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30 Cards in this Set

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common location of postop DVTs? (2)*
1.soleal sinuses
2.veins draining gastrocnemius muscles (calf muscles)
common location of skeletal muscle trauma DVTs?
proximal veins
what's Virchow's triad?
represents a triad of physiological effects that lead DVTs
1.vessel wall injury 2.hypercoagulability
3.venous stasis
some causes of venous stasis. (2)*
1.failure to dilute or clear activated clotting factors
2.stroke
a cause of vessel wall injury. *
drug induced irritation
some causes of hypercoagulability. (3)*
1.cancer
2.inflammatory bowel diseases (crohn's disease or ulcerative colitis)
3.unusual blood conditions (antiphospholipid syndrome, paroxysmal nocutral, hemoglobinuria)
what is thrombophilia?
tendency for recurrent DVT
causes of thrombophilia (3)*
1. increased antiphospholipid antibodies
2.congenital resistance - activated protein c
3.congenital deficiencies - antithrombin III, protein c, protein s, plasminogen
some factors that increase the risk of DVTs postop. (3)*
1.> 40 yo
2.operation > 1 hr
3.prostatectomy
a s/s of DVT *
scaling in affected leg
what is postthrombotic syndrome?
long-term complication of proximal vein thrombosis
primary cause of postthrombotic syndrome.
venous HTN's destruction of valves
some s/s of postthrombotic syndrome (2)*
1.stasis pigmentation
2.induration
diagnosis of DVT. (2)*
1.venography
2.plethysmography
treatment of DVT (2)*
anticoagulant meds
1.heparin = 1st line
2.coumadin
INR goal for coumadin therapy?
INR 2.0-3.0
complications of unfractionated heparin (3)*
1.major bleeding
2.immune-mediated thrombocytopenia (plates<100,000, more clots)
3.osteoporosis (tx >1 mnth during pregnancy)
benefits of regional anesth for DVTs.
50% decreased incidence of post-op DVT & PE during total hip or knee replacement.
mechanism of action of local anesthetics in relation to clot formation? (2)*
1.prevents platelet aggregation
2.ehance fibrinolysis
some symptoms of PE during anesth (5)*
1.bronchospasms
2.right axis deviation (ekg)
3.RBBB (ekg)
4.peaked T waves (ekg)
5.decreased PetCO2 but increased PaCO2
some differential dx of PE (3)*
1.anxiety
2.shingles
3.costochondritis
some diagnostics for PE (3)*
1.perfusion lung scanning (most useful)
2.d-dimer blood test
3.ekg to differential b/t MI
some txs of PE (3)*
1.inotropes for hypotension (isoproterenol, dopamine, dobutamine)
2.OETT w/ PEEP
3.pulmonary artery embolectomy w/ cardiopulmonary bypass
whats the implication of the following for PE surgery?
a.NMBAs
b.N2O
c.Ketamine
d.PEEP
a.NMBAs = prevent drug induced histamine release

b.N2O = don't use b/c need high O2 concentrations; possible increased PVR

c.Ketamine = possible adverse effects on PVR

d.PEEP = during surgical removal of emboli
when do fat embolism typically occur?
12-72 hrs after long bone fx
fx of which bones has highest risk of fat embolism?
long bones like femur or tibia
what are some other non-fx causes of fat embolism? (4)
1.acute pancreatitis
2.cardiopulmonary bypass
3.parenteral infusion of lipids
4.liposuction
some s/s of fat embolism (3)*
1.triad: arterial hypoxemia, mental confusion, petechiae
2.alveolar capillary leakage
3.temp 42 degrees
what will MRI following fat embolism show?
cerebral lesions
treatment of fat embolism syndrome? (3)
1.mngt of ARDS
2.immobilization of long-bone fx
3.corticosteriods (limits endothelial damage by free fatty acids)