Clinical Management of Aneurysms and ICP
49 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What symptom is least likely associated with a ruptured AAA?

  • Dull, vague abdominal pain
  • Flank ecchymosis (Grey Turner’s sign)
  • Severe acute back pain
  • Severe hypertension (correct)

Which action is most critical immediately after identifying a ruptured AAA?

  • Instruct the patient to remain calm
  • Provide immediate surgical intervention (correct)
  • Control and monitor renal function
  • Administer an ACE inhibitor

What is the best location for an AAA to rupture to minimize fatality?

  • Left renal artery
  • Distal aorta near the femoral arteries
  • Anterior wall of the aorta
  • Posterior aspect of the aorta (correct)

Which of the following is a complication associated with AAA related to blood flow?

<p>Duodenal obstruction leading to weight loss (A)</p> Signup and view all the answers

For patients with small aneurysms measuring 4.0 to 5.4 cm, what is the recommended frequency for monitoring?

<p>Every 6 to 12 months via ultrasound or CT (C)</p> Signup and view all the answers

What position should the patient be kept in to effectively drain cerebrospinal fluid?

<p>At 30 degrees elevation (B)</p> Signup and view all the answers

Which of the following symptoms is NOT a sign of increased intracranial pressure (ICP)?

<p>Normal temperature (B)</p> Signup and view all the answers

Which drug is considered a first-line treatment for patients with brain swelling and sodium issues?

<p>Hypertonic saline solution (B)</p> Signup and view all the answers

What is a potential adverse effect of using Mannitol for brain swelling management?

<p>Pulmonary edema (C)</p> Signup and view all the answers

Which clinical finding is characteristic of Cushing's Triad related to increased ICP?

<p>Severe bradycardia (C)</p> Signup and view all the answers

Why should corticosteroids not be given to patients with traumatic brain injuries?

<p>They are only for tumor-related conditions. (C)</p> Signup and view all the answers

Which monitoring parameter is crucial for patients receiving hypertonic saline solution?

<p>Blood pressure and sodium levels (D)</p> Signup and view all the answers

What is the appropriate action to take regarding temperature management in a patient with increased ICP?

<p>Use cooling blankets to prevent shivering. (B)</p> Signup and view all the answers

What is the primary goal when using the Train of 4 stimulation in patients?

<p>To achieve 1-2 twitches out of 4 (D)</p> Signup and view all the answers

Which of the following is a common treatment for esophageal varices?

<p>Endoscopic ligation (B)</p> Signup and view all the answers

In the management of end stage COPD, what dietary modification is recommended?

<p>Smaller meal portions (A)</p> Signup and view all the answers

What is a key sign of acute pancreatitis that may appear on a physical examination?

<p>Cullen's sign (B)</p> Signup and view all the answers

Which medication can adversely affect the heart and is therefore infrequently used for treating esophageal varices?

<p>Vasopressin (A)</p> Signup and view all the answers

What is a crucial consideration during balloon tamponade treatment for esophageal varices?

<p>Monitor airway patency (A)</p> Signup and view all the answers

Which condition is marked by rising ammonia levels leading to cerebral edema?

<p>Hepatic encephalopathy (B)</p> Signup and view all the answers

Why should patients with cirrhosis avoid acetaminophen and NSAIDs?

<p>They can exacerbate liver damage (C)</p> Signup and view all the answers

What is the primary function of the AV node in the heart's conduction system?

<p>Delays the impulse to allow for ventricular filling (A)</p> Signup and view all the answers

Which pathway is responsible for carrying impulse through the atria to the AV node?

<p>Interatrial and internodal pathways (C)</p> Signup and view all the answers

In the case of tension pneumothorax, what is the first intervention that should be performed?

<p>Perform needle decompression (A)</p> Signup and view all the answers

What is the estimated average blood loss associated with a femur fracture?

<p>1,276 mL (A)</p> Signup and view all the answers

What is a common symptom of autonomic dysreflexia following a spinal cord injury?

<p>Sudden pounding headache (A)</p> Signup and view all the answers

What happens during neurogenic shock in spinal cord injury?

<p>Decreased cardiac output with hypotension (A)</p> Signup and view all the answers

Which of the following is considered the worst type of bite in terms of infection risk?

<p>Cat bites (A)</p> Signup and view all the answers

What immediate action should be taken in case of poisoning?

<p>Call poison control (C)</p> Signup and view all the answers

Which treatment is crucial for drowning victims in addition to correcting hypoxia?

<p>Correcting acid-base and fluid imbalances (C)</p> Signup and view all the answers

What is the recommended heart rate when the Purkinje system assumes the pacemaker role?

