Seminar SP 25 Final Review Flashcards
(215 cards)
1
Q
the presence of air in the pleural space, which can lead to partial or complete collapse of the lung
A
Pneumothorax
2
Q
a serious complication of blood transfusion characterized by acute pulmonary edema due to circulatory overload
Diagnostic criteria include new or worsening respiratory distress, evidence of fluid overload, and radiographic findings of pulmonary edema
A
TACO
3
Q
a complication of blood transfusion characterized by acute pulmonary edema due to circulatory overload, rather than an immune-mediated process
A
TACO
4
Q
a serious complication of blood transfusion characterized by acute onset of non-cardiogenic pulmonary edema, typically occurring within 6 hours of transfusion
A
TRALI
5
Q
chest radiograph characterized by bilateral patchy infiltrates without signs of heart failure
A
TRALI
6
Q
a genetic bleeding disorder caused by a deficiency in clotting factors, specifically factor VIII and IX
A
Hemophilia
7
Q
Factor 8 Deficiency
A
Hemophilia A
8
Q
Factor 9 Deficiency
A
Hemophilia B
9
Q
Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Overriding Aorta
Right Ventricular Hypertrophy
A
Tetralogy of Fallot
10
Q
Tetralogy of Fallot
A
Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Overriding Aorta
Right Ventricular Hypertrophy
11
Q
a palliative surgical technique used for patients with single-ventricle physiology, meaning only one ventricle is functional enough to support circulation
A
Fontan Procedure
12
Q
Pulmonary Autograph
A
Ross Procedure
13
Q
DOE, orthopnea, paroxysmal nocturnal dyspnea, cough, crackles/rales. fatigue
A
Left-Heart Failure
14
Q
Peripheral edema, JVD, hepatomegaly, ascites, fatigue
A
Right-Heart Failure
15
Q
Behavioral abnormalities, aphasia (if dominant cortex is involved), and contralateral lower limb weakness and sensory deficits
A
Anterior Cerebral Artery Sroke
16
Q
Hypochloremic, hypokalemic metabolic alkalosis
A
Pyloric Stenosis
17
Q
ETT Size= (Age/4) +4
A
Uncuffed ETT Sizing
18
Q
ETT Size= (Age/4) + 3.5
A
Cuffed ETT Sizing
19
Q
A rare autosomal dominant genetic mutation on chromosome 11 that affects the C1-inhibitor protein
Can also occur due to spontaneous genetic mutation in up to 25% of cases
This results in cutaneous and mucosal swelling
A
Hereditary Angioedema
20
Q
Treatment for HAE
A
C1 Esterase Inhibitor
Bradykinin B2 receptor antagonist
Kallikrein Inhibitor
21
Q
Anxiety,Stress
Viral infections
Minor local trauma
Surgery**
A
Triggers for Hereditary Angioedema
22
Q
Medications contraindicated in HAE
A
ACE Inhibitors
Estrogens
NSAIDs
23
Q
Multi-system: urticaria (hives), hypotension, wheezing, GI distress
Skin involvement often present (hives, flushing)
Bronchospasm, hypotension, shock
Tryptase test to confirm
A
Anaphylaxis
24
Q
Localized swelling (face, lips, airway, GI) without hives
Airway swelling, especially tongue/larynx
CV sx - Rare (except in airway obstruction)
A
HAE- Hereditary Angioedema
25
provides diastolic support and enhances coronary perfusion. Reduces afterload by inflating during diastole and deflating before systole
IABP
26
Reduces LV afterload
Enhances coronary perfusion
Supports weaning from ECMO
IABP
27
fully unloads the left ventricle, critically reducing the work of the heart.
Impella
28
Direct LV unloading
Improves both LV and systemic perfusion
Helps wean from ECMO
Impella
29
If PaO₂ < 60, SaO₂ < 90% →
hypoxemia and may require urgent attention
30
Above ___ ___, the curve flattens, so increases in PaO₂ yield small increases in SaO₂
70 mmHg
31
PaO2 40-> SaO2
70%
32
PaO2 50 -> SaO2
80%
33
PaO2 60 -> SaO2
90%
34
PaO2 70-> SaO2
93-95%
35
PaO2 80 -> SaO2
95-97%
36
PaO2 90 -> SaO2
97-98%
37
VA Ecmo
Veno-Arterial- Supports both Heart and lungs
38
VV Ecmo
Supports Lungs
Veno-Venous
39
Heparin dose for CPB
BW (kg) x 300 (U)
Wait 3 mins, draw ACT
40
Goal ACT for CPB
ACT > 480 seconds
41
What if ACT < 400 seconds after heparin dose in CPB?
