Systems Review Flashcards
(181 cards)
1
Q
How much blood does the heart pump out every minute?
A
About 5 quarts (4.7L)
2
Q
3 functions of the heart:
A
- Pump blood through the lungs removes CO2 and refreshes blood with oxygen
- Oxygenated blood is pumped to the body to provide oxygen and nutrients and to remove waste products
- Coronary arteries are blood vessels that supply blood and oxygen to the heart
3
Q
Is heart a single or double pump?
A
Double
4
Q
Narrowing of coronary arteries that prevent adequate blood supply to the heart. Caused by atherosclerosis, it may progress to the point where heart muscle is damaged due to lack of blood supply and oxygen (infarction, arrhythmias, heart failure)
A
Coronary artery disease
5
Q
Males or females have higher cause of death from CVD?
A
Females
6
Q
3 complications of atherosclerosis:
A
- Narrowing of arterial lumen
- Plaque fissure
- Thrombus formation
7
Q
Causes of CAD? (5)
A
High blood cholesterol High BP Smoking Obesity Lack of PA
8
Q
How many cardiac arrest in the OR occur per year?
A
> 17,000
9
Q
S/S of CAD
A
None
Chest pain
Heart attack
Shortness of breath
10
Q
5 minor clinical predictors
A
- advanced age
- abnormal DCG
- rhythm other than sinus
- history of CVA
- uncontrolled HTN
11
Q
5 intermediate clinical predictors
A
- remote MI (>1month)
- stable angina
- compensated CHF
- creatinine 2
- diabetes
12
Q
5 high clinical predictors
A
- acute or recent MI (<1month)
- unstable or severe angina
- large ischemic burden (+stress test)
- decompensated CHF
- significant arrhythmias
13
Q
What does STEMI stand for?
A
ST elevation myocardial ischemia
14
Q
What is STEMI?
A
Abrupt occlusion/decrease in coronary perfusion
- inflammatory process
- mortality rate 15-20%
15
Q
3 period MI mechanisms
A
- Unstable plaque
- Catecholamines
- BP swings
16
Q
Low surgery risk: (4) <1%
A
Endoscopic
Breast
Skin
Cataracts
17
Q
Intermediate surgery risk: (4) 1-5%
A
Intraperitoneal/intrathoracic
Orthopedic
Head and neck
Carotid endarterectomy
18
Q
High surgery risk: (3) >5%
A
Emergent
Aortic
Peripheral vascular
19
Q
Treatments for CAD: (4)
A
Lifestyle changes
Medications
Angioplasty
Surgery
20
Q
How to beta blockers work?
A
Reduce myocardial oxygen consumption by decreasing HR, contractility, and BP
21
Q
How does Ca+ channel blockers work?
A
Dilate arteries-decrease SVR which decreases workload and O2 consumption
Decrease HR and myocardial contractility
22
Q
Antiplatelets
A
Prevent platelet aggregation on atheroma or thrombus
23
Q
How do you monitor heparin?
A
Partial thromboplastin time (PTT)
24
Q
What do statins do?
A
Lower cholesterol; decrease LDL
25
What do ACE inhibitors do?
Treat HTN, and lower risk of recurrent MI
26
Oxygen therapy through nasal cannula
2L/min
27
Balloon is inflated, compressing the plaque against the artery wall and then balloon catheter is deflated and removed
Angioplasty
28
Blood vessel removed from leg, arm, chest to create new blood flow path in heart
Bypass surgery
29
Average SV
60-100ml
30
Average CO
3-9liters/min
31
Vasodynamic parameter
- relates CO to body surface area (BSA)
- heart performance to the size of individual
Cardiac index (CI)
32
Normal CI
2.1-4.9 L/min/m2
33
Right atrial, central venous pressure
3-12
34
Right ventricular pressure systolic and diastolic
15-30
| 3-8
35
Pulmonary artery pressure systolic and diastolic
15-30
| 4-12
36
Pulmonary vein/capillary wedge pressure
2-15
37
Left ventricular pressure systolic and diastolic
100-140
| 3-12
38
Pressure of blood in thoracic vena cava, near the right atrium
-reflects amount of blood returning to the heart and ability of heart to pump the blood into the arterial system
Central venous pressure (CVP)
39
What is good estimation for CVP
Right atrial pressure, which is major determinant of R ventricular end diastolic volume
40
Factors that decrease CVP:
Hypovolemia
Deep inhalation
Distributive shock
41
```
Hypervolemia
Forced exhale
Tension pneumothorax
Heart failure
Pleural effusion
Decrease CO
Cardiac tamponade
Mechanical ventilation and PEEP
```
Factors that Increase CVP
42
3 things to avoid in valvular insufficiency:
Cardiac depression
Hypoxemia, hypercarbia, and acidosis bc they increase SVR
Over sedation preop
43
What is the most common type of heart defect?
