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Questions and Answers
Which symptom is most commonly associated with a ruptured AAA?
Which symptom is most commonly associated with a ruptured AAA?
What is the primary benefit of monitoring aneurysms smaller than 4.0 cm?
What is the primary benefit of monitoring aneurysms smaller than 4.0 cm?
What is a critical consideration during an open repair of an AAA?
What is a critical consideration during an open repair of an AAA?
Which factor is least likely to contribute to complications in patients with AAA?
Which factor is least likely to contribute to complications in patients with AAA?
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Which sign is indicative of internal bleeding associated with AAA rupture?
Which sign is indicative of internal bleeding associated with AAA rupture?
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What is the normal range for cardiac output?
What is the normal range for cardiac output?
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Which measurement indicates the amount of blood ejected from each ventricle with each heartbeat?
Which measurement indicates the amount of blood ejected from each ventricle with each heartbeat?
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What is the consequence of not intervening with increased ICP?
What is the consequence of not intervening with increased ICP?
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What is the normal range for systemic vascular resistance (SVR)?
What is the normal range for systemic vascular resistance (SVR)?
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To calculate cerebral perfusion pressure (CPP), which equation should be used?
To calculate cerebral perfusion pressure (CPP), which equation should be used?
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In what scenario would you expect to see a pulmonary vascular resistance (PVR) level?
In what scenario would you expect to see a pulmonary vascular resistance (PVR) level?
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What is the normal range for cerebral perfusion pressure (CPP)?
What is the normal range for cerebral perfusion pressure (CPP)?
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What positions should be maintained to help reduce ICP?
What positions should be maintained to help reduce ICP?
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What position should the patient be kept in to facilitate cerebrospinal fluid drainage?
What position should the patient be kept in to facilitate cerebrospinal fluid drainage?
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What is a potential consequence of removing cerebrospinal fluid too quickly?
What is a potential consequence of removing cerebrospinal fluid too quickly?
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Which of the following is NOT a sign of increased intracranial pressure (ICP)?
Which of the following is NOT a sign of increased intracranial pressure (ICP)?
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Which drug is used to decrease cerebral spinal fluid production?
Which drug is used to decrease cerebral spinal fluid production?
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What monitoring is essential when administering hypertonic saline solution?
What monitoring is essential when administering hypertonic saline solution?
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Which condition is associated with administering corticosteroids in patients?
Which condition is associated with administering corticosteroids in patients?
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What is a common side effect of mannitol that must be monitored?
What is a common side effect of mannitol that must be monitored?
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Which of the following is an important consideration when using antipyretics in this context?
Which of the following is an important consideration when using antipyretics in this context?
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What is the primary goal when using the Train of 4 method for assessing neuromuscular function?
What is the primary goal when using the Train of 4 method for assessing neuromuscular function?
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Which of the following is NOT a common complication associated with end-stage COPD?
Which of the following is NOT a common complication associated with end-stage COPD?
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Which drug is often used to stop bleeding in patients with esophageal varices?
Which drug is often used to stop bleeding in patients with esophageal varices?
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What symptom is indicative of hepatic encephalopathy in liver disease patients?
What symptom is indicative of hepatic encephalopathy in liver disease patients?
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In cases of acute pancreatitis, what is the advised nutritional status for the patient?
In cases of acute pancreatitis, what is the advised nutritional status for the patient?
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Which of the following conditions is a terminal complication of liver disease?
Which of the following conditions is a terminal complication of liver disease?
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What is the recommended meal size for patients with end-stage COPD to help manage their symptoms?
What is the recommended meal size for patients with end-stage COPD to help manage their symptoms?
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Which of the following foods should patients with esophageal varices avoid?
Which of the following foods should patients with esophageal varices avoid?
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What key feature distinguishes diabetic ketoacidosis (DKA) from hyperglycemic hyperosmolar state (HHS)?
What key feature distinguishes diabetic ketoacidosis (DKA) from hyperglycemic hyperosmolar state (HHS)?
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Which of the following is NOT a precipitating factor for diabetic ketoacidosis (DKA)?
Which of the following is NOT a precipitating factor for diabetic ketoacidosis (DKA)?
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In which condition is acidosis more likely to present?
In which condition is acidosis more likely to present?
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What are the common manifestations of hyperthyroid crisis?
What are the common manifestations of hyperthyroid crisis?
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Which manifestation is common to both DKA and HHS?
Which manifestation is common to both DKA and HHS?
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What is a significant characteristic of HHS compared to DKA?
What is a significant characteristic of HHS compared to DKA?
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Which of the following correctly describes the onset of hyperglycemic hyperosmolar state (HHS)?
Which of the following correctly describes the onset of hyperglycemic hyperosmolar state (HHS)?
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What symptom is associated with myxedema coma?
What symptom is associated with myxedema coma?
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What is the role of the AV node in the cardiac conduction system?
What is the role of the AV node in the cardiac conduction system?
