Review Miscellaneous Deck

Question 1

What is a normal Protime?

Answer 1

11 - 13.5

Question 2

What is a normal partial thromboplastin time? (PTT)

Answer 2

25-35 or 25-38

Question 3

What is normal minute ventilation?

Answer 3

5- 8 LPM

Question 4

Pulsus paradoxus is a sign of what surgical emergency?

Answer 4

Cardiac tamponade

Question 5

What is pulsus paradoxus?

Answer 5

a drop of 10 pts or more in the SBP during inspiration.

Question 6

Why is using the internal mammary artery (IMA) a risk for pleural effusion?

Answer 6

Dissection of pleural tissue can cause effusion. Pleural dissection required for harvesting the IMA.

Question 7

Milrinone is what type of drug?

Answer 7

a Pulmonary vasodilator (Phosphodiesterase-3 inhibitor)

Question 8

What is milrinone’s effect on contractility?

Answer 8

increases cardiac contractility

Question 9

what is the indication for Intra-aortic baloon pump (IABP)?

Answer 9

Refractory cardiogenic shock, unstable angina, ventricular failure

Question 10

What is IABP used for?

Answer 10

To reduce afterload and Myocardial O2 demand and improve coronary perfusion and cardiac output.

Question 11

What is a normal hematocrit?

Answer 11

41-50 (men)
36-48 (women)
Roughly 35-45

Question 12

Rapid overdrive pacing is indicated for what rhythm only?

Answer 12

Aflutter

Question 13

What is the effect of desmopressin (DDAVP)?

Answer 13

promotes platelet adhesion and clot formation

Question 14

Shivering and pain can lead to what metabolic state?

Answer 14

Respiratory ALKALOSIS (from rapid breathing)

Question 15

What is the signs of cardiac tamponade? (in pressure)

Answer 15

Equalization and elevation of diastolic pressures

Question 16

How to recognize an air leak?

Answer 16

continuous bubbling in the water seal chamber

Question 17

signs of Malignant hyperthermia?

Answer 17

rapid respiratory rate, tachycardia, hyperthermia

Question 18

Why must beta blockers be used with caution in COPD patients?

Answer 18

Due to the potential for bronchospasm

Question 19

Clevidipine

Answer 19

calcium channel blocker that is selective for vascular (not myocardial) smooth muscle

Question 20

What is clevidipine’s effect on the SVR?

Answer 20

it lowers it

Question 21

What is the Number 1 risk for deep sternal wound infections?

Answer 21

Obesity

Question 22

Why are Aortic valves always replaced, not repaired?

Answer 22

Leaflet fibrosis and retraction occur with repair, leading to aortic regurg.

Question 23

The internal mammary artery (IMA) perfuses what part of the body?

Answer 23

The sternum and chest wall

Question 24

Benefits of off - pump CABG?

Answer 24

1) Lowered risk of bleeding
2) Lowered risk of anemia/need for transfusions
3) Lowered risk of AKI

Question 25

What is the treatment for unstable AF (AF with hypotension)

Answer 25

cardioversion

Question 26

Symptoms of papillary muscle rupture?

Answer 26

- Holosystolic murmur - hypotension - elevated wedge pressure - -enlarged V waves on the PA waveform - decreased CO

Question 27

What are the indications for IABP?

Answer 27

- Papillary muscle rupture - failure to wean from bypass - severe MR - VSD - Cardiogenic shock due to MI

Question 28

Contraindications for IABP

Answer 28

Aortic insufficency/regurg Aortic/Thoracic dissection bilateral carotid stenosis

Question 29

How much bleeding in the first hour is too much? Whta should you do?

Answer 29

Elevate the HOB | > 200 mL

Question 30

What is the mean airway pressure? Does it affect oxygenation or ventilation?

Answer 30

MAP -> average airway pressure of the total ventilator cycle time Increase the MAP and you increase the surface area of the lung available for oxygenation.

Question 31

Von Willebrands Disease affects the function of which blood component?

Answer 31

Platelets adhesion

Question 32

What is bivalirudin? When is it used?

Answer 32

Anticoagulant (Thrombin inhibitor) | Used mainly in PCIs

Question 33

hemmhoragic shock profile

Answer 33

``` Low CO Low CVP Low MAP Low PAOP Elevated SVR Elevated Lactate Low SvO2 ```

Question 34

20-40% of people develop this complication after CABG.

Answer 34

Atrial fibrillation

Question 35

This neurological complication can occur in >25% of thoracic abdominal aneurism repairs.

Answer 35

Spinal ischemia | Lumbar pressure should be kept <10 mmHg

Question 36

Systolic BP differences of > 25 mmHg between arms should make you very suspicious of WHAT?

Answer 36

Aortic dissection (or aortic injury)

Question 37

Normal fibrinogen

Answer 37

150-400

Question 38

What is the treatment for low fibrinogen?

Answer 38

Cryoprecipitate

Question 39

What is the treatment for bleeding due to high INR, PT and PTT?

Answer 39

Fresh frozen plasma

Question 40

Nitroprusside Vs Nitroglycerin

Answer 40

Nitroglycerin is primary a venous vasodilator. Nitroprusside works for arterial and venous.

Question 41

In a pneumonectomy, should chest tubes be placed to suction?

Answer 41

No

Question 42

What does Pulsus alternans indicate?

Answer 42

Left ventricular systolic CHF

Question 43

Elevated LDH indicates what?

Answer 43

Tissue damage

Question 44

What does pulses paradoxus indicate?

Answer 44

Hypovolemia or tamponade

Question 45

How to calculate P:F ratio?

Answer 45

P = PaO2 F = FiO2 P/F

Question 46

What is the max dose for aminocaproic acid?

Answer 46

30g/day

Question 47

Tidaling in the chest tube is normal or no?

Answer 47

Normal - water level fluctuates with breathing

Question 48

Who gets GI prophylaxis?

Answer 48

- mechanically ventilated>48h - h/o GIB < 1 year ago - coagulopathic - TBI - traumatic spinal cord injuries - burns - lots of steroids - ICU stay> 1 week - occult GIB > 6 days

Question 49

What should you do if there is bubbling in the water seal chamber?

Answer 49

Assess for air leak (pneumothorax) You may need to place the chest tube to suction.

Question 50

How does VQ Mismatch appear in co2 readings? What does it indicate? Why?

Answer 50

ETCO2 will be decreased PCO2 will be increased The difference between arterial and alveolar co2 indicates that the lungs are poorly perfused but well ventilated. (Dead space.) Sign of a PE.