Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
234 Cards in this Set
- Front
- Back
|
Life threatening bronchospasm that persists despite treatment
|
status asthmaticus
|
|
|
A disease characterized by chronic airway inflammations, reversible expiratory airflow obstruction, bronchiolar inflammation and hyperactivity in response to a stimuli
|
asthma
|
|
|
what are the clinical manifestations of asthma
|
wheezing, productive or non-productive cough, dyspnea, chest discomfort or tightness that may lead to air hunger, and eosinophilia
|
|
|
What are direct measures of the severity of expiratory airflow obstruction
|
Forced expiratory volume in 1 second (FEV1)/Forced vital capacity (FVC) ratio of less than 70% and Maximum mid-expiratory flow (MMEF) rate less than 70%
|
|
|
early uncomplicated acute asthma attack causes:
1. 2. 3. |
Hypoxia
HYPOcapnia respiratory alkalosis |
|
|
FEV1/FVC <70% this is indicative of what?
|
Obstructive pulmonary diesase
|
|
|
during preop assessment of a patient with Asthma you should note the eosinophil count. Above what number would you expect the patient to be symptomatic
|
50
(<50 asymptomatic) |
|
|
Stimuli inciting symptoms of Asthma
|
allergens, Pharmacologic agents( B-antagonist, nn steroidal anti inflammatory drugs, sulfiting agents) respiratory viruses, exercise, emotional stress (endorphins and vagal mediation)
|
|
|
what are the most common arterial blood gas findings in the presence of asthma
|
Hypocarbia and respiratory alkalosis
|
|
|
During an asthma attack the PaCo2 is likely to increase when the FEV1 is less than 25% of the predicted value, this is due to what?
|
Fatigue of the skeletal muscles necessary for breathing. This leads to the development of Hypercarbia and impending resp. failure.
|
|
|
Asthma induced tracheobronchial changes include...
|
Reduction in airway diameter, inflammatory thickening of the bronchial mucosa, and accumulation of tenacious secretions
|
|
|
Cardiovascular changes with asthma include....
|
strain on both the right and left heart, and abnormal EKG (40% of pts have ST segment changes) and potential development of pulsus paradoxus
|
|
|
Characteristics of asthma to be evaluated preoperatively
|
age of onset, triggering events, previous hospitalization for asthma attack, last attack, allergies, cough and sputum characteristics, current medications, labs (eosinophil count) wheezing or SOB, EKG, CXR
|
|
|
In order to avoid bronchoconstriction in response to mechanical stimulation during induction and maintenance of anesthesia in asthmatic patients it is necessary to ....
|
suppress airway reflexes
|
|
|
Regional anesthesia is an attractive option for asthma patents wen the operative site is suitable, however what is the concern with this approach?
|
High sensory levels of anesthesia leading to sympathetic blockade and consequent bronchospasm.
|
|
|
use of what anesthetic agent may make coughing, which can trigger a bronchospasm, less likely
|
sevoflurane and halothane
|
|
|
Pts with asthma should be allowed sufficient time for exhalation to prevent
|
air trapping
|
|
|
In oder to ensure the presence of less viscous airway secretions so that they are removed more easily what should be done during the perioperative period
|
maintain adequate hydration
|
|
|
List three interventions for an interopeartive bronchospasm
|
Increase volatile agent
give albuterol through metered does inhaler, and corticosteroids |
|
|
What are the s/s of a intraoperative bronchospasm
|
increase peak pressures, decreased tidal volumes, hypoxia, and change in end tidal waveform
|
|
|
what drug is used in the treatment of asthma to prevent bronchospasm, it is a mast cell stabilizer
|
cromolyn
|
|
|
this drug is used in the treatment of asthma by decreasing airway inflammation and reducing airway hyperrsponsiveness. It can be used for both acute and chronic exacerbations
|
corticosteriods
|
|
|
What is an exmaple of a B-adrenergic agonists that stimulates B2 receptors of the tracheobroncial tree
|
albuterol
|
|
|
these drugs used in the treatment of asthma decrease vagal tone by blocking muscarinic receptors in airway smooth muscle
|
anticholinergics
|
|
|
before giving anticholinesterase drugs you should give what
|
anticholinergic..provides protective bronchodilating effects
|
|
|
Volume of air remaining in the lungs after max expiration (1200mm capacity)
|
residual volume (RV)
|
|
|
Max volume that can be expired below (Vt)
(1100 mm capacity) |
Expiratory reserve volume (ERV)
|
|
|
volume of air inspired or expired with each normal breath
(500mm capacity) |
tidal volume (Vt)
|
|
|
max additional volume that can be inspired above Tv
(3500mm capacity) |
inspiratory reserve volume (IRV)
|
|
|
Your inspiratory capacity (IC) =
|
IC=IRV+Tv
|
|
|
Your vital Capacity(VC)=
|
VC=IRV+Tv+ERV
|
|
|
Functional Reserve Capacity(FRC)=
|
FRC=ERV+RV
|
|
|
Total Lung Capacity(TLC)=
|
TLC=FRC+IC
|
|
|
What provides air to the alveoli between breaths keeping them open.