<p>20-40 beats per minute (C)</p> Signup and view all the answers

What is the formula used to calculate cardiac output?

<p>Heart rate X stroke volume (B)</p> Signup and view all the answers

Which of the following statements about systemic vascular resistance (SVR) is true?

<p>SVR's normal value ranges from 800 to 1200. (A)</p> Signup and view all the answers

What is the normal range for cerebral perfusion pressure (CPP)?

<p>60-100 mm Hg (C)</p> Signup and view all the answers

Which factor does NOT influence intracranial pressure (ICP)?

<p>Body temperature (C)</p> Signup and view all the answers

When is the condition of increased ICP concerning for brain matter?

<p>When ICP exceeds 20 mm Hg (D)</p> Signup and view all the answers

What is the consequence of failing to manage increased intracranial pressure?

<p>Pockets of infarction in the brain (D)</p> Signup and view all the answers

How should the external transducer for monitoring ICP be positioned?

<p>Level at 0 at the foramen of Monro (C)</p> Signup and view all the answers

Which potential complication is associated with the use of a Swan Ganz Catheter?

<p>Thromboembolism (D)</p> Signup and view all the answers

What is the recommended treatment for asymptomatic patients with PAC?

<p>Nothing (C)</p> Signup and view all the answers

Which condition is characterized by the presence of more P waves than expected in a normal rhythm?

<p>Third-degree heart block (B)</p> Signup and view all the answers

What is the preferred treatment for unstable patients experiencing VTACH?

<p>Cardioversion (D)</p> Signup and view all the answers

What feature distinguishes a Mobitz II heart block from other types?

<p>Grouped P waves (C)</p> Signup and view all the answers

In the treatment of Junctional Escape with a slow heart rate, what is the initial drug choice?

<p>Atropine (D)</p> Signup and view all the answers

What is the first action to take when a patient presents with VFIB?

<p>Defibrillation (D)</p> Signup and view all the answers

What heart rate range characterizes atrial flutter?

<p>200-350 bpm (D)</p> Signup and view all the answers

What is the primary concern in treating A-flutter to prevent complications?

<p>Preventing clots (C)</p> Signup and view all the answers

In symptomatic patients with PVCs, which treatment is typically used?

<p>Amiodarone (A)</p> Signup and view all the answers

What is the appropriate response to a patient showing signs of Wenckebach?

<p>Observe and potentially use atropine (B)</p> Signup and view all the answers

Flashcards

AAA Symptoms

Abdominal Aortic Aneurysm (AAA) symptoms include: pain (dull, vague, or severe), pulsatile abdominal mass, and hypotension/syncope (especially with rupture).

AAA Rupture Location

A ruptured AAA is more likely to be potentially survivable if it ruptures posteriorly (back) than if it ruptures anteriorly (front).

AAA Associated Complications

AAA complications include diminished femoral pulses, "blue toe" syndrome, duodenal obstruction, and vertebral body erosion leading to various symptoms (like pain).

AAA Monitoring

AAA monitoring involves periodic ultrasound or CT scans for aneurysms 4.0-5.4 every 6-12 months, and every 3 years for smaller aneurysms.

Signup and view all the flashcards

AAA Treatment: Medical Management

Medical management for AAAs involves controlling blood pressure, quitting smoking, and managing other risk factors. Optionally, STATIN and/or ACE inhibitor may assist.

Signup and view all the flashcards

Cardiac Output (CO)

The total amount of blood pumped by the heart per minute.

Signup and view all the flashcards

Cardiac Index (CI)

Cardiac output adjusted for body size.

Signup and view all the flashcards

Stroke Volume (SV)

The amount of blood pumped per heartbeat.

Signup and view all the flashcards

Systemic Vascular Resistance (SVR)

Resistance to blood flow in the systemic circulation.

Signup and view all the flashcards

Cerebral Perfusion Pressure (CPP)

The pressure needed to ensure adequate blood flow to the brain.

Signup and view all the flashcards

Intracranial Pressure (ICP)

Pressure inside the skull.

Signup and view all the flashcards

Normal ICP

Less than 15 mmHg.

Signup and view all the flashcards

Swan-Ganz Catheter Complications

Potential risks of using a Swan-Ganz catheter including air emboli, thromboembolism, catheter displacement, infection, inaccurate pressures.

Signup and view all the flashcards

Increased intracranial pressure (ICP) signs

Symptoms indicating a rise in pressure inside the skull, including changes in consciousness (from calm to agitated or comatose), headache (often worse in the morning), vomiting without nausea, and specific posturing (decerebrate or decorticate).