Give additional Heparin
42
What if ACT < 400 seconds after second heparin dose?
Give antithrombin III (1000 U) or FFP (2-4 U)
43
Indications for a CVP Monitor + Central Line
CVP monitoring, administration of fluid to treat hypovolemia/shock, infusion of caustic drugs or TPN, gain venous access in vasculopaths
44
Normal CVP
Normal CVP: 0-6 mmHg (SV)
3-12 mmHg (MV, PEEP)
45
Site selection for central line placement
RIJ > subclavian > femoral
46
ACLS Rescue breathing rate
1 breath every 5-6 secs or 10-12 breaths per minute
47
Pulse check interval in ACLS
Every 2 mins
48
Compression rate, depth, ratio in ACLS
100-120 compressions per minute;
At least 5 cm;
30:2 in adults
49
A target EtCO2 of at least 10-20 mmHg during CPR indicates
adequate chest compressions and blood flow to the lungs
50
EtCO2 values below 10 mmHg in CPR are associated with
poor outcomes and indicate a need for improved CPR quality
51
ROSC in CPR
A sharp increase in EtCO2 during CPR, especially from teens to ~40 mmHg, is a strong indicator
52
ACLS Epinephrine dose
1 mg every 3-5 mins
53
Amiodarone IV/IO Dose in ACLS
First dose: 300 mg
Second dose: 150 mg
54
Lidocaine IV/IO Dose in ACLS
First dose: 1-1.5 mg/kg
Second dose: 0.5 – 0.75 mg/kg
55
Biphasic shock energy in ACLS
Biphasic -> 120-200 J
56
Monophasic shock energy in ACLS
Monophasic -> 360 J
57
the asynchronous delivery of a high-energy shock to get a patient out of either VT or VF
Defibrillation
58
cervical dilation & uterine contractions
1st stage of Labor
59
T10 – L1 nerve roots causing visceral pain
1st stage of Labor
60
uterine contractions & stretching of perineum as fetus descends into birth canal
2nd Stage of Labor
61
T10 – L1 nerve roots causing visceral pain AND S2-S4 nerve roots causing somatic pain
2nd Stage of Labor
62
What spinal level would neuraxial be considered during labor?
Neuraxial options: @ L3-L4
63
INCREASE uterine tone – useful for atony and post-partum hemorrhage
Uterotonics
64
Oxytocin dose
18-54 U/hr IV
65
Side effect of Oxytocin
Hypotension
66
Methergine dose
0.2 mg IM
67
Side effect of Methergine
HTN, coronary vasospasm, n/v
68
Carboprost (Hemabate) Dosing
0.25 mg IM q 15 min (up to 2 mg)
69
Side effects of Carbaprost/Hemabate
bronchospasm, increased PVR, diarrhea, n/v
70
Carbaprost/ Hemabate is contraindicated in what patient population?
Asthmatics
71
Methergine is contraindicated in what patient population
Pre-Eclampsia
Coronary Artery Disease
72
DECREASE uterine tone – useful for pre-term labor or emergent uterine relaxation
Tocolytics
73
What type of DLT is most commonly used at the U?
Left-Sided
74
measures how effectively gases (like oxygen) move from the lungs into the bloodstream
DLCO
75
measures how effectively gases (like oxygen) move from the lungs into the bloodstream
PPO DLCO
76
estimates how much lung function (specifically, how much air a person can forcibly exhale in one second) a patient will retain after lung surgery, such as a lobectomy or pneumonectomy
Predicted Postoperative Forced Expiratory Volume in 1 Second
PPO FEV1
77
one of the strongest independent predictors of poor postoperative outcomes in lung resection surgery, especially for pneumonectomy. Below this threshold, patients are at significantly increased risk for respiratory failure, prolonged ventilation, and death.
PPOFEV1 <40%
78
How to manage hypoxia during OLV
passive oxygenation
Fiberoptic tube to confirm positioning
CPAP to dependent lung
recruitment maneuver
increase PEEP
increase FiO2
ask to re-inflate the lung
79
Lung-Protective ventilation in OLV
Vt 5-6 mL/Kg IBW
PEEP 5-10 cm H2O
PIP should remain < 30 cmH2O
80
Anesthetic Management of Pneumonectomy-consideration
Fluid restriction is essential to minimize the risk of postpneumonectomy pulmonary edema, which can be catastrophic.