|
residual volume (RV)
|
|
|
Vital Capacity is dependent on
|
body habitus, resp. muscle strength, and chest and lung compliance
|
|
|
what is the normal vital capacity
|
60-70 ml/kg
|
|
|
what is the most common cause of pulmonary disfunction
|
obstructive disease
|
|
|
all obstructive diseases have
|
increased resistance to airflow
|
|
|
a major complication of airway resistance is __________which leads to __________
|
V:Q mismatch and abnormal oxygen exchange which leads to arterial hypoxemia
|
|
|
a FEV1/FVC ration <70% is indicative of what?
|
obstructive disease
|
|
|
with obstructive disease you have an increased _____ and ____
|
TLC and RC See chart pt 169 stoeltings
|
|
|
This is a term often applied to emphysema, chronic bronchitis, or a combination of both of these.
|
COPD
|
|
|
COPD is mainly related to
|
smoking
|
|
|
presence of productive cough on most days of 3 consecutive months for at least 2 consecutive years
|
chronic bronchitis
|
|
|
Patients with chronic bronchitis show what on spirogram?
|
Increased Residual volume with a normal total lung capacity
|
|
|
draw spirogram: know what capacities and what they are composed of
|
TV, IRV, ERV, FRC, VC, IC, and TLC (draw)
|
|
|
is COPD reversible?
|
no
|
|
|
Chronic bronchitis
|
obstruction of small airways
|
|
|
emphysema
|
enlargement of air sacs, destruction of lung parenchyma, loss of elasticity, and closure of small airways
|
|
|
what are the hallmark characteristics of COPD
|
Chronic productive cough and progressive exercise limitation, pt is a long term smoker
|
|
|
Patients with predominant chronic bronchitis present with a chronic productive cough, whereas patients with predominant emphysema complain of
|
dyspnea
|
|
|
slowing of expiratory air flow and gas trapping behind prematurely closed airways are responsible for the increase in
|
residual volume, which allows for an enlarged airway diameter and increased elastic recoil for exhalation.
|
|
|
what has to be present on a CXR for the diagnosis of emphysema to be certain
|
bullae
|
|
|
what are typical features of an arterial blood gas of a patient with emphysema?
|
Pa02 usually >60 and normal PaCo2
|
|
|
what are the typical features of an arterial blood gas of a patient with chronic bronchitis
|
Pa02 usually less that 60 and PaCo2 greater than 45
|
|
|
Patients with emphysema "pink puffers" have what symptoms
|
thin, pursed lip breathing, anxious, 50-75 years old, severe dyspnea, potential bullae
|
|
|
What is the mechanism of airway obstruction of patients with pulmonary emphysema?
|
loss of elastic recoil
|
|
|
Patients with chronic bronchitis "Blue Bloaters" have what symptoms?
|
overweight and dusky, 40-55 years old, marked cyanosis, copious sputum with chronic productive cough, frequent upper resp. infections, RV failure (jugular venous distention, peripheral edema, hepatic congestion) cor pulmonale
|
|
|
What is the mechanism of airway obstruction of patients with chronic bronchitis
|
decreased airway lumen due to mucus and inflammation
|
|
|
Dominant feature of COPD is
|
progressive air flow obstruction
decreased FEV1 |
|
|
What are things to consider during preop assessment of COPD patient
|
determine the severity of the disease...ID tx to decrease inflammation....treat infections...increase small airway caliber
|
|
|
PaO2 is typically only mildly depressed in patients with emphysema due to what?
