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Exam 2- Principles 2015
Numbers, numbers, numbers
116
Nursing
Graduate
03/16/2015

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Cards

Term
The brain consumes what percentage of total body oxygen
Definition
20%
Term
How much of the O2 consumed by the brain is used to make ATP
Definition
60%
Term
CMRO2 is greater in white or grey matter?
Definition
Gray matter
Term
Average cerebral metabolic rate for oxygen
Definition
3-4 ml/100gm/min
Term
If you lose O2 to the brain, how long will it take to go unconscious
Definition
10-20 seconds
Term
If you lose O2 to the brain, how long will it take to have irreversible damage
Definition
3-8 minutes
Term
Average CBF
Definition
750 ml/min (15% of total CO) or
50 ml/100g/min
Term
CBF of <25ml/100g/min causes what?
Definition
cerebral impairment and EEG slowing
Term
CBF of <10ml/100g/min causes what?
Definition
irreversible damage and isoelectric EEG (flat line)
Term
What is the most important extrinsic factor on CBF
Definition
CO2 gas tension
Term
PaCO2 is _____ proportional to SVR
Definition
inversely
Term
CBF is _______ proportional to PaCO2
Definition
directly
Term
CBF changes ______ for every 1 mmHG change in PaCO2 (between PaCO2 20-80 mmHg), how long does this effect last?
Definition
1-2ml/100g/min, lasts 6-8 hours
Term
PaO2 effects CBF when it reaches what level?
Definition
<50mmHg, then CBF increases
Term
CBF is _____ proportional to temperature
Definition
directly (it follows a change in CMRO2 in the same direction)
Term
CBF changes _____ for every ___ change in temperature
Definition
5-7%, 1 degree celsius
Term
Autoregulation occurs independently when MAP is what?
Definition
50-150 mmHg
Term
Normal CPP
Definition
80-100 mmHg
Term
CPP must be what (minimun)?
Definition
> 60-70 mmHg
Term
CPP calculation
Definition
CPP= MAP- ICP or
CPP= MAP- CVP (if CP > ICP)
Term
MAP calculation
Definition
SBP + 2 (DBP) / 3
Term
Temp calculation
Definition
C x 1.8 + 32= F
Term
% of cranial vault that contains brain, blood, CSF respectively
Definition
80, 12, 8
Term
Normal ICP
Definition
5-15 mmHg
Term
Focal ischemia (localized) occurs at what ICP
Definition
25-55 mmHg
Term
Global ischemia occurs at what ICP
Definition
>55 mmHg
Term
Cushing's Triad
Definition
Irregular Respirations
MAP increased (HTN)
Bradycardia
(I'M Bad)
Term
A patient has n/v and altered LOC, what is their ICP
Definition
>20 mmHg
Term
Normal CSF production
Definition
21 ml/hr (500ml/day)
Term
Total CSF volume (at any given time)
Definition
150 ml
Term
Dural sinus pressure in flat position
Definition
6 cm H2O
Term
Dural sinus pressure in sitting 25 degrees
Definition
0
Term
Dural sinus pressure in sitting 60 degrees
Definition
-6
Term
Dural sinus pressure in sitting 90 deg.
Definition
-13
Term
Dural sinus pressure in sitting 20 deg.
Definition
3
Term
Dural sinus pressure in prone
Definition
6
Term
Hyperventilation includes what range of PaCO2?
Definition
25-30 mmHg
Term
Inverse Steal (robinhood effect)
Definition
Occurs with Hypocarbia, normal vessels contrict, shunting blood to ischemic areas and potentially causing ischemia in normal tissue
Term
Intracerebral Steal
Definition
Hypercarbia causes non-ischemic vessels to dilate and pull blood away from ischemic areas.
Term
mannitol dose
Definition
0.25-1.0 grams/kg
Term
Goal serum osmolality with mannitol treatment
Definition
>320 mOsm/L
Term
Lasix
Definition
0.5-1 mg/kg, with mannitol 0.15-0.3 mg/kg
Term
Halothane reduces CBF by how much?
Definition
200% and reduces autoregulation the most
Term
Isoflurane is best, why?
Definition
increases CBF the least, and reduces CMRO2 the most, also reduces CSF
Term
Don't use nitrous because...
Definition
increases CBF and ICP, incresases intracranial air, VAE and pneumothorax size
Term
Ketamine increases CBF by how much?
Definition
50-60% and blocks CSF absorption
Term
Avoid opioids because they do what?
Definition
Hypoventilation= increased CO2= cerebral vasodilation= increased CBF= increased ICP
Term
Alfenta activates what?
Definition
Seizure foci
Term
Demerol metabolite promotes what?
Definition
Seizure activity
Term
Dilantin dose for seizures
Definition
15mg/kg over 20 minutes, must mix with 0.9 NS
Term
Midazolam dose for seizures
Definition
1-5 mg IV
Term
Pentothal dose for seizures
Definition
25-100 mg IV
Term
Diazapam dose for seizures
Definition
2-20 mg IV
Term
most effective therapy for atherosclerosis
Definition
cessation of smoking
Term
What percentage of CVAs are preceded by TIAs?
Definition
50%
Term
Is a patient more at risk for an MI or stroke post CAE?
Definition
MI
Term
What is the single most important cause of morbidity and mortality in vascular surgery?
Definition
Myocardial dysfunction
Term
What is the major goal of anesthesia for vascular surgery?
Definition
To preserve myocardial function
Term
What are the major goals for vascular surgery?
