Final_Week 1

Question 1

What are the recommended fasting times in hours for different infant milk preparations?

Answer 1

• Clear liquids (2 hours)
• Breast milk (4 hours)
• infant formula (6 hours)
• nonhuman milk (6 hours)

Question 2

What are the major clinical predictors of increased periop CV risk that should be evaluated more closely during preop period?

Answer 2

• CV dx
• DM
• CVA dx

Question 3

Noncardiac surgery should be delayed _____ following MI without coronary intvn

Answer 3

at least 60 days

Question 4

General NPO guidelines

Answer 4

Up to \_\_\_\_ hours before surgery 
Clear liquids: 2
Breast milk: 4
Light meal/non-human milk: 6
Heavy meal (fried/fatty/meat): 8

Question 5

Why do we say NPO after MN for adults?

Answer 5

Patients can be:

• unreliable
• not truthful
• gastric emptying varies
• cases can be moved earlier
• multiple instructions are difficult to remember/follow

Question 6

Massive transfusion is defined as

Answer 6

transfusion of 10 units of PRBCs in 24h

Question 7

Class I Hemorrhage:

Blood loss, S/S, Tx

Answer 7

• blood loss of up to 15% of blood volume or up to about 750 mL (70-kg M)
• s/s: minimal-none
• Tx: not reqd

Question 8

Class II Hemorrhage:

Blood loss, S/S, Tx

Answer 8

• blood loss of 15%–30% of blood volume or ~ 750–1500 mL
• s/s: Tachycardia, tachypnea, decreased pulse pressure, not a significant decrease in SBP. Subtle CNS changes (anxiety), Urine output only minimally decreased
• Tx: Depends

Question 9

Class III Hemorrhage:

Blood loss, S/S, Tx

Answer 9

• blood loss of 30%–40% of blood volume or ~ 1.5-2L.
• s/s: classic signs - marked tachycardia, tachypnea, systolic HOTN, significant changes in mental status, oliguria.
• Tx: req transfusion

Question 10

Least amount of blood loss that causes decrease in SBP

Answer 10

Class III Hemorrhage

Question 11

MTP ideal ratio

Answer 11

1:1:1 plasma:platelets:pRBCs

Question 12

MTP ideal ratio is associated with

Answer 12

improved hemostasis, decreased mortality d/t exsanguination at 24h

Question 13

> 2L blood loss

Answer 13

Class IV hemorrhage

70kg

Question 14

Class IV Hemorrhage:

Blood loss, S/S, Tx

Answer 14

• blood loss > 40% of blood volume or > 2L
• immediately life threatening
• S/S: Marked tachycardia, significant/sustained HOTN, narrow pulse pressure, negligible urine output, markedly depressed mental status, cold pale skin
• Tx: req transfusion of blood products + immediate control of bleeding source

Question 15

Loss of ______ blood volume results in ______

Answer 15

> 50% blood volume

results in LOC, bradycardia

Question 16

major risks of perioperative CV issues

Answer 16

• Unstable coronary syndromes (unstable or severe angina, acute/recent < 3months MI)
• Decompensated HF
• significant arrhythmia (Mobitz II, 3rd degree HB, sympt. ventricular arrhythmia, SVT)
• severe valvular disease

Question 17

Delay elective surgery if HTN

Answer 17

SBP > 200

DBP > 115

Question 18

Proceed with elective surgery if HTN

Answer 18

SBP < 180

DBP < 110

Question 19

BOOTS

Answer 19

*difficult to mask ventilate
Beard
Obese (BMI > 26)
Old (age > 55) 
Toothless
Snoring (OSA, hx snoring)

Question 20

surviving sepsis tx

Answer 20

• CVP: 8 – 12 mm Hg
• MAP: 65 mmHg+
• U/O: 0.5 mL/kg/hr+
• SCVO2 of 70% or SVO2 of 65%
• Normalization of lactate •Identify septic source
• Antibx
• Fluid resuscitation
• Vasopressors & inotropes
• Steroids?
• Hgb target: 7 – 9 g/dL
• Avoid ARDS
• Blood glucose 180 mg/dL or less

Question 21

STOP-BANG

Answer 21

High OSA risk >/=3
Low risk < 3
Stop: Snoring, Tired, Observed (anyone saw you stop breathing at night), bP (tx for HTN)
B: BMI > 35
A: Age > 50
N: Neck circumf. > 40 cm
G: Gender = M

Question 22

Lethal triad

Answer 22

hypothermia, acidosis, and coagulopathy

Question 23

One MET is defined as

Answer 23

the amount of oxygen consumed while sitting at rest and is equal to 3.5ml O2 per kg bodyweight per min

Question 24

A patient’s self-reported inability to perform average levels of exercise (i.e., 4 to 5 METs) suggests

Answer 24

increases the risk of perioperative complications.

Question 25

METs are used to

Answer 25

help determine whether additional preanesthetic evaluation should be performed and may predict perioperative outcomes