|
loss of pul. capillary vascular bed leading decreased diffusing capacity
|
|
|
Home O2 is recommended if
|
PaO2 is less than 55 and the hematocrit is more than 55
|
|
|
What is more effective in treatment of COPD? Supplemental o2 or drug therapy
|
supplemental O2 due to relief of arterial hypoxemia
|
|
|
COPD is often more effectively treated by _______drugs than _______
|
anticholinergic drugs than by B2-agonist
|
|
|
Use of diuretic therapy for patients with COPD may lead to
|
Hypochloremic metabolic alkalosis
|
|
|
What is Hypochloremic metabolic alkalosis a problem in patients with COPD
|
decrease ventilatory drive increasing CO2 retention
|
|
|
Within 12 hours of somocking cessation the plasma levels of ________ decrease from 6.5% to approximately 1%
|
carboxyhemoglobin
|
|
|
General anesthesia is used for cases involving patients with COPD having what types of surgery
|
upper abdominal or intrathoracic
|
|
|
Regional anesthetic techniques that produce sensory anesthesia above ___ are not recommended due to impaired ventilatory functions. (non-productive cough)
|
T6
|
|
|
If a patients has emphysema why would you be cautious when using N2O
|
potential for pulmonary bullae ruptures leading to tension pneumothorax
|
|
|
Why are opioid less useful in patients with COPD
|
may lead to prolonged ventilatory depression
|
|
|
What type of mechanical ventilation is useful for optimizing oxygenation in patient with COPD
|
Large tidal volumes, slow rates allowing time for exhalation to occur.
|
|
|
lung disease that is characterized by decreases in all lung volumes, decreased lung compliance and preservation of expiratory flow rates
|
Restrictive lung disease
|
|
|
three types of restrictive lung disease
|
acute intrinsic, chronic intrinsic, and extrinsic restrictive lung disease
|
|
|
acute intrinsic restrictive lung disease examples
|
pul. edema, ARDS, aspiration, opioid overdoes, high altitude, negative pressure pul. edema, CHF
|
|
|
Chronic intrinsic restrictive lung disease examples
|
sarcoidosis, drug induced pulmonary fibrosis
|
|
|
extrinsic restrictive lung disease examples
|
obesity, ascites, pregnancy, kyphoscoliosis, sternal deformities, flail chest, neuromuscular disorders, pleural effusion pheumothorax, mediastinal mass
|
|
|
What drug is given to patients with sarcoidosis the suppress the manifestation and to treat hypercalcemia
|
corticosteroids
|
|
|
What vent settings would be favorable for a patient with chronic intrinsic or extrinsic restrictive lung disease.
|
decreased tidal volume and an increased rate. (pressure control ventilation should be considered)
|
|
|
although the kidneys represent only 0.5% of total body weight, their blood flow is equivalent to about what % of cardiac output
|
20%
|
|
|
The ability to maintain real blood flow at a constant rate despite changes in perfusion pressure is known as
|
autoregulation (MAP 80-180)
|
|
|
Renal blood flow is influenced by what system?
|
SNS and renin release
|
|
|
what is the normal GFR
|
125ml/min
|
|
|
______is a proteolytic enzyme secreted by the juxtaglomerular apparatus of the kidneys in response to SNS stimulation, decreased renal perfusion pressure, and decreases in the delivery of Na+ to the distal convoluted renal tubules
|
renin
|
|
|
angiotensin II is an important stimulus for the release of _________ from the adrenal cortex
|
aldosterone
|
|
|
Prostaglandins are synthesized during periods of hypotension and renal ischemia and have what effect?
|
vasodilation
|
|
|
serum creatinine is directly related to _______ but indirectly related to _______
|
skeletal muscle mass
GFR |
|
|
normal BUN concentrations
a value more than____reflect a decreased GFR |
10-20mg/dl
50 |
|
|
which two renal function test evaluate renal tubular function
|
Urine osmolarity and urine specific gravity
|
|
|
what type of diuretics are generally administered for the treatment of essential hypertension and for mobilization of the edema fluid that is associated with renal, hepatic, or cardiac dysfunction.
|
thiazide diuretics (HCTZ)
|
|
|
Chronic administration of loop diuretics may result in
|
hypochloremic, hypokalemic metabolic alkalosis and deafness.
|
|
|
what type of osmotic increase fluid movement from intracellular spaces into extracellular spaces such that intravascular fluid volume ex[ads acutely.
