients
* increased opioid requirement * prolonged duration in those that need liver * albumin bound drugs will have a prolonged effect
114
Most common complication following massive transfusion
dilutional thrombocytopenia
115
After how many PRBC will a patient need FFP and platelets?
12 units - FFP 20 units - platelets
116
What causes a hemolytic transfusion reaction?
ABO incompatibility * Kell, Kidd, Lewis, and Duffy antigens * hemolysis takes place in either extravascular or intravascular space
117
Signs and symptoms of hemolytic transfusion reaction in patient under GA
* hypotension * hemoglobinuria * diffuse bleeding * oliguira leading to renal failure
118
Signs and symptoms of hemolytic transfusion reaction in awake patient
* fever, chills, nausea * hypotension * tachycardia * restlessness * flused and dyspneic
119
Types of Blood transfusion reactions
* febrile non-hemolytic (most common) * hemolytic and delayed hemolytic * allergic urticarial
120
What is the treatment for febrile non-hemolytic transfusion reaction?
* acetaminophen, NSAIDS * antihistamines * leukocyte depleted blood products
121
What lab value abnormalities would you expect in a patient with DIC?
* Prolonged PT and PTT * Reduced platelet count * Reduced fibrinogen level * Elevated fibrin degradation products
122
Citrate
anticoagulant used in stored blood products * can cause hypocalcemia and dysrhythmias
123
TRALI
non-cardiac pulmonary edema occuring within 6 hours of transfusion * related to antibodies to leukocytes * resolves within 96 hours * treat with oxygen, mechanical ventilation, and support of BP and CO
124
Shunt
phenomenon that occurs when portion of venous return of one circulation (pulmonary or systemic) is redirected back to arterial outflow of the same circulation
125
(3) Types of Shunt
simple, bidirectional, and complex
126
Left to Right shunt
pulmonary venous directed towards pulmonary arterial system
127
Potential problems of L-to-R shunt
* hypotension * pulmonary edema * increased PVR
128
Right to Left Shunt
systemic venous return directed to systemic arterial outflow * bypasses the lungs * results in arterial oxygen desaturation
129
(5) Lesions characterized by excessive pulmonary blood flow
* atrial septal defects * ventricular septal defects * atrioventricular septal defects * truncus arteriosus * hypoplastic left heart
130
(4) lesions characterized by inadequate pulmonary blood flow
* transposition of great vessels * tetralogy of fallot * tricuspid atresia * total anomalous pulmonary venous return
131
Marfan's Syndrome
disorder of connective tissue
132
Symptoms of Marfan's
* lens dislocation * aortic dissection, myocardial ischemia, and arrhythmias * restrictive lung disease * tall stature, joint hypermobility, and hernias
133
Preoperative preparation for Marfan's
* antibiotics for SBE * BB * reduce risk of aortic wall tension
134
airway concerns in Marfan's
* high arched palate * potential cervical instability * potential for TMJ dislocation
135
Lifespan of tissue valve
12 - 15 years
136
Advantage and Disadvantage of mechanical valves
lasts forever require anticoagulation for remainder of life
137
In a mitral valve replacement, the heart is opened through the \_\_\_\_\_
left atrium
138
In mitral stenosis, avoid increases in \_\_\_\_
PVR and tachycardia
139

Quarter 4 (15 decks)

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