Pathophysiology Of Deep Vein Thrombi & Pulmonary Emboli

Front 1

common location of postop DVTs? (2)*

Back 1

1.soleal sinuses
2.veins draining gastrocnemius muscles (calf muscles)

Front 2

common location of skeletal muscle trauma DVTs?

Back 2

proximal veins

Front 3

what's Virchow's triad?

Back 3

represents a triad of physiological effects that lead DVTs
1.vessel wall injury 2.hypercoagulability
3.venous stasis

Front 4

some causes of venous stasis. (2)*

Back 4

1.failure to dilute or clear activated clotting factors
2.stroke

Front 5

a cause of vessel wall injury. *

Back 5

drug induced irritation

Front 6

some causes of hypercoagulability. (3)*

Back 6

1.cancer
2.inflammatory bowel diseases (crohn's disease or ulcerative colitis)
3.unusual blood conditions (antiphospholipid syndrome, paroxysmal nocutral, hemoglobinuria)

Front 7

what is thrombophilia?

Back 7

tendency for recurrent DVT

Front 8

causes of thrombophilia (3)*

Back 8

1. increased antiphospholipid antibodies
2.congenital resistance - activated protein c
3.congenital deficiencies - antithrombin III, protein c, protein s, plasminogen

Front 9

some factors that increase the risk of DVTs postop. (3)*

Back 9

1.> 40 yo
2.operation > 1 hr
3.prostatectomy

Front 10

a s/s of DVT *

Back 10

scaling in affected leg

Front 11

what is postthrombotic syndrome?

Back 11

long-term complication of proximal vein thrombosis

Front 12

primary cause of postthrombotic syndrome.

Back 12

venous HTN's destruction of valves

Front 13

some s/s of postthrombotic syndrome (2)*

Back 13

1.stasis pigmentation
2.induration

Front 14

diagnosis of DVT. (2)*

Back 14

1.venography
2.plethysmography

Front 15

treatment of DVT (2)*

Back 15

anticoagulant meds
1.heparin = 1st line
2.coumadin

Front 16

INR goal for coumadin therapy?

Back 16

INR 2.0-3.0

Front 17

complications of unfractionated heparin (3)*

Back 17

1.major bleeding
2.immune-mediated thrombocytopenia (plates<100,000, more clots)
3.osteoporosis (tx >1 mnth during pregnancy)

Front 18

benefits of regional anesth for DVTs.

Back 18

50% decreased incidence of post-op DVT & PE during total hip or knee replacement.

Front 19

mechanism of action of local anesthetics in relation to clot formation? (2)*

Back 19

1.prevents platelet aggregation
2.ehance fibrinolysis

Front 20

some symptoms of PE during anesth (5)*

Back 20

1.bronchospasms
2.right axis deviation (ekg)
3.RBBB (ekg)
4.peaked T waves (ekg)
5.decreased PetCO2 but increased PaCO2

Front 21

some differential dx of PE (3)*

Back 21

1.anxiety
2.shingles
3.costochondritis

Front 22

some diagnostics for PE (3)*

Back 22

1.perfusion lung scanning (most useful)
2.d-dimer blood test
3.ekg to differential b/t MI

Front 23

some txs of PE (3)*

Back 23

1.inotropes for hypotension (isoproterenol, dopamine, dobutamine)
2.OETT w/ PEEP
3.pulmonary artery embolectomy w/ cardiopulmonary bypass

Front 24

whats the implication of the following for PE surgery?
a.NMBAs
b.N2O
c.Ketamine
d.PEEP

Back 24

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

Front 25

when do fat embolism typically occur?

Back 25

12-72 hrs after long bone fx

Front 26

fx of which bones has highest risk of fat embolism?

Back 26

long bones like femur or tibia

Front 27

what are some other non-fx causes of fat embolism? (4)

Back 27

1.acute pancreatitis
2.cardiopulmonary bypass
3.parenteral infusion of lipids
4.liposuction

Front 28

some s/s of fat embolism (3)*

Back 28

1.triad: arterial hypoxemia, mental confusion, petechiae
2.alveolar capillary leakage
3.temp 42 degrees

Front 29

what will MRI following fat embolism show?

Back 29

cerebral lesions

Front 30

treatment of fat embolism syndrome? (3)

Back 30

1.mngt of ARDS
2.immobilization of long-bone fx
3.corticosteriods (limits endothelial damage by free fatty acids)