|
osmotic (mannitol)
|
|
|
What is the predominant cause of death in patients with ESRD
|
cardiovascular disease
|
|
|
renal patients are chronically anemic because of decreased what?
|
erythropoiesis
|
|
|
is succinylchoine contraindicated in patients with ESRD
|
no, may need because lots of these pts are increased risk for aspiration
|
|
|
should morphine be used in renal patients?
|
no, because of long acting renally excreted metabolites (morphine 6 glucuronide)
|
|
|
Why are atracurium and cisatracurium particularly useful in patients with ESRD.
|
they are metabolized by spontaneous Hoffman degradation ...independent of liver or kidney function
|
|
|
sevoflurane has been shown in rats to produce compound A with fresh gas flows less than.....
|
2lpm
|
|
|
do you give a patients with renal disease LR or NS?
|
NS...LR has 4meq of K
|
|
|
what is a metabolite of atracurium and cisatricurium that may accumulate and lead to stimulation of CNS
|
laudanisine ( do not give to patients with seizure disorders)
|
|
|
Regardless of what type of NMB you choose to use for patients with ESRD it is important to....
|
reduce initial dose and monitor
|
|
|
characterized by the excretion of concentrated urine that contains minimal amounts of sodium
|
prerenal oliguria
|
|
|
prerenal acute renal failure is caused by
|
hypovolemia and decreased cardiac output
|
|
|
renal ischemia, nephrotoxins, and free hemoglobin, myoglogin are examples of what type of renal failure.
|
ATN or intrarenal renal failure
|
|
|
what type of block is useful for lacing the vascular shunts necessary for chronic hemodialysis
|
brachial plexus block
|
|
|
loop diuretics inhibit reabsorption of sodium and chloride where?
|
loop of henle
|
|
|
patients with ATN will excrete urine that contains excess amounts of _________. Also there serum ____ must be carefully monitored
|
sodium
k |
|
|
Mannitol causes redistribution from what compartments
|
intracellular to extracellular, decreasing brain size and lowering ICP
|
|
|
What is considered to be the best measure of renal function
|
Glomerular filtration rate
|
|
|
production of urea is increased by
|
high protein diets or GI bleeds
also dehydration and increased catabolism |
|
|
What ist he first selective DA1 receptor agonist
|
Fenoldopam
|
|
|
Causes both systemic and renal artery vasodilation and decreased renal oxygen demand and increased renal oxygen delivery
|
fenoldopam
|
|
|
Fenoldopam is useful for what surgical procedure
|
AAA repair with high renal artery clamp
|
|
|
what patient position is required for cystoscopy? Why could this be a potential problem?
|
lithotomy...decrease FRC
|
|
|
If a patient begins complaining of shoulder pain following a TURP what may you be concerned about
|
bladder perf
|
|
|
what is a major complication of the TURP or TURBT procedures....why does this happen?
|
TURP syndrome, due to the IV absorption of Irrigating fluids.
|
|
|
Factors that influence the amount of irrigation solution absorbed during a TURP:
The height of the irrigation bag above the prostatic sinuses ( limit ____) The resection time____ and the number of sinuses opened. |
40cm above prostate
one hour |
|
|
if intraop your patient begins to complain of headache restlessness, confusion, SOB, and has hypotension what may be the cause?
|
TURP syndrome
|
|
|
What is a metabolite of glycine
|
ammonia
|
|
|
TURP syndrome leads to
|
dilutional hypnatremia
symptoms when Na less than 120 |
|
|
early signs of hyponatremia
|
hypertension and reflex bradycardia
|
|
|
What type of anesthesia is perferred for management of TURP procedures.
|
spinal
|
|
|
If you perform a spinal for management of anesthesia for a TURP it must be at what level
|
T10
|
|
|
Whay must you limit IVF until the end of robotic prostatecomy surgery
|
because of facial and trachea edema
|
|
|
What type of positioning is required for robotic prostatecomy
|
EXTREME trendlenburg and arms tucked
|
|
|
CO2 pneumoperitoneum may result in pathologic derangements such as....
|
acidosis, hypercarbia (increase MV to blow off extra CO2) and increased intra abdominal pressure
|
|
|
what is the master endocrine gland
|
pituitary gland (hypophysis)
|
|
|
The pituitary secretes hormones that are essential to
|
growth and reproduction
|
|
|
overproduction of anterior pituitary hormones is most often reflected by hypersecretion of ACTH which leads to "______"
|
cushing's syndrome
|
|
|
this is due to excessive secretion of growth hormone in adults.