Signup and view all the flashcards

Cerebrospinal fluid (CSF) drainage

Removing CSF to help lower intracranial pressure. The process requires patient positioning (30-degree elevation) and slow removal (20-30ml/hour) to avoid complications like 'Dumping syndrome'

Signup and view all the flashcards

Decerebrate posturing

A type of abnormal muscle movement where the arms are extended straight out and away from the body, indicating severe brain stem injury.

Signup and view all the flashcards

Decorticate posturing

An abnormal muscle movement characterized by flexed arms close to the body, indicative of a brain injury, usually less severe than decerebrate.

Signup and view all the flashcards

Mannitol (Osmitrol)

A drug to reduce brain swelling by decreasing CSF production and drawing excess fluid out of brain tissues. CAUTION: Can induce pulmonary edema or heart failure.

Signup and view all the flashcards

Hypertonic saline (3% saline)

A solution used to reduce brain swelling by shifting water from brain cells into the bloodstream. Carefully monitor sodium and blood pressure.

Signup and view all the flashcards

Cushing's Triad

A combination of high blood pressure, slow heartbeat (bradycardia), and abnormal breathing patterns (irregular respiration) seen in increased intracranial pressure.

Signup and view all the flashcards

Antipyretics in brain injury

Medications to lower fever during a brain injury without causing shivering (which increases pressure).

Signup and view all the flashcards

Train of 4

A method of neuromuscular stimulation using 4 electrical currents to assess nerve function. Goal is 1-2 twitches out of 4. No twitches indicates potential neurological issues or improper equipment.

Signup and view all the flashcards

ABG Values

Arterial blood gas results are important for assessing acid-base balance. Normal values include pH 7.35-7.45, PaCO2 45-35, and HCO3 22-26.

Signup and view all the flashcards

Esophageal Varices

Enlarged, fragile veins in the esophagus caused by portal hypertension. They are prone to bleeding, which can be life-threatening.

Signup and view all the flashcards

Sandostatin

A medication used to control bleeding in esophageal varices by decreasing blood flow to the varices.

Signup and view all the flashcards

Acute Pancreatitis

Inflammation of the pancreas characterized by severe abdominal pain (often radiating to the back), decreased bowel sounds, low-grade fever, and potentially Grey Turner's or Cullen's sign.

Signup and view all the flashcards

Hepatic Encephalopathy

A serious complication of liver disease involving rising ammonia levels, leading to cerebral edema and neurological symptoms. Asterixis (flapping hand tremor) is an early sign.

Signup and view all the flashcards

Asterixis

A flapping hand tremor, a key early indicator of hepatic encephalopathy

Signup and view all the flashcards

Corticosteroids

Anti-inflammatory medications used to treat various conditions, including inflammatory lung diseases like COPD.

Signup and view all the flashcards

PAC

A premature atrial contraction, often characterized by an extra beat and an upright P wave. It's often related to stress, caffeine, or other stimulants.

Signup and view all the flashcards

PAC Treatment

Treatment for PACs depends on whether they are symptomatic or asymptomatic. For asymptomatic PACs, no treatment is necessary. For symptomatic PACs, reducing caffeine intake and using beta-blockers are common approaches.

Signup and view all the flashcards

Asystole

A flat line on an EKG, indicating no electrical activity in the heart. It is considered a fatal rhythm and requires immediate CPR and epinephrine.

Signup and view all the flashcards

A-flutter

A rapid heart rhythm that appears as a sawtooth pattern on an EKG. It usually occurs at a rate of 200-350 beats per minute. Treatment depends on whether the patient is stable or unstable.

Signup and view all the flashcards

A-flutter Treatment (Stable)

For stable A-flutter, treatment involves using medications like calcium channel blockers (Cardizem), digoxin, or radiofrequency ablation as the preferred method.

Signup and view all the flashcards

A-flutter Treatment (Unstable)

For unstable A-flutter, treatment involves immediate synchronized cardioversion, adenosine (which temporarily slows the heart rate), and anticoagulation therapy to prevent blood clots.

Signup and view all the flashcards

Normal Sinus Rhythm with a PJC

Normal sinus rhythm with episodes of a premature junctional contraction (PJC). This can appear inverted or hidden depending on the P wave location.

Signup and view all the flashcards

Junctional Escape

A heart rhythm where the SA node doesn't pace the heart, and the AV node takes over, resulting in a slower heart rate.