Ventricular septal defect (VSD)
44
Septum between the two ventricles does not fully develop, leaving a hole
-blood flows from L to R ventricle and into lungs
Ventricular septal defect (VSD)
45
Slow, shallow breathing
| CO2 buildup in blood (acidosis)
Hypoventilation
46
Rapid, deep breathing
| CO2 blown off (alkalosis)
Hyperventilation
47
Primary muscles of respiration
Diaphragm
External intercostal muscles
Accessory muscles
48
Amount of air remaining in lungs at end of normal exhale
Function residual capacity (FRC)
49
Measures lung function, specifically the amount and/or speed of air that can be inhaled and exhaled
Spirometry
50
4 most common measured in spirometry?
1. Forced vital capacity
2. Forced expiratory volume at timed intervals (FEV1)
3. Forced expiratory flow
4. Maximal voluntary ventilation
51
Volume of air that can forcibly be blown out after full inspiration (L)
FVC
52
Volume of air that can forcibly be blown out in 1sec, after full inspiration
FEV1
53
Flow of air coming out of lung during the middle portion of forced expiration
Forced expiratory flow (FEF)
54
Mild severity of COPD
>80 FEV1
55
Moderate severity of COPD
50-79 FEV1
56
Severe severity of COPD
30-49 FEV1
57
Very severe severity COPD
<30 FEV1
58
Renal auto-regulate at what MAPs
50-150mmHg
59
Is urine output auto regulated?
No but is linearly related to MAP >50mmHg
60
What are renal protective drugs?
Dopamine
| Fenoldopam
61
How does dopamine help renal?
Increase renal blood flow
62
How does fenoldopam help renal?
AntiHTN, arterial/arteriolar vasodilation
63
What 2 are most problematic antimicrobials?
Aminoglycosides
| Amphotericin B
64
What are the 3 nephrotoxins?
Antimicrobials
Contrast
NSAIDs
65
What drugs are affected by kidney function (6)
Propofol
Morphine and hydromorphone
Midazolam
Vecuronium and rocuronium
66
Which of the drugs that affect kidney function, is though tot have the least amount of renal excretion?
Vecuronium
67
2 surgical consideration with renal?
Increased intra-abdominal pressure during laparoscopy
| Aortic cross clamping
68
Most common cause of death in pts with end stage renal failure?
Cardiovascular disease
69
Percent of blood flow through portal vein?
70%
70
Percent of blood flow through hepatic artery?
30%
71
Percent of blood flow of CO?
25%
72
Does liver maintain auto regulation of blood flow with cirrhosis and exposure to volatile anesthetics?
NO
73
What vit K factors are produce by liver?
10,9,7,2 (1972)
74
Portupulmonary HTN can increase risk of RHF if become....
Acidotic
Hypoxic
Hypercapnic
75
How much can hepatic blood flow decrease from volatiles and regional without stimulation?
20-30%
76
What drugs can cause spasm of sphincter of oddi?
Narcotics (fentanyl, morphine, meperidine, nalbuphine)
77
How to treat spasm of sphincter of oddi?
Naloxone or glucagon (1-3mg)
78
```
Reglan
Neostigmine
Sux
Metoprolol
Alpha adrenergic stimulants
Antacids
```
Increase lower esophageal sphincter tones
79
```
Atropine
Glycopyrrolate
Dopamine
Beta adrenergic stimulants
Opioids
Propofol
```
Decrease lower esophageal sphincter tone
80
Propranolol
Atracurium
Nitrous oxide
Not change lower esophageal sphincter tone
81
Protrusion of portion of stomach through hiatus of diaphragm and then into the thoracic cavity?
Hiatal hernia
82
Rigid structure with fixed volume of brain, blood, CSF
80%
12%
8%
83
Normal ICP
<15mmHg
84
Management of neuro pts relies on what manipulation?
