CRNA Interview - Clinical Questions 1

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Questions and Answers

Peak Pressure is alarming, what do you check?

secretion plug, pneumo, coughing, biting on tube, swelling, bronchospasm, tubing kinked, pulmonary edema, decreased chest wall compliance

Which of the following are supplies for intubation? (Select all that apply)

  • Airway cart (correct)
  • Glidescope (correct)
  • Crash cart (correct)
  • Medications (correct)

What are some reasons for post-operative tachycardia?

pain, bleeding, awareness of surgery, adrenaline overdose, low BP, other vital changes, medication reaction, hypercarbia, inadequate ventilation, cardiac rhythm abnormalities

Explain the different types of anesthesia.

<p>Local - removes pain at a specific site; Regional - removes pain from a certain region; General - patient unconscious with breathing tube; MAC - conscious sedation ready for intubation.</p> Signup and view all the answers

Explain Intra Aortic Balloon Pump.

<p>Inserted into the aorta to help heart pump, allows blood flow to coronary arteries, used short term in shock or heart failure.</p> Signup and view all the answers

Explain Swan Catheters.

<p>Catheter that goes into the RA to RV to PA, measures the pressures in and around the heart.</p> Signup and view all the answers

What is CVVH?

<p>Removes blood at a continuous rate at lower volumes, better for unstable BP.</p> Signup and view all the answers

What is ECMO?

<p>VV supports lungs, returned venous; VA supports heart and lungs, returned arterial; oxygenates blood in a circuit.</p> Signup and view all the answers

What are typical ventilator settings?

<p>TV - 6-8/kg, PEEP - increased if not oxygenating, FiO2 - 30 to 100%, PS usually 5-10, Rate - 14-30.</p> Signup and view all the answers

What is MTP?

<p>Replaces patient's total blood volume in less than 24 hours, giving PRBC, FFP/cryo, platelets usually 1:1:1 or 2:1:1.</p> Signup and view all the answers

What is ICP? When do you treat?

<p>Normal 5-15; treat if &gt;20.</p> Signup and view all the answers

What does EVD stand for?

<p>External Ventricular Drain.</p> Signup and view all the answers

How do you calculate minute ventilation?

<p>Tidal volume X respiratory rate.</p> Signup and view all the answers

How do you calculate MAP?

<p>Systolic + 2x(Diastolic)/3.</p> Signup and view all the answers

What are ventilator settings for an ARDS patient?

<p>Low TV, increase PEEP, increase iTime.</p> Signup and view all the answers

What are appropriate interventions for cardiogenic shock?

<p>Inotropes, fluids, anticoagulation meds, intubation, ECMO, antiarrhythmic meds, dialysis.</p> Signup and view all the answers

Describe techniques used to manage a patient's pulmonary condition.

<p>Pulm toilet, suctioning, HFNC, BiPAP, intubation, respiratory treatments, etc.</p> Signup and view all the answers

What are complications from blood transfusions?

<p>TACO, TRALI, anaphylaxis, reaction, increased K, decreased Ca, dilutional thrombocytopenia.</p> Signup and view all the answers

What does PCWP measure?

<p>Measures LAP and can indicate problems in the LV.</p> Signup and view all the answers

What does PAP reflect?

<p>Normal is 8-12; reflects PCWP, LAP, LVEDP.</p> Signup and view all the answers

What is SVR?

<p>800-1200 dynes/sec/cm; reflects systemic vascular resistance.</p> Signup and view all the answers

What should you do if you see a weird heart rhythm like bigeminy?

<p>12 Lead EKG.</p> Signup and view all the answers

What is the normal range for CVP?

<p>2-6.</p> Signup and view all the answers

What is CO?

<p>4-8 L/min; CO = SV x HR.</p> Signup and view all the answers

What is CI?

<p>2.5-4 L/min/m2.</p> Signup and view all the answers

What are EKG changes with hyperkalemia?

<p>Peaked T waves, wide QRS, flat P, prolonged PR interval, asystole.</p> Signup and view all the answers

What is an action potential?

<p>The change in electrical potential associated with the passage of an impulse along a muscle or nerve cell membrane.</p> Signup and view all the answers

What is depolarization?

<p>Loss of a state of polarity; due to change in permeability and migration of Na ions inside the cell.</p> Signup and view all the answers

What is hyperpolarization?

<p>A state where the membrane potential is more negative than the resting potential.</p> Signup and view all the answers

What is dead space?

<p>Volume air inhaled that does not participate in gas exchange.</p> Signup and view all the answers

What is Cushing's triad?

<p>Increased ICP, widening pulse pressure, bradycardia, and irregular respirations.</p> Signup and view all the answers

What does CPP stand for?

<p>Cerebral Perfusion Pressure; MAP - ICP, want above 60.</p> Signup and view all the answers

What is PAWP?

<p>Normal range is 6-12; used to assess left ventricular preload.</p> Signup and view all the answers

How do you calculate MAP?

<p>(Systolic + 2Diastolic)/3.</p> Signup and view all the answers

Flashcards

Causes of Peak Pressure Alarms

Secretion plugs, bronchospasm, or tubing issues.

Intubation Supplies

Crash cart, glidescope, medications; RN, RT, and MD involvement.

Postoperative Tachycardia Causes

Pain, bleeding, awareness during surgery, medication reactions, and hypercarbia.

Local Anesthesia

Pain relief in a specific area (e.g., dental procedures).

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Regional Anesthesia

Blocks pain in a specific region (e.g., epidural for C-section).