Signup and view all the flashcards

Junctional Escape Treatment

Treatment for junctional escape depends on symptoms. Asymptomatic cases may be treated with atropine if the heart rate is slow, while symptomatic cases often require a pacemaker.

Signup and view all the flashcards

VTACH

Ventricular tachycardia, a fast heart rhythm originating in the ventricles. It appears as 'tombstone' shaped QRS complexes on the EKG and can be life-threatening depending on the patient's stability.

Signup and view all the flashcards

SA Node Pacemaker

The sinoatrial (SA) node is the heart's natural pacemaker, initiating electrical impulses that regulate the heartbeat. It normally generates impulses at a rate of 60-100 beats per minute.

Signup and view all the flashcards

AV Node Function

The atrioventricular (AV) node relays electrical impulses from the atria to the ventricles, causing them to contract and pump blood. It also delays the signal to allow for proper ventricular filling.

Signup and view all the flashcards

What happens if the SA node fails?

If the SA node fails to function, the AV node takes over as the pacemaker. However, the AV node's intrinsic rate is slower, typically 40-60 beats per minute, leading to a slower heartbeat.

Signup and view all the flashcards

Bundle of His Function

The Bundle of His is a pathway that carries electrical impulses from the AV node to the ventricles. It branches into two bundle branches, one for each ventricle.

Signup and view all the flashcards

Purkinje System Function

The Purkinje fibers spread the electrical impulses throughout the ventricles, ensuring a coordinated contraction. They can also act as a backup pacemaker in case the higher centers fail.

Signup and view all the flashcards

Tension Pneumothorax

A life-threatening condition where air trapped in the chest cavity compresses the lung and heart. It requires immediate treatment with needle decompression followed by chest tube insertion.

Signup and view all the flashcards

Femur Fracture Complications

Fractures of the femur can lead to significant blood loss, compartment syndrome, and rhabdomyolysis, which are serious complications that can damage muscles and kidneys.

Signup and view all the flashcards

Autonomic Dysreflexia

A potentially dangerous condition that occurs in individuals with spinal cord injuries above T6. It involves sudden hypertension, headache, sweating, and other symptoms.

Signup and view all the flashcards

Spinal Shock

A temporary loss of reflexes and paralysis below the level of a spinal cord injury. It usually resolves within a few weeks.

Signup and view all the flashcards

Neurogenic Shock

A condition that occurs in high spinal cord injuries, causing a loss of sympathetic nervous system control and resulting in low blood pressure, slow heart rate, and temperature dysregulation.

Signup and view all the flashcards

Study Notes

Symptoms

  • Dull, vague pain in abdomen, back, or flank
  • Can be acute and severe in ruptured AAA
  • Sensation of pulsatile mass in abdomen
  • Hypotension, often manifesting as syncope
  • Occurring in cases of ruptured AAA
  • Diminished femoral pulses
  • "Blue Toe" Syndrome
  • Duodenal obstruction, leading to vomiting and weight loss
  • Due to microemboli from aortic thrombus
  • Vertebral body erosion leading to severe back pain
  • Best place for AAA rupture is often in the posterior (back) to tamponade and hold internal pressure

Associated Complications

  • Occurring in cases of ruptured AAA

Where is the best place for a AAA to rupture?

  • Best place for AAA to rupture is in the back or posterior because it can tamponade and hold pressure on itself. If it ruptures anteriorly, the outcome is typically fatal.

Treatment: Medical Management

  • Control hypertension
  • Quit smoking
  • Control other risk factors
  • Could give a STATIN and/or an ACE inhibitor (beneficial)
  • Monitoring small aneurysms (4.0 - 5.4) with ultrasound or CT (every 6-12 months)
  • Monitoring aneurysms smaller than 4.0 (every 3 years)
  • Open repair is more challenging for patients, with cross-clamping, requiring monitoring of kidney function, urine output, pedal pulses, and extremity movement.
  • Keeping the patient stable and preventing further issues (blood clot formation or graft rupture)

Additional Notes

  • Monitor neurologic status, peripheral status, and renal perfusion status.
  • Grey Turner's sign: flank ecchymosis (bruising)
  • Severe back pain.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Related Documents

Medical Notes on AAA and Related Conditions PDF

Description

This quiz assesses knowledge on the symptoms, management, and complications associated with ruptured abdominal aortic aneurysms (AAA) and increased intracranial pressure (ICP). It includes questions on monitoring strategies and drug treatments for brain swelling. Test your understanding of critical actions in emergency situations and the physiological impact of these conditions.

More Like This

Use Quizgecko on...
Browser
Open
Browser
Browser