Intracranial volume and pressure
85
How much adult brain weighs
1400kg
| 2% of TBW
86
High oxygen consumption of brain
3. 3ml/100g/min
| - 20% of total body consumption
87
Cerebral blood flow
50ml/100g/min
| -15% of CO
88
Auto regulation of CBP
50-150 (60-160)
89
Cerebral vasodilation is max
Vessels collapse
CBF falls passively with falls in MAP
Lower limit of cerebral auto regulation
90
Vasoconstriction is max
Elevated intraluminal pressure
-force vessels to dilate
-increase CBF but damage BBB
Upper limit to cerebral auto regulation
91
3 consequences to increase ICP
Cerebral ischemia due to reduction of cerebral perfusion pressure
Brain shifts
Brain herniation
92
What are most pts at high risk for with neurosurgery
Electrolyte abnormalities
93
6 ways to lower ICP
```
Elevate head
Hyperventilate (PaCO2 25-30)
Drain CSF
Osmotic diuretics
Steroids
Barbiturates, propofol
```
94
How much decrease in CBF for every 1mmHG decrease in PaCO2 levels?
2% decrease
95
Hyperventilation effects on CBF diminish over how long?
6-24 hrs
96
Hyperventilation to what PaCO2 has shown to induce cerebral ischemia?
20mmHg
97
4 monitors for neurosurgery
Arterial catheter
Second IV
Urinary catheterization
Central line
98
5 best agents for neurosurgery
```
Propofol
Desflurane
Sevoflurane
Fentanyl
Remifentanil
```
99
All IV drugs except what decrease CBF and CMRO2?
Ketamine
100
Narcotics reduce MAC by up to what?
50%
101
What two things are coupled with neurosurgery?
Cerebral blood flow and cerebral metabolic rate
102
CBF with volatile agents
Halothane>des>iso>sevo
103
What does volatile agents do to CMRO2?
Decrease
104
What is the only exception that actually leads to increase CBF and increase CMRO2?
Nitrous oxide
105
What does IV anesthetics do to CBF?
Decrease
106
What does IV anesthetics do to CMRO2?
Decrease
107
What does ketamine do to CBF and CMRO2?
Increase both
108
What does benzodiazepines do to CBF?
Minimal change unless over sedation, then hypercarbia
109
What does benzodiazepines do to CMRO2?
Decrease
110
What does opioids do to CBF?
No affect until rapid infusion and decrease MAP which increase ICP
111
What does opioids do to CMRO2?
Minimal effect
112
What does non depolarizing NMBDs cause to CBF and CMRO2?
```
No effect
(Other agents do decrease CBF tho)
```
113
What does Sux do to CBF and CMRO2?
Increase both
114
What should you consider doing right after induction?
Hyperventilate
115
Typical presentation/diagnosis of intracranial tumors:
40-60yrs
Increasing ICP
Seizure disorder
Diagnosed by CT or MRI
116
what kind of emergence is needed for neuro assessment with intracranial tumors?
Rapid emergence
117
Most common hypertonic solution used to provide relaxed brain by cerebral dehydration and decreasing ICP?
Mannitol
118
How fast should mannitol be given?
Slowly over 10min
119
What other drug should be considered if pt has cardiac disease and not tolerate volume load?
Furosemide
120
What 2 complications has caused sitting position to be life threatening?
Venous air embolism and severe hypotension
121
What can acute flexion of neck cause with neurosurgery?
Airway obstruction and obstruction to cerebral venous outflow (brain swell)
122
Problem with elevation of head above heart with neurosurgery?
Risk of venous air embolism from open veins
123
How can nociceptive stimulation during 3pin hold application be prevented?
Fentanyl or infiltration of scalp with LA
124
Where are ruptured aneurysm most common in adults?
Subarachnoid hemorrhage
125
6 anesthetic goals for intracranial aneurysms:
1. Avoid HTN
2. Decrease ICP
3. Maintain CPP >70mmHg
4. Prevent cerebral ischemia
5. No movement, brain relaxed
6. Maintain euvolemia
126
What can N2O cause with intracranial aneurysm emergence?
Tension pneumocephalus
127
3 things to do to prevent intraop hemorrhage on emergence:
1. Do not reverse paralytics until head dressing is on
2. Give 1.5 mg/kg IV lidocaine 90sec before suction/extubation
3. Consider prophylactic labetalol
128
What kind of tube for ENT?
