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Surgical emergencies Flashcards

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1
Q

What is the definition of DIC?

A

inappropriate clotting followed by hemorrhaging, from massive amounts of tissue factor circulating systemically

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2
Q

What are the 2 causes of DIC?

A
  1. systemic response
  2. release of procoagulant into the blood stream
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3
Q

What are the 3 types of systemic responses that cause DIC?

A
  1. trauma - tons of tissue factor touching the vascular system
  2. sepsis
  3. obstetrics - amniotic fluid emboli
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4
Q

What is something that excretes procoagulant into the blood stream?

A

boney tumor

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5
Q

What are 4 complications of DIC?

A
  1. severe bleeding
  2. stroke
  3. reduced blood flow to organs
  4. overload of liver and kidneys
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6
Q

What are the 4 treatment options for DIC?

A
  1. correct the cause
  2. treat with FFP AND cryoprecipitates
  3. heparin sometimes used in the beginning
  4. volume/blood replacement
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7
Q

What are the 2 types of air embolisms?

A
  1. venous
  2. arterial
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8
Q

venous air embolisms can happen what?

A

passively, because the CVP can be lower than atmospheric pressure

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9
Q

Pressure in the right atrium is less than what?

A

atmospheric pressure

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10
Q

Whenever you get a cut or scrape, why does our body not take on air?

A

because our vascular system collapses where the cut is

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11
Q

Where is the only place in the body where the vasculature does not collapse?

A

the dura

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12
Q

What patients are most at risk for venous emboli? why

A

neuro procedures where the patient is sitting, because you are pulling air down venous sinuses as water table starts to drop

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13
Q

What does surgeon do during sitting procedures to prevent venous embolisms?

A

sews them, but if they miss one it can cause venous embolism

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14
Q

What are 2 other procedures where patients are at risk for venous air embolism? why?

A

hysteroscopies and TUR. If there is air in the tubing it can press air into the venous sinuses

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15
Q

What are 2 ways you can get an arterial air embolism?

A
  1. bypass
  2. dialysis
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16
Q

Can you receive an arterial air embolism passively?

A

no

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17
Q

What are 6 s/sx of air embolsim?

A
  1. rapid onset pulmonary edema - fluid in between the lungs and vasculature, because that space is usually one cell thick
  2. drop in ETCO2
  3. hypoxia
  4. hypotension
  5. arrhythmias
  6. neurologic damage
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18
Q

What is your first step in treating a venous air embolsim?

A

1st identify and occlude the sites of air entry

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19
Q

If you are working in the cranial region what are things you can do to treat venous air embolisms?

A

sloppy wet sponges, irrigation syringe

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20
Q

If you are working in bone, what is one thing you can do to treat venous air embolsim?

A

bone wax

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21
Q

What does nitrous oxide do to promote venous air embolisms?

A

it increases surface tension of air, making the fizzy little bubbles in venous sinuses one big bubble

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22
Q

What do you want to do with nitrous oxide when doing a procedure where venous air embolism is likely or one shows up?

A

discontinue it or don’t use it at all

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23
Q

where else do you see nitrous oxide not being used because it can actually make one big bubble in this area?

A

retina procedures

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24
Q

What kind of position do you put a patient in when they have a venous air embolism?

A

place patient in left lateral position (durant’s maneuver)