|
acromegaly
|
|
|
virtually all hormones are controlled by this mechanism
|
negative feedback mechanisms
|
|
|
acromegaly is a disorder of what gland
|
anterior pituitary
|
|
|
What assessment is very important for patients with anterior pituitary disorders
|
airway assessment
|
|
|
what type of preoperative history would suggest involvement of the larynx by acromegaly.
|
hoarseness or strider
|
|
|
posterior pituitary (neurohypohysis) hormones
|
vasopressin and oxytocin
|
|
|
Disease that reflects the absence of vasopressin owing to destryction of the posterior pituitary or failure of renal tubules to respond to ADH
|
diabetes insipidus
|
|
|
diabetes insipidus causes increased levels of what. What is the treatment for DI?
|
hypernatremia
ADH is the TX |
|
|
What is a common cause of SIADH
|
oat cell lung cancer
|
|
|
what is the treatment for SIADH
|
hypertonic saline , fluid restriction and lasix
|
|
|
This gland maintains metabolism, stimulates oxygen consumption, regulates lipid and carbohydrate metabolism and secretes calcitonin
|
Thyroid gland
|
|
|
normal quantities of thyroid hormones depend on exogenous _______.
|
iodine
|
|
|
which thyroid hormone is more active and may be the only active thyroid hormone in peripheral tissues
|
T3
|
|
|
What is the most common cause of Hyperthyroidism
|
Graves disease
|
|
|
Graves disease is a common cause of hyperthyroidism that cause enlargement of the thyroid and other symptoms such as....
|
exophthalmos, heat intolerance, and anxiety
|
|
|
does graves disease typically occur in males or females
|
females
|
|
|
In managing hyperthyroid patients for surgery, ________should definitely be established preoperatively
|
Euthyroidism
|
|
|
why is establishing adequate anesthetic depth extremely important in patients with Hyperthyroidism
|
to avoid exaggerated sympathetic nervous system responses
|
|
|
What drugs should be avoided in patients with hyperthyroidism
|
anything that stimulates SNS (ketamine, pancuronium, atropine, ephedrine, epi)
|
|
|
For induction on anesthesia for a patient with hyperthyroidism what may be the best drug.
|
thiopental
|
|
|
Hypoparathyroidism =
|
hypocalcemia
|
|
|
what is a life threatening exacerbation of hyperthyroidism
|
thyroid storm
|
|
|
life threatening exacerbation of hyperthyroidism
|
Thyroid storm
|
|
|
Patients that present postop (6-12 hrs) with extreme anxiety, fever, tachycardia, cardiovascular instability and altered consciousness may be suffering from what?
|
thyroid storm
|
|
|
what is the treatment of thyroid storm?
|
antithyroid meds, fluids, control temp, esmolol
|
|
|
what is the most common type of hypothyroidism is
|
hashimoto's thyroiditis
|
|
|
what is the treatment for hypothyroidism
|
levothroxine sodium
|
|
|
signs and symptoms of this disease include general decrease in metabolic activity, bradycardia, and increased SVR, and depressed response to hypoxia and hypercarbia
|
hypothyroidism
|
|
|
This glad promotes the movement of calcium across GI tract, renal tubules, and bone to maintain normal plasma calcium balance
|
parathyroid glands
|
|
|
how many parathyroid glands are there?
|
4
|
|
|
Is secretion of PTH directly or inversely related to plasma levels of ionized ca+.
|
inversely
|
|
|
IF your patients has hyerparathyroidism how would you decrease the serum calcium levels.
|
hydrate with NS and diuresis with lasix
(chronic hypercclcemia can lead to renal failure) |
|
|
if an operation for hyperparathyroidism where do they relocated the 4th gland after the other three have been removed?
|
upper arm
|
|
|
why do you want to avoid hypoventilation in a patient with hyperparathyroidism?
|
because hypoventilation leads to acidosis, which then increases Ca+ levels
|
|
|
the clinical manifestations related to hypoparathyroidism are related to.....