81
What type of rapid infuser requires the bag to be "burped"
Level 1
82
Capable to run at set rates from 2.5 to 750 ml/min
Belmont
83
Level I can be used for
pRBCS
FFPS
NS
84
Level I cannot be used for
Platelets
Dextrose solutions
Hypotonic Solutions
Medications
85
Why can you not mix Lacted ringers with blood products?
Calcium in LR chelates with the citrate in the blood products, causing clots
86
What changes do pRBCS undergo in storage?
Hyperkalemia d/t hemolysis
Decreased 2,3 DPG
87
Max shelf life for PRBC
42 Days
88
How much can one bag increase Hgb? Hct?
1 hgb
3 HCt
89
Universal Donor Blood Type (PRBCs)
O-
90
Universal donor type for FFP
AB+
91
How are Platelets stored?
Room Temp
92
Shelf life of Platelets
5-7 Days
93
Caution when using Platelets
Stored at room temp, high incidence of bacterial infection
94
Contains all plasma coagulation actors except for V and VIII
Platelets
95
1 bag of platelets =300ml and is composed of 6 units of whole blood-derived platelets Increases plt account by ___? on average.
30K
96
Factors VIII, XIII, Fibrinogen, vWF and fibronectin
Cryoprecipitate
97
Fibrinogen levels less than 80-100mg/dl
Give Cryo
98
How long does it take cryo to thaw?
30 mins
99
administration of 10 units or more, of greater than blood volume
Massive Transfusion protocol/ MTP
100
Blood volume of an average adult
~5-5.5L
101
Name at least 3 metabolic derangements that can occur from massive transfusion
Hypocalcemia
Hyperkalemia
Hypomagnesemia
Dilutional thrombocytopenia
102
Most common transfusion rxn
Febrile, nonhemolytic transfusion reactionW
103
What type of transfusion Rxn has a 50% mortality rate?
Acute Hemolytic Transfusion Rxn
104
How is an Acute hemolytic transfusion rxn diagnosed
Direct Coomb's test
105
FFP and Plt from multiparous women is the biggest risk factor
TRALI
106
now leading cause of mortality associated with transfusions.
TACO
107
What is the first structure that
participates in gas exchange?
The Respiratory Bronchioles
108
Which lung is more commonly involved in cases of foreign body aspiration or
unintentional mainstem intubation?
Right
109
The tracheobronchial tree consists of ___ generations of branching
23
110
the Respiratory Zone arises after ___ generations of branching
17
111
lines the chest wall
Parietal pleura
112
lines the lungs
Visceral pleura
113
When considering surgical intervention of the lungs, such as in a
pneumonectomy, patients may experience significant pain due to
stimulation of which layer(s) of the pleura?
Parietal
114
When considering surgical intervention of the lungs, such as in a
pneumonectomy, patients may experience significant pain due to
stimulation of which layer(s) of the pleura?
FVC
Forced Vital Capacity
115
Measurement of airflow limitation → Total exhaled volume in the first second
○ The most common causes of decreased FEV1 include airway obstruction from bronchospasm, airway inflammation, loss
of lung elastic recoil, and increased airway secretions.
FEV1- Forced Expiratory Volume in 1 second
116
Helps differentiate obstructive vs restrictive disease
FEV1/FVC Ratio
117
Normal FEV1/FVC Ratio
Normal = 0.75-85 (most often 0.70 is used as the standard for ‘normal’)
118
FEV1/FVC <0.70 = Suggestive of airflow limitation with a(n) ______
Obstructive Pattern
119
FEV1/FVC >0.70= Suggestive of ____
Restrictive Pattern
120
Performed if obstruction is suspected or if the baseline spirometry
was abnormal
Post-Bronchodilator Test
121
Loop shifts to the RIGHT
○ Volumes are LOWER than normal
○ Normal or slightly flattened shape
Restrictive
122
Loop shifts to the LEFT
○ Volumes are LARGER than normal
○ Scooped out or "steeple" appearance
Obstructive
123
(IRV + VT ) or (End VTto TLC)
Inspiratory Capacity
124
IRV + VT+ ERV)
Vital Capacity
125
ERV + RV)
Functional Residual Capacity (FRC)
126
(VT + IRV + ERV + RV)
TLC
Total lung Capacity
127
Volume remaining in the lung after maximum expiration
Residual Volume
128
Volume that can be expired below tidal volume
Expiratory Reserve volume
129
Volume inhaled or
exhaled during a normal breath
Tidal Volume
130
Volume that can be inspired above tidal volume
Inspiratory Reserve Volume
131
Exhale to FRC → Breathe from a spirometer containing 100% O₂ → The test ends when the exhaled [N] = 0
□ The collected volume of exhaled nitrogen is equal to 81% of the initial FRC
Nitrogen Washout
132
Exhale to FRC → Connect to a closed system containing known volumes & known [He] & [O₂] → Breath until [He] in the
spirometer & [He] in the lungs equilibrate (FiHe = FeHe) → Estimate lung volume
Helium Dilution
133
Absolute OLV indications
Isolation of lungs to avoid spillage/contamination
○Infection
○Massive hemorrhage
134
↓ FRC in the ventilated lung → Atelectasis + ↓ Oxygenation
Trendelenburg
135
↑ Ventilation + ↓ Preload → HoTN + Compromised perfusion
Reverse Trendelenburg
136
↓ Gravitational differentiation between lungs → Similar perfusion to
both lungs → Significant Shunt
Supine
137
Compression of the dependent lung by the mediastinum or
abdomen → Impaired ventilation
Lateral Decubitus
138
DLT Contraindications
Difficult airway
Distorted Anatomy
Full Stomach
Critically ill pts, already intubated, high PEEP
Hx of Lung tx.