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Which of the following accurately describes the Purkinje system?
Which of the following accurately describes the Purkinje system?
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What is the estimated blood loss from a femur fracture in the discussed study group?
What is the estimated blood loss from a femur fracture in the discussed study group?
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Which of the following symptoms is indicative of Autonomic Dysreflexia?
Which of the following symptoms is indicative of Autonomic Dysreflexia?
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What is the primary intervention for a suspected tension pneumothorax?
What is the primary intervention for a suspected tension pneumothorax?
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What is a potential complication associated with compartment syndrome after a femur fracture?
What is a potential complication associated with compartment syndrome after a femur fracture?
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What symptom is commonly seen in patients with neurogenic shock?
What symptom is commonly seen in patients with neurogenic shock?
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What should be the first course of action for a patient with a cat bite?
What should be the first course of action for a patient with a cat bite?
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Which of the following describes the appropriate management for a drowning victim?
Which of the following describes the appropriate management for a drowning victim?
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Study Notes
AAA Symptoms
- Dull, vague pain in abdomen, back, or flank
- Can be acute and severe in ruptured AAA
- Sensation of a pulsatile mass in abdomen
- Hypotension (often manifesting as syncope)
- Commonly occurring in ruptured AAA
- Associated complications: diminished femoral pulses, "blue toe" syndrome, duodenal obstruction (vomiting, weight loss), vertebral body erosion (severe back pain)
- Best place to rupture is in the back/posterior because it can tamponade and hold pressure
- Grey Turner's sign: flank ecchymosis
- Severe back pain
AAA Treatment
- Medical management: control hypertension, stop smoking, ACE inhibitors/statins may be beneficial
- Monitoring: ultrasound/CT scans every 6-12 months (smaller aneurysms 4.0-5.4), every 3 years (smaller than 4.0)
- Open repair (more involved): monitor kidneys, urine output, pedal pulses, and extremity movement to ensure proper function
- Maintain normal conditions to avoid graft busting or clotting
Hemodynamic Monitoring
- Catheter markings: thin line = 10cm, thick line = 50cm
- RV waveform: normal value 15-25/0-8mmHg; catheter in RV may cause ventricular ectopy, swan tip may drift from PA to RV
- PA waveform: normal value 15-25/8-15mmHg; dicrotic notch represents PV closure; PAD approximates PAWP (LVEDP)
- RA waveform: normal value 0-8mmHg
- PAWP waveform: normal value 8-12mmHg; balloon floats and wedges in pulmonary artery; PAWP = LAP = LVEDP; wedging can cause capillary rupture
CO, CI, SV, SVR, and PVR
- CO (cardiac output): normal 4-8 liters, heart rate x stroke volume
- CI (cardiac index): normal 2.5-4.5 liters
- SV (stroke volume): normal 50-100 ml/beat
- SVR (systemic vascular resistance): normal 800-1200
- PVR (pulmonary vascular resistance): normal 50-250
Cerebral Perfusion Pressure (CPP)
- Pressure needed to ensure blood flow to the brain.
- Calculated as CPP = MAP - ICP (whichever is higher)
- Normal CPP is 60-100.
- Factors influencing cerebral blood flow include trauma and bleeding
Intracranial Pressure (ICP)
- Factors influencing ICP: arterial pressure, venous pressure, posture
- Normal ICP is less than 15 mmHg.
- Increased ICP (greater than 20) necessitates intervention to prevent brain infarction.
- Neuro assessments are crucial, and the external transducer should be leveled accurately at the foramen of Monro/tragus at the ear.
- Keep the patient at a 20-30-degree angle to help drain cerebrospinal fluid, done slowly. 30 ml cerebrospinal fluid an hour drain, can be slow or fast.
- Signs of increased ICP include: decerebrate or decorticate posturing, headache (worse in the morning), vomiting, changes in consciousness (from calm to agitated to comatose), Cushing triad (systolic hypertension, bradycardia, irregular respirations).
- Therapeutic measures- Mannitol (osmitrol) which is osmotic and should prevent pulmonary edema. and decrease cerebral spinal fluid production.
- Drug therapy- antipyretics, cooling blankets (prevent shivering), barbiturates, when necessary. Antiseizure medications
ICP Treatment
- Manage contributing factors (e.g., hypertension, fever)
- Drain cerebrospinal fluid (e.g., lumbar or ventricular)
- Medications: osmotic diuretics (e.g., mannitol), barbiturates
- Monitor ICP closely
Other important information
- Hypertonic saline (3% saline) or normal saline may be used in cases of brain swelling.
- Monitor blood pressure, electrolytes, and glucose levels.
- Avoid alcohol, aspirin, acetaminophen, and NSAIDs in patients with cirrhosis.
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Description
This quiz covers key symptoms and treatment options for Abdominal Aortic Aneurysms (AAA). It highlights the importance of hemodynamic monitoring and the various medical and surgical interventions available. Test your knowledge on identifying AAA complications and management strategies.