|
hypocalcemia
|
|
|
early signs and symptoms of primary hyperparathyroidism and associated hypercalcemia include
|
sedation and vomiting
|
|
|
a positive _________ sign consists of facial muscle twitching produced by manual tapping over the wear f the facial nerve at the angle of the mandible
|
chvosteks
|
|
|
A positive ________ sign is carpopedal spasm produced by 3 minutes of limb ischemia produced by a tourniquet
|
trousseau's
|
|
|
Skeletal muscle cramps, fatigue and a prolonged QT interval on the elecrocardiogram are associated with what
|
hypocalcemia
|
|
|
The bodies adjustments to the upright posture and repsonses to stress, as produced by hemorrhage, sepsis, anesthesia, and surgery, are dependent on normal function of the___________
|
adrenal glands
|
|
|
THe adrenal cortex is responsible for the synthesis of three groups of hormones classified as
|
glucocorticoids, mineralocorticoids, and androgens
|
|
|
what mineralcorticoid plays a role in extracellular regulation of potassium and sodium
|
aldosterone
|
|
|
what is the main glucocotricoid that is essential for life
|
cortisol
|
|
|
what stimulates the adrenal cortex to produce cortisol?
|
ACTH
|
|
|
The adrenal medulla is a specialized part of the sympathetic nervous system that is capable of synthesizing what? what is the only important disease process associated with the adrenal medulla
|
epi, norepi and dopamine
Pheochromocytoma |
|
|
aldosterone release is stimulated by
|
hyperkalemia, angiotensin II, hyponatremia, ACTH
|
|
|
aldosterone causes the reabsorption of what? and the secretion of what? what is the net effect?
|
Na, K
increased bp and blood volume |
|
|
hypersecretion of aldosterone can be related to what type of tumor
|
conns
|
|
|
spontaneous hypokalemia in patients with systemic hypertension is highly suggestive of what?
|
hyperaldosteronism (conn's syndrome)
|
|
|
what type of diuretic is given to a patient with primary aldosteronism?
|
spironolactone (K sparing)
|
|
|
sudden onset of weight, usually central and often accompanied by thickening of the facial fat (moon Face) HTN, glucose intolerance, decreased libido are common symptoms of what disease.
|
cushing's syndrome (glucocorticoid excess)
|
|
|
destruction of the adrenal gland leads to what disease
|
addison's
|
|
|
patients with this disease have hyperpigmentation over palmar surfaces and pressure points.
|
Addison's disease (adrenalcorticoid deficiency)
|
|
|
any patient who has received steroids by any route for a period of more than two weeks any time within the pervious 12 months should
|
receive steroid replacement preop.
|
|
|
what is the treatment for addisonian crisis
|
rapid administration of D5NS,
hydrocortisone 200-300mg IV Hydrocortisone q6h X 24h |
|
|
catecholamin secreting tumor
|
pheochromocytoma
|
|
|
in pheochromocytoma it is important to get what drugs for HR and BP control.
|
alpha adrenergic blockade THEN beta blockade (giving B blocker first can further increase BP and HR
|
|
|
a syndrome of carbohydrate metabolism with inappropriate hypergycemia secondary to impaired synthesis, secretion, utilization of insulin
|
diabetes mellitus
|
|
|
Absolute deficiency of insulin, exogenous insulin necessary to avoid hypergylcemia, and usually juvenile in onset.
|
type 1 diabetes
|
|
|
results from impaired insulin secretion or insulin resistance
|
type 2 diabetes
|
|
|
diabetes type II can be drug induced by what drugs
|
corticosteroids
|
|
|
DKA is more common in what type of diabetics? What are most common clinical findings?
|
type 1....dehydration, kussmauls respirations, "fruity" breath of acetone, metabolic acidosis
|
|
|
Increasing HR does what to O2 demand?
|
increases
|
|
|
what heart disesase shows an increased T wave in all leads
|
pericarditis
|
|
|
changes in lead II, III and aVF show ischemia in what area of the myocardium. what coronary A. is responsible?
|
RCA, inferior wall (RA, SA Node, AV node, RV)
|
|
|
changes in leads V3-V5 show involvement of what areas of the myocardium. What coronary A. is responsible?
|
LAD, anterolateral aspects of LV
|
|
|
Changes in leads I and aVL show involvement in what area of the myocardium, what coronary A is responsible?