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General Anesthesia

Patient is unconscious and does not remember the procedure (e.g., heart surgery).

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Monitored Anesthesia Care (MAC)

Conscious sedation with ability to intubate for further anesthesia if necessary.

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Intra Aortic Balloon Pump

Helps the heart pump, improves blood flow to coronary arteries; used in shock or heart failure.

Signup and view all the flashcards

Swan Catheters

Measure pressures in the heart, inserted through right atrium to right ventricle to pulmonary artery.

Signup and view all the flashcards

ECMO

Provides oxygenation; can support lungs (VV) or heart and lungs (VA).

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Typical Ventilator Settings

Tidal Volume (TV) 6-8 mL/kg, PEEP adjustments based on oxygenation, FiO2 ranging from 30-100%, rate set between 14-30 breaths per minute.

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ARDS Ventilation Management

Low TV, increased PEEP, and optimized inspiratory time.

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Minimum Transfusion Protocol (MTP)

Rapid replacement of total blood volume within 24 hours using a balanced ratio of PRBC, FFP/cryo, and platelets.

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Normal Intracranial Pressure (ICP)

5-15 mmHg; treat pressures over 20 mmHg with measures like mannitol, repositioning, or external ventricular drainage (EVD).

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Normal Cardiac output (CO)

4-8 L/min, calculated as Stroke Volume (SV) times Heart Rate (HR).

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Normal PCWP

25/10 mmHg; indicates left atrial pressure and potential pulmonary congestion.

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Normal PAP

8-12 mmHg; important for assessing left-sided heart function.

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Normal SVR

800-1200 dynes/sec/cm; signifies resistance against which the heart must pump, relevant in heart failure management.

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EKG Signs of Hyperkalemia

Peaked T waves, widened QRS complexes, and asystole; IV calcium helps cardioprotect.

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Action Potentials

Na and K ion movements across muscle and nerve cell membranes, essential for electrical signaling.

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Complications from Blood Transfusions

TACO, TRALI, and various electrolyte disturbances.

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Techniques for Managing Pulmonary Conditions

High-flow nasal cannula (HFNC), BiPAP, suctioning, and respiratory treatments like albuterol.

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Cushing's Triad

Widening pulse pressure, bradycardia, and irregular respiration.

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Cerebral Perfusion Pressure (CPP)

Calculated as MAP - ICP, with values above 60 mmHg desired for adequate brain perfusion.

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Study Notes

Airway Management

  • Peak Pressure alarms may indicate obstruction; check for factors like secretion plugs, bronchospasm, or tubing issues.
  • Essential supplies for intubation include a crash cart, glidescope, medications, and involvement of RN, RT, and MD.

Postoperative Care

  • Common causes of postoperative tachycardia: pain, bleeding, awareness during surgery, medication reactions, and hypercarbia.

Types of Anesthesia

  • Local Anesthesia: Provides pain relief in a specific area (e.g., dental procedures).
  • Regional Anesthesia: Blocks pain in a specific region (e.g., epidural for C-section).
  • General Anesthesia: Patient is unconscious and does not remember the procedure (e.g., heart surgery).
  • Monitored Anesthesia Care (MAC): Conscious sedation with ability to intubate for further anesthesia if necessary.

Cardiac Support Devices

  • Intra Aortic Balloon Pump: Helps the heart pump, improves blood flow to coronary arteries, used in shock or heart failure.
  • Swan Catheters: Measure pressures in the heart, inserted through right atrium to right ventricle to pulmonary artery.
  • ECMO: Provides oxygenation; can support lungs (VV) or heart and lungs (VA).

Ventilation Management

  • Typical ventilator settings: Tidal Volume (TV) 6-8 mL/kg, PEEP adjustments based on oxygenation, FiO2 ranging from 30-100%, rate set between 14-30 breaths per minute.
  • In ARDS management: use low TV, increased PEEP, and optimized inspiratory time.

Shock and Hemodynamic Monitoring

  • Minimum Transfusion Protocol (MTP): Rapid replacement of total blood volume within 24 hours using a balanced ratio of PRBC, FFP/cryo, and platelets.
  • Normal Intracranial Pressure (ICP): 5-15 mmHg; treat pressures over 20 mmHg with measures like mannitol, repositioning, or external ventricular drainage (EVD).
  • Cardiac output (CO) normal range: 4-8 L/min, calculated as Stroke Volume (SV) times Heart Rate (HR).

Pressure Measurements

  • PCWP: Normal values 25/10 mmHg; indicates left atrial pressure and potential pulmonary congestion.
  • PAP: Normal 8-12 mmHg; important for assessing left-sided heart function.
  • SVR: Normal 800-1200 dynes/sec/cm; signifies resistance against which the heart must pump, relevant in heart failure management.

EKG and Electrophysiology

  • Signs of hyperkalemia on EKG: Peaked T waves, widened QRS complexes, and asystole; IV calcium helps cardioprotect.
  • Action potentials involve Na and K ion movements across muscle and nerve cell membranes, essential for electrical signaling.

Clinical Conditions and Interventions

  • Common complications from blood transfusions may include TACO, TRALI, and various electrolyte disturbances.
  • Techniques for managing pulmonary conditions include high-flow nasal cannula (HFNC), BiPAP, suctioning, and respiratory treatments like albuterol.

Neurological Assessment

  • Cushing's Triad signifies increased ICP with symptoms like widening pulse pressure, bradycardia, and irregular respiration.
  • Cerebral perfusion pressure (CPP) calculated as MAP - ICP, with values above 60 mmHg desired for adequate brain perfusion.

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