Definition
Restore normal perfusion to prevent stroke, improve functional status, or prevent death
Term
What are the five other causes of morbidity and mortality in vascular surgery (aside from myocardial dysfunction)?
Definition
Pulmonary infections, renal insufficieny/failure, hepatic failure, CVAs, spinal cord ischemia
Term
What stump pressure reflects neurological hypoperfusion and is a criterion for shunt placement?
Definition
40-50 mmHg
Term
If there is a pulse felt on the distal end of the clamped carotid artery, then what is the stump pressure?
Definition
60 torr, no shunt needed
Term
Goal SBP after CAE
Definition
145 mmHg or less
Term
What is the most important predictor of subsequent aneurysm rupture and mortality?
Definition
Size of the aneurysm
Term
Aneurysms ____ have a 20% incidence of rupture within 6 years
Definition
>5cm
Term
Mortality after aneurysm rupture
Definition
85%
Term
Traditional repair of AAA is associated with what percentage of mortality?
Definition
50%
Term
What are the only definitive methods to prevent spinal cord ischemia with an aortic cross clamp?
Definition
-fast surgery and maintenance of normal cardiac function
Term
Suprarenal clamping decreases renal blood flow by how much?
Definition
>80%
Term
Infrarenal clamping is associated with what percentage of renal failure?
Definition
3%
Term
What are the most important determinants of post op renal function?
Definition
maintaining intravascular volume and normal myocardial function
Term
Cross clamp time should be limited to...
Definition
<30-45 minutes
Term
SBP goal for AV fistula
Definition
>140 mmHg
Term
Exertional Dyspnea
Definition
FEV-1 <1500ml
Term
Chronic Bronchitis
Definition
Recurrent productive cough for 3 months for 2 consecutive years
Term
Examination findings of pulmonary hypretension include
Definition
1) Split 2nd heart sound
2) RV hypertrophy
3) RA hypertrophy
Term
What things will worsen pulmonary hypertension?
Definition
Hypoxemia, acidosis, sepsis, and peep
Term
ECG features of RV/RA strain
Definition
Low voltage QRS, Poor R wave progression (precordial leads), enlarged or biphasic P wave in lead II is diagnostic of RA hypertrophy
Term
Three goals of PFTs
Definition
-ID risk of morbidity and mortality
-who will need vent postop
-who will benefit from bronchodilators
Term
Vital Capacity of ____% or ____L idicates increased postoperative risk
Definition
<50%, <2L
Term
Spirometry cannot measure
Definition
FRC, RV, TLC
Term
Normal FEV1
Definition
2.4 L
Term
FVC normal
Definition
3L
Term
FEV1/FVC in obstructive disease
Definition
<0.8, FEV-1 decreased
Term
FEV1/FVC in restrictive disease
Definition
> or = to 0.8, both are reduced
Term
Severe risk is FEV! < _____L and FEV1/FVC <
Definition
2L, 0.5
Term
Cyclic AMP action in lungs
Definition
bronchodilation
Term
Cyclic GMP action in lungs
Definition
bronchoconstriction
Term
Beta 2 specific drugs (albuterol) do what
Definition
Stimulate beta receptors and increase cyclic AMP
Term
PDE inhibitors
Definition
prevent breakdown of cyclic AMP, aminophylline, also improve diaphragm contractility
Term
Cromolyn sodium
Definition
Stabilizes mast cells, inhibits degranulization and histmaine release
Term
Atropine/ipratropium (parasympatholytics)
Definition
block formation of cyclic GMP
Term
High risk FVC____
Definition
<50%
Term
high risk FEV1 ____
Definition
<2L
Term
high risk MVV ___
Definition
<50%
Term
high risk residual volume ___-
Definition
>50%
Term
high risk PaCO2 -_____
Definition
>45 torr
Term
arrythmias occur during one lung ventilation due to
Definition
hypoxemia, hypercarbia, cardiac manipulation (SVT)
Term
What lead detects the p wave and is good for arrhythmia detection
Definition
Lead II
Term
What lead detects anterlateral wall ischemia
Definition
Lead V
Term
What should you consider adding to assist with ventilation of the lower lung in an anesthetized, lateral, paralyzed, chest closed patient?
Definition
PEEP!
Term
Drugs that do not effect hypoxic pulmonary vasoconstriction
Definition
-fentanyl, propofol, pentothal, ketamine
Term
Carlens tube
Definition
Left side DLT with carinal hook
Term
White tube
Definition
Right side DLT (carlens tube) with carinal hook
Term
Bryce-Smith
Definition
Right side tube with no hook, slotted cuff
Term
Robert Shaw
Definition
Right or left sided DLT
Term
Sizes of DLTs
Definition
41 (6.5 mm), 39 (6.0), 37 (5.5), 35 (5.0), 28 (4.5).
Term
Size ETT needed to accomodate an Arndt Endobronchial blocker
Definition
> or = to 8.0mm
Term
Trachea length
Definition
11-13 cm
Term
Cricoid cartilage is at what vertebral level?
Definition
C6
Term
Trachea bifurcates at what vertebral level?
Definition
T5
Term
Average depth of a DLT
Definition
29 cm at the teeth
Term
Tracheal cuff color and amount of air that can be inserted
Definition
White, 5-10ml
Term
Bronchial cuff color and amount of air that can be inserted
Definition
Blue, 1-2 ml
Term
The right upper lobe is how far from the carina?
Definition
<1cm
Term
thoracic epidural catheters need to be placed at what level for postop analgesia for thoracic surgery?
Definition
T6-T8
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