|
cirumflex, lateral aspects of LV
|
|
|
CPP=
|
diastolic pressure- LVEDP
|
|
|
will decreases in BP increase of decrease CPP (coronary perfusion pressure)
|
decrease
|
|
|
Will and increase in HR or LVEDP increase or decrease CPP (coronary perfusion pressure)
|
decreases
|
|
|
What has the most effect on O2 demand?
|
HR
|
|
|
What occurs when coronary blood flow is inadequate and dose not meet the needs of the myocardium?
|
ischemia
|
|
|
your patient has a BP of 90/45 HR of 99 and PCWP of 12, what is there CPP
|
45-12=33
|
|
|
What surgical procedures place the cardiac patient at highest risk?
|
major abdominal surgery, thoracic, emergency surgery
|
|
|
At what level should you maintain the heart rate and blood pressure of awake values
|
20%
|
|
|
It is very important to do what on induction of the cardiac patient
|
blunt sympathetic response
|
|
|
What volatiles may lead to coronary artery steal?
|
isoflurane
|
|
|
which volatiles is a more potent coronary arteriole vasodilator?
|
Isoflurane is more potent than desflurane or sevoflurane
|
|
|
When desflurane is used to treat HTN, the patient may also experience what other side effects?
|
increased BP and HR
|
|
|
What is a major coronary contraindication for spinal anesthesia?
|
aortic stenosis
|
|
|
What neuromuscular blocking drug maybe elicit and increased HR and BP
|
Pavulon
|
|
|
How long should you wait before providing anesthesia to a patient that has had an MI
|
6 months
|
|
|
if your patient has a drug eluting stent how long should you delay elective surgery that requires cessation of plavix
|
12 months
|
|
|
if your patient has a bare metal stent how long should you delay surgery that requires cessation of plavix
|
4-6 weeks
|
|
|
if your patient had a balloon angioplasty how long should you delay surgery that requires cessation of plavix
|
2-4 weeks
|
|
|
ST changes are seen best in what lead
|
V5
|
|
|
arrthymias best seen in what lead
|
V2
|
|
|
This disease of the heart is characterized by mechanical obstruction of the left heart
|
mitral stenosis
|
|
|
the cause of stenoic mitral valve is almost always from what?
|
rheumatic carditis
|
|
|
With mitral stenosis what part of the heart dilates
|
left atrium...leads to pulmonary HTN
|
|
|
IF a patient has mitral stenosis what are important anesthetic considerations in reguards to HR
|
keep it slow to allow fo diastolic filling, if AFib occurs, control rate
|
|
|
This heart disease is characterized by left artial volume overload and decreased left ventricular forward stroke volume due to passage of part of each stroke volume back through the incompetent valve
|
mitral regurgitation
|
|
|
What are important anesthetic considerations in regards to HR for patients with mitral regurgitation
|
mainatin or increase HR because bradycardia worsens regurgitant flow...avoid sudden decreases in HR
|
|
|
This is a heart disease characterized by increased left ventricular sytolic pressures to maintain the forward stroke volume through a narrowed aortic valve
|
aortic stenosis
|
|
|
What valve area is considered critical in AS (aortic stenosis)
|
0.5-0.7cm2
|
|
|
Patients with aortic stenosis should maitain a HR of.... what part of there CO is fixed?
|
70-80
severe bradycardia is associated with decreased CO becuase SV IS FIXED |
|
|
failure of teh aortic valve to close tightly causes back flow of blood into where?
|
left ventricle (aortic regurgitation)
|
|
|
Pts with diastolic murmur, widened PP, decreased diastolic pressure and bounding peripheral pulses are showing signs of what heart disease
|
chronic aortic reguritation (back flow of blood)
|
|
|
What is the best HR for patients with aortic reguritation
|
80-100
(fast, full, forward) |
|
|
What is the goal of anesthesia in patients with idiopathic subaortic stenosis
|
decrease pressure gradient across the left ventricular outflow obstruction
|
|
|
what patients receive SBE prophalysis
|
if the patient is hgih or moderate risk AND is having a procedure with increased risk
|
|
|
What do the three letters of the pacemaker stand for?
|
1st-chamber paced
2nd-chamber sensed 3rd-mode of response |
|
|
A condition where blood or fluid accumulates in the pericardium, stroke voulme is fixed, and CO becomes dependent on the rate
|
cardiac tamponade
|
|
|
If a patient has cardiac tamponade it is very important to control what?
|
HR, if too low decreases CO because SV is fixed
|