RAE tube
129
What paralytic is used for ENT?
Sux
130
What kind of LA is good to minimize blood loss?
Cocaine or LA with Epi
131
Why crucial to monitor chest wall motion during ENT?
Avoid air trapping and barotrauma
132
Should you ever completely remove the ETT during a tracheotomy?
NO
133
What 3 steps to do if airway fire occurs:
1. Disconnect circuit
2. Remove ETT
3. If fire continues, flood field with saline
134
Should yo avoid NMBDs for ear surgery?
Yes
135
What kind of extubation for ear surgery?
Deep
136
Mixing methyl methacrylate powder with a liquid methyl methacrylate monomer, which leads to exothermic polymerization rnx
Bone cement
137
What could force marrow, fat, and cement into circulation that produces pulmonary emboli?
Increasing intracellular pressure (500mmHg) from introduction of hot acrylic cement under pressure
138
What are the most dangerous for bone cement?
Femoral prosthetics
139
Hemodynamic effects of medullary fat embolism, rather than toxic effects of cement itself
Bone cement implantation syndrome
140
Pneumatic tourniquet should be inflated to how much?
100mmHg over highest anticipated systolic pressure
141
Temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of 6-8wks before full recovery
Postop neuropraxias
142
What does cuff deflation of pneumatic tourniquet immediately lower?
CVP and MAP
143
Which cases have the highest risk to venous thromboembolism?
Total hips, knees and lower extremely trauma (50%)
144
5 other risk factors for venous thromboembolism
```
Immobility (>4dys)
Age (>60)
Use of tourniquet
Duration of procedure
Type of anesthesia
```
145
3 potential life threatening complications with total hip:
Hemorrhage
Venous thromboembolism
Bone cement implantation syndrome
146
Which anesthesia lowers the risk of VTE?
Regional anesthesia
147
What kind of ETT should be used with cervical spine surgery?
Armored ETT
148
When is there increase risk of aspiration with pregnancy?
After 8-12wks
149
4 physiologic changes with pregnancy:
1. Increased risk of aspiration
2. Increased circulation blood volume but diluted
3. Increased CO
4. Decrease SVR
150
What two drugs cross placental barrier?
Versed and narcotics
151
What has traditionally been the vasopressors of choice in pregnant women?
Ephedrine
152
What is now the suggest vasopressor to use in pregnant women?
Phenylephrine
153
Neonate age
<30dys
154
Infant age
1-12months
155
Child age
1-12yrs
156
5 differences of peds airways
1. Tongue is larger
2. More anterior and cephalad larynx
3. Long, floppy epiglottis
4. Short trachea and neck
5. Narrowest part at cricoid cartilage
157
6 different respiratory system factors for peds
1. LOWER FRC
2. Lower closing volume
3. Less compliant lungs (Sm.alveoli)
4. Greater chest wall compliance
5. O2 requirement 2x
6. CO2 production 2x
158
What is the main determinant of CO up to age 2?
Heart rate
159
Normal function of renal?
6months
160
Adult function of renal
2 years
161
Main difference of GI for peds?
Increase GERD
162
When does hepatic become fully matured?
42wks
163
Normal hematocrit full term
55%
164
Normal hematocrit 3months
30%
165
Normal hematocrit 6months
35%
166
NPO of breast milk
4hrs
167
NPO of formula, non human milk
6hrs
168
IV line access for peds
Saphenous
| Love vein
169
Normal induction for peds
70/30 N2O/O2 then sevo 8%
170
Rapid induction for peds
Prime with 8% sevo and 100% O2
171
Steal induction with peds
N2O/O2 under blanket
172
Neonate RR, HR, BP
40
140
65/40
173
12months RR, HR, BP
30
120
95/60
174
3yrs RR, HR, BP
25
100
100/70
175
12yrs RR, HR, BP
20
80
110/60
176
4 physiologic changes for elders
1. Basal organ function unchanged
2. Decreased functional reserve
3. Decreased ability to compensate
4. HEARING LOSS
177
How much does CO decrease with elders?
1% /year after 30
178
Renal function maintained for elders:
>.5ml/kg/hr
179
Basal metabolic rate decreases by how much with elders?
1% /yr after 30
180
Does post-op shivering increase with age?
Yes
181
What diuretic to use with renal transplant?
Mannitol
