Test 3 Flashcards by Brandon Edmondson

Bezold jarish reflex triad

HotN, bradycardia, coronary artery dilation

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when is bezold jarish most often seen?

awake pt with interscalene block

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tourniquet pain starts after?

30min, or 45-60min for GA

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what fiber types involved in tourniquet pain?

c fibers and a delta

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Tourniquet placment pressues and max time

LE:
max 2 hours, 100-150 above SBP

UE: Max 90min, 50-75 above SBP

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Bleeding ammount in trachanteric/subtrochanteric hip fx?

1200ml

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bleeding ammount in intracapsular hip fx?

800ml

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Off NSAIDs for how long before spinal?

no delay

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off coumadin for how long before spinal?

INR 1.4 after 5 days

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off plavix for how long before spinal?

7 days

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off Ticlid for how long before spinal?

14 days

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Off xarelto/rivaroxaban for how long before spinal?

3 days

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When is surigical correcton done for scoliosis? ANd what is the goal?

when cobb angle is greater than 50%
stop cardiac and resp compromise

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S/s of VAE

unexplain HoTN, and increased ET nitrogen

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VAE tx

wound irrigated with saleine, DC N20, pressors, aspiration of air from CVP, lay pt right side up

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Tell me about BAEP

brainstem auditory evoked potentials
used in resections of acoustic neuromas
uses sound waves to stimulate cochlea

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SSEP key info

somatosensory evoked potentials
stimulate peripheral nerves, impulse goes up spinal cord via dorsal root.

monitors the afferent sensory pathway

the failure of SSEPs to reliably predict post-op deficits is well documented

you can have motor deficits with unchagned SSEPs

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blood supply for afferent sensory pathway?

post spinal arteries

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EMG info

Electromyogram
used to record electrical activity of muscles, used to find the cause of weakness, paralysis, or muscle twitching

doesn’t show brain or spinal cord disease

During spinal surgery for stenosis/degneration: used to protect nerve roots; extremely sensitive to nerve root irritation

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MEP

stimulate spinal cord above operative site and recording resonse below operative site

monitors descending motor pathways supplied by anterior spinal artery

monitors motor tracts, especially corticospinal tract

MEPs are the gold standard for monitoring motor pathways

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Anesthetic plan for SSEP

avoid N2o
avoid VA >1 MAC

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anesthetic plan for EMG

limit NMB to 2-4 twitches
With NIMs tube, no NMB past intubation

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anesthetic plan for MEPs

TIVA or balanced technique with VA < 0.6 mac

propofol 75-150mcg.kg/min

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Drugs that affect SSEPs

VA senstive > 1 MAC
N20 sensitive decease amplitiude

opiods mild depression no change in amplitude or latency

midazolam: mild depression: ^ latency and decrased amplitude

ketamine desierable

Propofol amplitude depression with induction but rapid recovery

NMBs: insenstive, may improve responses due to less EMG interference

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Drugs that effect Transcranial MEPs

VA >0.6 MAC N20 sensitive midazolam less desirable, CMAP depression muscle relaxants, senstive and usually avoided

define amplitue and latency

amplitude: height latency length

change in evoked potentials means what?

worsening situation; critical decrease in amplitude or increase in latency indicates early warning of structures in danger.

acute increase of only ___ to ___ ml of fluid can cause tamponade?

40-50ml

What is kussmauls sign?

JVD in inspiration

how often is pulsus pradoxus present?

75% in actue tamponade and only 30% in chronic pericardial effuseion

what do both kussmauls and pulsus pradoxus represent?

ventricular discordance or apposing resonses of the RV and LV to filling during the resp cycle

what is becks triad? How often is it seen?

distended neck veins, HotN, muffled heart tones only seen in 1/3 of actue tamponade patients

Pressure volume loop in tamponade?

short and shifted to the left

three word acronym for mgnmt of tamponade?

Fast Tight Full Goals: tachycardia, vasoconstriction, and volume

What treatments can reverse remodeling in HF?

ACE-I Beta blockers cardiac reschyronization Dont drink alcohol

restrictive cardiomyopathy affects filling or systole?

filling. Systolic fxn usually normal

most common type of cardiomyopathy?

dilated cardiomyopathy

SVT and vertricular dysrhythmias common in which cardiomyopathy?

dilated

When is EF > 80%?

HOCM

pathcy scaring is seen when?

HOCM

when do you see speckled ventricle?

restrictive cardiomyopathy

How does lying down affect symptoms of HOCM?

releives them

how does valsava affect symptoms of HOCM?

aggravates them

SNS stimulation redisributes blood from where to where?

from kidneys, splanchnic and skeletal circulation to vital organs

mild tachycardia can be helpful in which type of HF?

systolic

How does ANP protect CV system? What is the caveat?

by decreasing RAAS and SNS over time response to ANP is blunted

are ANP and BNP antiinflammatory?

yes

Why are opiods benficial in anesthetic mgmt of HF?

they temper teh SNS

what is gold standard/1st lean tx for pericarditis?

NSAIDS1

cholchicine in pericarditis is associated with what?

less relapse

why don't we like to use steroids in pericarditis?

frequently cause relapse once discontinued, so only use if other therapies don't work.

resistance pericarditis may respond to what?

Imuran / azathiprine

tell me about dresslers syndrome

delayed form of pericarditis that occurs week sto months after myocardial event, it is often auto-immune

3 thigns that can move oxyhgb dissasociate curve to the right

sickle cell, materanl hbg, renal failure

3 things that can move oxyhgb diss curve to the left?

fetal hbg, carboxyhgb, methgb

heart O2 extraction ratio

55-70%

brain o2 extraction ratio

30-35%

how to calculate O2 transport?

Hct/viscosity

how long can platlets be stored at room temp?

5 days

do platletse need to be ABO compattible?

No, but preffered

can platlets be warmed?

what size filter for platlets vs RBCs?

170micron for platlets and 20-40 for blood

effective coagulationc an occur with clotting factors as low as?

20-30% of normal

the four factors found in cryo?

fibrinogen vWF F 8 F13

waht is used for uremeic bleeding not responsive to DDVAP?

cryo

how fast does TRALI occur?

within 6hrs of transufsion

2 causes of acutue hemolytic reactions?

presence of antibodies from prior exposure transfusion of white cells or white cell antibodies

main cause of sepsis from bacterial contamination with tranfusions?

platlets >> RBC > FFP & Cryo

1 unit of regular insulin lowers BG by how much?

25-30mg/dl

what rate for D5 infusion?

1.5ml/kg/hr

how much does 1ml of D50 raise BG?

by 2mg/dl