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25
What does left lateral position or durant's maneuver allow to you to do?
you can do an echo, throw down a right atrial line, and aspirate the air out
26
What part of anatomy does the left lateral position or durant's maneuver elevate?
right atrium becomes the high point in the body
27
What position do you put patients in for an arterial embolism? which makes most sense for what?
deep trendelenburg position, which makes most sense for dialysis not for bypass
28
How can we treat arterial air embolisms for bypass?
perfusionist can aspirate the air out, because deep trendelenburg is not really an option
29
What are medical reasons for compressions in cardiac arrest?
MI, arrhythmias, anaphylactic reactions, emboli, vagal stimulation, MH, anesthesia overdose, hypoxia, laryngospasm, aspiration, hypothermia, electrolyte imbalances
30
What is 1 surgical reason for doing compressions in cardiac arrest?
hypovolemic shock r/t blood loss
31
What is the RN's first job of cardiac arrest?
1st get help in your room
32
What is the RN's 2nd job of cardiac arrest?
get the defibrillator
33
What is the RN's 3rd job of cardiac arrest?
DOCUMENT
34
What 3 things are you going to document during cardiac arrest?
1. meds, time and dose 2. rhythms 3. time start and stop CPR
35
As the RN you should know what during a code?
who is running it
36
In cardiac emergencies what is your priority treatment?
OMI (oxygen, monitors, IV fluid)
37
If you have inadequate HR/BP in cardiac emergencies what 4 things are you going to do in order?
1. CPR 2. defibrillator 3. epinephrine for BP 4. amiodarone for HR and BP
38
If you have adequate HR/BP in cardiac emergencies what 5 things are you going to do in order?
1. epinephrine 2. amiodarone 3. dopamine 4. ICU monitored bed 5. cardioversion - slower intervention. After they have trialed a medication and it has failed then this is next resort
39
A premature ventricular contraction (PVC) is a what?
a relatively common event where the heartbeat is initiated by the ventricles rather than by the sino atrial node
40
Is there CO in PVC's?
no there is no real cardiac ouput because there is not enough time for ventricles to fill
41
Are PVCs a big deal?
no not unless you have a lot in a row, because they are going to lose their BP
42
What is ventricular tachycardia?
tachycardia with beats initiated in the ventricles
43
What is ventricular fibrillation?
uncoordinated contraction of the ventricles
44
How do we treat v tach and v fib?
1. CPR - FIRST THING YOU DO! IF CPR IS NOT OPEN, DO EARLY DEFIBRILLATION 2. early defibrillation 3. epinephrine 4. amiodarone
45
What is bigeminy?
PVC every other beat, the others are QRS
46
What is a couplet of bigeminy?
Pair of PVC's
47
What is trigeminy?
every third beat is PVC
48
How is bigeminy treated?
adequate HR, but not adequate BP so support BP and put them on a drip overnight. If they do not snap out of it with meds then cardioversion
49
What is a run of bigeminy?
Several PVCs in a row.
50
What is another way to describe a run of bigeminy?
unsustained v tach
51
What should you do if anesthesia is talking about couplets and runs?
definitely need to fix it whether it be a volume or electrolyte issue. WARNING SHOT!
52
What is a supraventricular tachycardia (SVT)?
tachycardia caused by an electrical impulse originating above the ventricles
53
Because SVT is not a ventricular arrhythmia, what medication is not going to work?
amiodarone
54
What are 3 things that can help break SVT?
vagal stim (like bearing down) adenosine, sync cardioversion
55
What are characteristics of adenosine?
it has a short half-life, metabolizes very quickly
56
How do you want to give adenosine?
slam it
57
What is the one freaky thing about adenosine?
it causes a long cardiac pause
58
We only treat what kind of bradycardia? which means?
symptomatic, which means they don't hold a BP
59
What are 3 things we want to do with treating bradycardia?
1. atropine 2. dopamine drip to maintain good HR and BP 3. pacer
60
If it is 3rd degree heart block, or complete heart block, what is the only thing that fixes that?
surgery to put a pacer in; no medication can be given to fix that long term
61
What 3 things are contraindicated in glaucoma patients?
1. atropine 2. robinol 3. succinylcholine
62
What are 5 H causes of pulseless electrical activity?
1. hypovolemia 2. hypoxia 3. hydrogen ions (acidosis) 4. hypoglycemia 5. hypothermia
63
What are the 6 T causes of pulseless electrical activity?
1. Toxins 2. Cardiac TAMPONADE 3. Tension pneumothorax 4. Thrombosis (MI/PE) 5. Tachycardia 6. Trauma
64
What is PEA?
a dead patient who's heart has not figured it out yet. The heart is not moving, but the electrical current is moving through the myocardium
65
How do we treat pulseless electrical activity?
1. CPR 2. Treat the underlying cause
66
What kind of diagnosis is PEA?
a medical diagnosis
67
How would a nurse document PEA?
whatever rhythm you see on the monitor followed by the words "NO PULSE"
68
What is normal pH?
7.35-7.45
69
What is normal pO2?
80-100
70
What is normal O2 sat?
> or equal to 98
71
What is normal PCO2?
35-45 (respiratory)
72
What is normal HCO3?
22-26 (metabolic)
73
What is normal base excess?
+2 to -2 (buffer to base ratio
74
What does the acronym ROME tell you?
respiratory = opposite metabolic = equal
75
Respiratory acidosis is caused by what?
decreased ventilation
76
What do we ultimately treat respiratory acidosis with?
ventilation, give reversal agents, oral airway
77
Respiratory alkalosis is caused by what?
hyperventilation
78
What do you treat respiratory alkalosis with what?
treat with sedation or decreased ventilation
79
Metabolic acidosis is ultimately caused by what?
excess production of metabolic acids
80
What 4 things would you see an excess production of metabolic acids?
1. cardiac arrest 2. sepsis 3. ketoacidosis 4. renal failure
81
Treat metabolic acidosis with what?
bicarb
82
What 4 things cause metabolic alkalosis?
1. acid loss 2. upper GI loss 3. diuretics (potassium loss = hydrogen ion loss) 4. over administration of alkali
83
Treat metabolic alkalosis with what?
treat the cause
84
ph is 7.30 pCO2 is 70 HCO3 is 30
respiratory acidosis
85
pH 7.48 pCO2 20 HCO3 15
respiratory alkalosis, with partial compensation
86
pH 7.25 pCO2 40 HCO3 12
uncompensated metabolic acidois
87
pH 7.50 pCO2 45 HCO3 35
uncompensated metabolic alkalosis
88
What is the definition of compensation in terms of pH, CO2, HCO3?
pH is WNL, CO2 is not WNL, and HCO3 is not WNL
89
What is the definition of partially compensated in terms of pH, CO2, HCO3?
pH is NOT WNL, CO2 is NOT WNL, and HCO3 is NOT WNL
90
What is the definition of uncompensated in terms of pH, CO2, HCO3?
pH is NOT WNL, CO2 and HCO3 - one is NOT WNL and the other one is WNL

ZANDER CNOR (15 decks)

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