Assessment Exam 1 Ekg, H2 Blocker, Fluids

Front 1

what is the mechanism of action of H2 antagonists

Back 1

blocks histamine binding to the H2 receptors thereby reducing gastic acid output and raising PH

Front 2

what is the reason for giving an H2 antagonists preop

Back 2

decrease gastic vol and ph and decrease risk of aspiration pneumonia

Front 3

when should an H2 antagonists be given

Back 3

at bedtime before surgery and then again at least 2 hours prior to surgery

Front 4

if a patient weighs more than 20kg how do you determine maintenance IVF

Back 4

pt weight plus 40

Front 5

How do you determine the maintenance fluid requirements for a patient weighing less than 20 kg

Back 5

for first 10kg=4ml/kg/hr
for next 10kg=2ml/kg/hr
and anything over is 1ml/kg/hr

Front 6

a hernia repair would have what type of fluid loss

Back 6

minimal replace with 0-2ml/kg/hr

Front 7

a cholecystectomy would have what type of fluid loss

Back 7

moderate replace with 2-4/ml/kg/hr

Front 8

a bowel resection would have what type of fluid loss?

Back 8

severe replace with 4-8ml/kg/hr

Front 9

how should you replace the deficit

Back 9

half in the first hour and then the second half over the next two hours

Front 10

what is the total body water of adults

Back 10

men 60% females 50%

Front 11

what are contraindications to TEE

Back 11

not NPO >4-6 hours, unstable C-spine, esophagitis, esophageal varices, Barrett's esophagus, hiatal hernia, difficulty swallowing, previous esophageal surgery, and radiation to the mediastinum

Front 12

what leads increase the sensitivity of ischemia 95%

Back 12

II and V5

Front 13

what is the best way to detect venous or arterial air?

Back 13

TEE

Front 14

what is important for prep for an TEE in the awake patient?

Back 14

need to numb the airway, can use lidocaine neb or gargle 5% viscous lidocaine and have the patient swallow it

Front 15

what are important things to remember in set up for an TEE

Back 15

need to numb airway, bite block, o2, suction and airway rescue equipment

Front 16

if a patient coming for a TEE is sick and has LV dysfunction what type of sedation would you want to give them?

Back 16

versed and fent, will not tolerate prop.

Front 17

it is important to remove what before TEE?

Back 17

dental work

Front 18

if you are getting an intra op TEE it is important to also have what monitor?

Back 18

3 lead EKG

Front 19

the short axis view of the TEE is also known as the ____ view and looks at what part of the heart

Back 19

doughnut view Left ventricle

Front 20

the long axis view looks at what parts of the heart

Back 20

l atrium, l ventricle, and l ventricular outflow tract

Front 21

the pulse oximetry is based upon an application of what law?

Back 21

Beers-lambert

Front 22

an increase in absorbance of red light transmitted through tissue during what cardiac cycle is related to arterial hemoglobin saturation

Back 22

systole

Front 23

what are factors that influence the accuracy of pulse oximetry?

Back 23

low blood flow, patient movement, ambient light, carboxyhemoglobin, methemoglbin, metylene blue, and shift of oxyhemoglobin dissociation curve

Front 24

what does methemoglobinemia do to pulse ox reading

Back 24

if SsO2 >85% = falsely low
if SaO2<85%= falsely high

Front 25

how would you replace blood loss with Crystoloid vs. colloid?

Back 25

crystal 3-1
colloid 1-1

Front 26

if a patient has carbon monoxide poisoning how will this effect there pulse ox?

Back 26

false high because COHb and HbO2 absorb light at identical speeds

Front 27

each hemoglobin molecule binds up to how many O2 molecules?

Back 27

4

Front 28

what two ways is O2 carried?

Back 28

dissolved in the blood and chemically bound to hemoglobin

Front 29

of the two ways the O2 is carried which is more clinically relevant?

Back 29

the O2 chemically bound to hemoglobin...1.34 ml/g of O2

Front 30

red light no pulse ox absorbs more ______

Back 30

deoxyhemoglobin (66nm)

Front 31

the infrared light absorbs more ______

Back 31

oxyhemoglobin (960nm)

Front 32

What things shift the HbO2 cure to the right?

Back 32

acidosis, increased temp, increased PaCO2, and increased 2,3 DPG

Front 33

if the HbO2 curve is shifted to the right what is happening to O2?

Back 33

Hbg is dumping it to the tissues allowing increased O2 delivery

Front 34

what factors shift the HbO2 curve to the left?

Back 34

alkalosis, decreased temp, decreased PCO2, decreased 2,3 DPG

Front 35

If the HbO2 curve is shifted to the left what is O2 doing?

Back 35

Hbg is holding on to it, so it has an increased affinity for O2, less is being delivered to the tissues

Front 36

when does a human see cyanosis?