Hx of pneumonectomy
139
Supine Hypotension Syndrome
Aortocaval compression
140
In Pregnancy, decrease MAC by
40%
141
Is pregnancy a hyper or hypo-coagulable state?
Hypercoagulable
142
Airway considerations for the parturient
Engorgement of airway mucosa
increased potential for Difficult intubation
Rapid o2 Desaturation
143
Presents after 20 weeks gestation
oBP > 140/90 AND proteinuria
oCan be with or without severe features (headaches, thrombocytopenia, elevated Cr or LFTs,
visual disturbances, RUQ pain, seizures)
oPatient be on magnesium to prevent eclamptic seizures
Pre-Eclampsia
144
What meds can be put in a spinal/epidural?
Local anesthetic – Bupivacaine (0.25 - 0.75%), lidocaine
(2%), 2-Chloroprocaine (3%)
oOpioid – fentanyl, morphine
oEpinephrine
oBicarbonate (epidural ONLY)
145
When blood loss > 1000 mL or blood loss accompanied by signs or symptoms of
hypovolemia within 24 hours of birth
Postpartum hemorrhage
146
4x4 blood loss
10
147
Raytec blood loss
10-20
148
Lap sponge blood loss
100
149
4 T's of postpartum hemorrhage
Tone-Uterine Atony
Trauma- Laceration, rupture, physical trauma
Tissue-Retained Products/Placenta
Thrombin- Coagulation factor deficiency
150
ETT Depth equation
Tube size * 3
Age + 11 cm
151
Adjust APL to 20 cmH2O and hold constant pressure, inflate cuff until leak disappears
Leak Test
152
Pediatric Sux dosing
1-2 mg/kg IV
4 mg/kg IM
153
Pediatric Atropine dosing
10-20 mcg/kg IV
20-30 mcg/kg IM
154
Pediatric Epi dosing
10 mcg/kg arrest dose
0.5-1mcg/kg vasopressor
155
Pediatric Midazolam dosing
0.25-0.5 mg/kg oral (Max: 20 mg)
0.05-0.10 mg/kg IV (Max: 0.25 mg/kg)
156
Pediatric Propofol dosing
2-3 mg/kg
157
Pediatric Ephedrine dosing
0.1-0.2 mg/kg
158
Pediatric Decadron dosing
0.10-0.15 mg/kg PONV
up to 0.5 mg/kg airway dose
159
Pediatric Ancef Dosing
30 mg/kg
50 mg/kg SBE prophylaxis
160
Why to avoid Sux in peds
Bradycardia
161
NPO guidelines Breast Milk
4 Hours
162
NPO guidelines for Formula
6 Hours
163
Metabolic derangement with pyloric stenosis
Hypopchloremic
hypokalemic
Metabolic alkalosis
164
First 0-10 kg = kg*4
next 10-20 kg = kg*2
Remaining 20-40 kg = kg*1
4-2-1 Rule for Maintenance
165
Primary hemostasis
platelet plug
166
Secondary hemostasis
Coagulation Cascade
167
Steps to primary hemostasis
Adhesion- exposure, collagen, vwf
Activation-plts txa2
Aggregation-GPIIb/IIIA
168
Factors that make up the intrinsic pathway
12, 11, 10, 9, 2, 1
169
Factors that make up the extrinisic pathway
7, 10, 2, 1C
170
Common pathway-coagulation
10, 2, 1
171
II, VII, IX, and X
Protein C and S
Vitamin K-Dependent Factors
172
PT/INR is associated with which pathway
Extrinsic
173
PTT is associated with which pathway
Intrinsic
174
Normal PTT
25-35s
175
Thrombin acts as negative feedback and activates
Plasminogen-> plasmin
176
Protein C and S prevent coagulation by inactivating which factors?
