Aneurysms

Question 1

What are the types of true aneurysms?

Answer 1

• Berry (sacular)
• Fusiform
• Mycotic

Question 2

What is the most common type of aneurysm?

Answer 2

Berry (sacular)

Question 3

Which type of aneurysm is associated with infection?

Answer 3

Mycotic

Question 4

What are the criteria to treat a pseudoaneurysm?

Answer 4

• 1 or more of the following:
  
  • 5mm or greater in size
  • located in the posterior
    circulation
  • has odd, non-smooth morphology
  • significant changes in size and shape between monitoring visits

Question 5

What are the management options for an aneurysm?

Answer 5

• clipping (open surgery)
• coiling
• medical management if <10mm and no hx of SAH

Question 6

What is the criteria for medical management of an aneurysm?

Answer 6

• < 10mm in size and pt has not PMH of SAH

Question 7

What are the potential complications r/t an aneurysm?

Answer 7

• vasospasm
• rebleed
• hydrocephalus d/t block of CSF flow resulting in dilation of the ventricular system
• seizures
• increased ICP

Question 8

What type of fluid is NaCl 0.9%

Answer 8

Isotonic, crystalloid
- does not cause tissue, swelling, or contractions

Question 9

What type of solution is LR?

Answer 9

Isotonic crystalloid

Question 10

Dextrose containig solutions are what type of solutions?

Answer 10

crystalloid

Question 11

Which type of solution is the first choice for fluid resuscitation?

Answer 11

crystalloids
1) LR - sepsis, dehydration, in OR, acute pancreatitis, metabolic acidosis, burn pts
- almost like plasma
- has sodium lactate which is converted into bicarbonate
2) plasmalyte
3) NS 0.9% - neuro emergencies, TBI, hyponatremia, metabolic alkalosi
- can cause hyperchloremic metabolic acidosis (non-anion gap acidosis). high chloride content can cause renal afferent arteriolar vasoconstriction, reducing GFR and causing kidney damage in high volumes

Question 12

What affect does a unit of red blood cells have on the hematocrit?

Answer 12

increases by 3%

Question 13

What affect does a unit of red blood cells have on the hemoglobin value?

Answer 13

increases by 1 g/dL

Question 14

Albumin is what type solution?

Answer 14

colloid

Question 15

What are signs of low intravascular blood volume requiring fluid resuscitation?

Answer 15

• hypotension
• low CVP (< 8 mmHg)
• low PCWP (< 4 mmHg)
• UO < 0.5mL/kg/hr
• excess fluid loss (bleed, emesis, diarrhea, sepsis, high UO)

Question 16

What is the purpose for providing fluid resuscitation?

Answer 16

• increase BP
• increase UO
• normalize hemodynamics (CVP, PCWP)
• treat lactic acidosis (increase pH)

Question 17

What imaging study should be done when a pericardial effusion is suspected?

Answer 17

cardiac echocardiogram