July 7, 2009 | In: GENERAL TOPICS
12 CENTRAL VENOUS AND PULMONARY ARTERY PRESSURE MONITORING Dipin Gupta M.D., Glenn J.R. Whitman M.D., Alden H. Harken M.D. 1. What does a catheter in the central venous circulation measure? Show answer All intrathoracic veins have nearly...
July 7, 2009 | In: GENERAL TOPICS
EXTRA-CREDIT QUESTIONS 22. Four hours after your patient undergoes an exploratory laparotomy following a motor vehicle accident, the nurse reports that the patient's vital signs, urine output, and oxygen transport numbers are normal. Can the...
July 7, 2009 | In: GENERAL TOPICS
11 OXYGEN MONITORING AND ASSESSMENT James B. Haenel R.R.T., Jeffrey L. Johnson M.D. 1. How does a pulse oximeter work? Show answer Light-absorption characteristics differ for the four most common circulating species of hemoglobin in...
July 7, 2009 | In: GENERAL TOPICS
10 WHAT DOES POSTOPERATIVE FEVER MEAN? Alden H. Harken M.D. 1. What is a fever? Show answer Normal core temperature varies between 36°C and 38°C. Because we hibernate a little at night, we are cool (36°C) just before rising in the morning;...
July 7, 2009 | In: GENERAL TOPICS
CONTROVERSIES 20. Does preoperative TPN enhance surgical outcome? Show answer It is well documented that malnourished patients are at an increased risk for septic complications, problems with wound healing, longer hospital stays, and...
July 7, 2009 | In: GENERAL TOPICS
9 PARENTERAL NUTRITION Margaret M. McQuiggan M.S., R.D., CNSD, Frederick A. Moore M.D. 1. What is parenteral nutrition? Show answer Parenteral nutrition is the provision of protein as amino acids (4 kcal/g), dextrose (3.4 kcal/g), and fat...
July 7, 2009 | In: GENERAL TOPICS
CONTROVERSIES 23. How fat is fat? Show answer Lean body mass is three times more metabolically active than adipose tissue. Multiple definitions of clinical obesity exist: > 120% ideal body weight (IBW), > 130% IBW, body mass index (BMI) >...
July 7, 2009 | In: GENERAL TOPICS
ENTERAL NUTRITION 10. When should enteral nutrition be considered? Show answer Always, but especially when a patient is unlikely to meet > 70% of nutritional needs by mouth. Patients who have sustained major head injury (Glasgow Coma Scale...
July 6, 2009 | In: GENERAL TOPICS
8 NUTRITIONAL ASSESSMENT AND ENTERAL NUTRITION Margaret M. McQuiggan M.S., R.D., CNSD, Frederick A. Moore M.D. NUTRITIONAL ASSESSMENT 1. What does a nutritional assessment include? Show answer 1. The medical and surgical history is...
July 6, 2009 | In: GENERAL TOPICS
7 FLUIDS, ELECTROLYTES, GATORADE, AND SWEAT Alden H. Harken M.D. 1. What is hypertonic saline? Show answer Normal saline is 0.9% sodium chloride. Hypertonic saline is 7.5% sodium chloride (eight times as concentrated as normal...
July 6, 2009 | In: GENERAL TOPICS
6 WHY GET ARTERIAL BLOOD GASES? Alden H. Harken M.D. 1. Is breathing really overrated? Show answer It may be. A Japanese yoga master survived just fine breathing once per minute for an hour (see reference 1)! 2. Mr. O'Flaherty has just...
July 6, 2009 | In: GENERAL TOPICS
5 WHAT IS PULMONARY INSUFFICIENCY? Alden H. Harken M.D. 1. What is pulmonary insufficiency? how answer The alveolar-capillary surface of the lung is the size of a singles tennis court. The purpose of the lung is to match alveolar ventilation...
July 6, 2009 | In: GENERAL TOPICS
4 HOW TO THINK ABOUT SHOCK Alden H. Harken M.D. 1. Define shock. Show answer Shock is: * Not just low blood pressure * Not just decreased peripheral perfusion * Not just limited systemic oxygen delivery Ultimately, shock is...
July 6, 2009 | In: GENERAL TOPICS
3 EVALUATION AND TREATMENT OF CARDIAC DYSRHYTHMIAS Alden H. Harken M.D. 1. Are cardiac dysrhythmias and cardiac arrhythmias the same? Show answer Yes. Some purists will tell you that an arrhythmia can be only the absence of a cardiac...
July 6, 2009 | In: GENERAL TOPICS
2 CARDIOPULMONARY RESUSCITATION Norman A. Paradis M.D., Alden H. Harken M.D. 1. Define sudden cardiac death. Sudden ventricular fibrillation (VF) or pulseless electrical activity (PEA). Acute coronary ischemia and preexisting cardiac...