V and VIII
177
what happens to clots when you inhibit plasminogen to plasmin?
clots are not broken down -> TXA!!
178
The Liver produces all coagulation factors except
VIII
Vwf
179
why is PT prolonged first?
A: FVII has the shortest half life
180
what is the most common hereditary coagulation disorder?
Von Willebrand
181
Activated protein C resistance
HYPERcoagulable
Factor V Leiden
182
O2Sat – VO2/CO x Hb x 1.34
MvO2 Sat
183
Normal MVO2 Sat
70-75%
184
Retrograde flow in the aorta from femoral arterial cannula.
North-South Syndrome
185
Divert blood away from the patient’s heart and lungs to create a
bloodless, motionless field for surgical procedures, and return warm,
oxygenated (extracorporeal) blood to the patient’s systemic arterial
system
CPB
Cardiopulmonary Bypass
186
supply/demand issue → hypoperfusion and cellular stress
Ischemia
187
blood supply completely cut off → myocardial tissue is actively dying
Infarct
188
Peaked (hyperacute) T waves, ST elevation and/or depression, new Q waves, T
wave inversion, tombstone ST elevation
Acute MI
189
What three factors determine myocardial oxygen demand?
Heart rate, contractility, ventricular wall tension
190
What factors affect oxygen supply to myocardial tissue?
Heart rate (diastolic filling time), coronary perfusion pressure (diastolic pressure),
arterial oxygen content, coronary artery diameter
191
X= Aortic Diastolic Pressure - LVEDP
CPP
192
In a MAC Central line catheter, what is each port for?
Brown-Distal- Hotline, blood
White- Proximal- infusion Line
Middle-Swan-Ganz catheter goes thru middle
193
How will you know when you’ve placed the PAC in the right spot
Diastolic Step-up
194
When you hear the bone saw, what do we need to do as Anesthesia Providers (in Cardiac Surgery?)
Drop the lungs
195
placed in ascending aorta
proximal to cross clamp (antegrade) or
coronary sinus (retrograde)
Cardioplegia line
196
Heparin reversal dose for Protamine
1 mg of protamine per 100 U of heparin given
197
Complication of protamine administration
Systemic HoTN, anaphylaxis, anaphylactoid rxn, acute
pulmonary HTN
198
After 100% of the protamine is in, what should be done?
Draw an ABG and ACT 5 minutes after
199
Clot causes obstruction of blood flow in the brain
Ischemic Stroke
200
Ruptured vessel causes bleeding into the brain
Hemorrhagic stroke
201
Speech issues
Unilateral facial droop
Arm weakness
Symptoms of stroke
202
Ischemic Stroke intra-op BP Goal
SBP 140-160 mmhg
203
Hemorrhagic stroke intra-op BP Goal
BP under 150/90 mmhg
204
caused when PVR increases, thus worsening a
right-to-left shunt. This can cause cyanosis and hypoxemia, leading to
bradycardia or asystole.
TET Spells
205
Small LV, abnormal mitral valve, small aortic valve, small ascending aorta,
and possible ASD. Staged surgical repair in three steps (Norwood, Glenn, and
Fontan).
HLHS
206
an embryologic condition in which the ventricles of the
heart are switched during fetal development.
○ The left ventricle replaces the right ventricle, and the right
ventricle becomes the left ventricle.
○ The atrioventricular valves are also reversed
CCTGA
207
to a set of clinical interventions for the urgent treatment of cardiac arrest and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
ACLS
208
V-Fib
Asystole
V-Tach
PEA
Non-Perfusing Arrhythmias
209
V-Fib
V-Tach
Shockable Rhythms
210
Asystole
PEA
Non-Shockable Rhythms
211
Flat T waves, Prominent U waves, ST depression
Hypokalemia
212
Flat P waves, Peaked T waves, Wide QRS, Sine wave pattern
Hyperkalemia
213
Hypotension, JVD, Muffled Heart Sounds
Beck's Triad
214
Hypertension, Bradycardia, Abnormal breathing pattern
Cushing's Triad
215
Beck’s Triad (Hypotension, JVD, Muffled Heart Sounds), Chest Pain, SOB, Tachycardia, Pulsus Paradoxus (drop in BP on inspiration
Signs of Cardiac Tamponade