Back 36

SaO2 85%
PaO2= 60

Front 37

what increases 2.3 DPG

Back 37

high altitude, chronic alkalosis and chronic hypoxia

Front 38

what decreases 2,3 DPG

Back 38

Stored bank blood chronic acidosis and cell age

Front 39

what may lead to venous pulsations that will call failure of the pulse ox

Back 39

pulse ox on too tight, RV failure or incomplete tourniquet

Front 40

if there is a change in your capnograph you should first assume what?

Back 40

problem with the patient, anomaly in the patients caridopulmonary system

Front 41

mass spectrometer uses what to determine the exhaled gas content?

Back 41

infrared light

Front 42

mass spectrometer uses what to determine the exhaled gas content?

Back 42

infrared light

Front 43

Mass spectometer is affected by ______ in teh exhaled gases?

Back 43

ethanol

Front 44

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 44

0...denitrogenation prior to induction

Front 45

mass spectrometer uses what to determine the exhaled gas content?

Back 45

infrared light

Front 46

Mass spectometer is affected by ______ in teh exhaled gases?

Back 46

ethanol

Front 47

Mass spectometer is affected by ______ in teh exhaled gases?

Back 47

ethanol

Front 48

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 48

PE...has air in it, thus nitrogen

Front 49

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 49

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 50

mass spectrometer uses what to determine the exhaled gas content?

Back 50

infrared light

Front 51

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 51

0...denitrogenation prior to induction

Front 52

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 52

PE...has air in it, thus nitrogen

Front 53

Mass spectometer is affected by ______ in teh exhaled gases?

Back 53

ethanol

Front 54

mass spectrometer uses what to determine the exhaled gas content?

Back 54

infrared light

Front 55

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 55

0...denitrogenation prior to induction

Front 56

mass spectrometer uses what to determine the exhaled gas content?

Back 56

infrared light

Front 57

mass spectrometer uses what to determine the exhaled gas content?

Back 57

infrared light

Front 58

mass spectrometer uses what to determine the exhaled gas content?

Back 58

infrared light

Front 59

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 59

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 60

Mass spectometer is affected by ______ in teh exhaled gases?

Back 60

ethanol

Front 61

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 61

PE...has air in it, thus nitrogen

Front 62

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 62

0...denitrogenation prior to induction

Front 63

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 63

0...denitrogenation prior to induction

Front 64

Mass spectometer is affected by ______ in teh exhaled gases?

Back 64

ethanol

Front 65

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 65

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 66

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 66

PE...has air in it, thus nitrogen

Front 67

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 67

PE...has air in it, thus nitrogen

Front 68

Mass spectometer is affected by ______ in teh exhaled gases?

Back 68

ethanol

Front 69

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 69

0...denitrogenation prior to induction

Front 70

Mass spectometer is affected by ______ in teh exhaled gases?

Back 70

ethanol

Front 71

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 71

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 72

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 72

0...denitrogenation prior to induction

Front 73

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 73

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 74

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 74

PE...has air in it, thus nitrogen

Front 75

when you are preoxygenating your patient what should you mass spect nitrogen reading be?

Back 75

0...denitrogenation prior to induction

Front 76

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 76

PE...has air in it, thus nitrogen

Front 77

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 77

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 78

if you are not using air as a gas and you suddenly see Nitrogen on your spectormetry what can you suspect?

Back 78

PE...has air in it, thus nitrogen

Front 79

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 79

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 80

if a patient has an increased metabolic rate what effect will this have on CO2 production

Back 80

increased (thyroid storm, MH will see increased CO2 on mass spec)

Front 81

How can you tell that you have increased dead space?

Back 81

PaCO2-EtCO2....if difference greater than 10...normal is 5

Front 82

If your PaCO2 is 60 but your EtCO2 is 40 what might have happened?

Back 82

R mainstem, your perfusing but not ventilating

Front 83

if your PaCO2 - ETCO2 is small what is happening?

Back 83

shunt, perfusion but no ventilation

Front 84

what is a major cause of a small difference bt your PaCO2 and your EtCO2...

Back 84

obstruction.

Front 85

what are causes of sudden changes in EtCo2

Back 85

endotracheal tube accident caridopulmonary resuscitation and venous air emblolism

Front 86

what are three big things that will cause a sudden fall is ETCO2

Back 86

decreased CO, hypovolemia MI arrythmias,
*Decrease in perfusion..PE
*Drastic change in tidal volume...increased dead space

Front 87

what are causes of decreased arterial O2 content

Back 87

low hemoglobin, low PaO2, and decreased fractional hemoglobin saturation

Front 88

where do 90% of PE's form?

Back 88

DVT of the iliofemoral vessels

Front 89

three factors that promote thrombi

Back 89

stasis fo blood, venous injury and hypercoagulation states

Front 90

what type of oxygenation numbers will a patient with a PE have

Back 90

increased PaCO2, decreased PaO2, and no end tidal on capnograph

Front 91

what is the anesthesia management of PE

Back 91

turn off N20, increase Fio2 to 100%, heparin, decrease volitile to prevent myocardial depression