CRNA Interview- Clinical Questions AT

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

Supplies for intubation

crash cart, glidescope, medications, RN, RT, MD, airway cart

What are some reasons for post operative tachycardia?

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

Explain the different types of anesthesia

local- removes pain at a specific site, dental procedure or mole removal

regional- epidural/spinal/nerve block, removes pain from a certain region like in a C- section

General- patient unconscious with breathing tube, feels and experiences nothing, will not remember procedure- heart surgery, transplants

MAC- monitored anesthesia care, conscious sedation but patient is ready to be intubated and have general anesthesia if needed- lumbar puncture, G button placement

Explain Intra Aortic Balloon Pump

inserted into the aorta to help heart pump

-allows blood flow to the coronary arteries

-used short term in shock or heart failure

-dilates when heart is in diastole to pump blood to the coronary arteries, deflates when heart in systole

Explain Swan Catheters

catheter that goes into the RA to RV to PA, measures the pressures in and around the heart

CVVH

removes blood at a continuous rate at lower volumes, better for unstable BP

ECMO

VV- supports lungs, returned venous

VA- supports heart and lungs, returned arterial

ECMO- oxygenates blood in a circuit

ventilator settings

TV- 6-8/kg

PEEP- increased if not oxygenating

Fi02- 30 to 100 %

PS- smaller the tube higher the PS, usually 5-10

Rate- 14-30 most common

MTP

replaces patients total blood volume in less than 24 hours, or acute admin of more than half patients blood volume/hour

- give PRBC, FFP/cryo, platelets usually 1:1:1 or 2:1:1

ICP

normal 5-15

>20 treat

causes- tumor, brain injury, trauma, shunt malfunction, meningitis, high BP, surgery,stroke

treat- raise HOB, EVD, mannitol, hypertonic saline, low CO2

EVD

keep level to tragus

calculate minute ventilation

tidal volume X respiratory rate

calculate MAP

Systolic + 2x(Diastolic)/3

ventilator settings for an ARDS patient

low TV, increase PEEP, increase iTime

what are appropriate interventions for cardiogenic shock?

inotropes- dobutamine, dopamine, levofed

fluids

anticoagulation meds- aspirin

intubated

ecmo

antiarrhythmic meds

dialysis

describe techniques used to manage a patients pulmonary condition

pulm toilet, suctioning, HFNC, BIpap, intubation, NC, respiratory treatments like albuterol, advair, flovent, CPT, IPV, steroids, fluids, IS, weaning Fi02

What are complications from blood transfusions?

TACO

TRALI

anaphylaxis- transfusion

reaction

increased K

decreased Ca

dilutional thrombocytopenia

acid/base disturbances

PCWP

25/10

- measures LAP, can be problems in LV, can cause pulmonary edema and need diuretics

- can be a good indicator in PHTN

PAP

8-12, in pulmonary artery if waveform notched

20-30/10-20

reflects PCWP, LAP, LVEDP if the mitral valve is normal and there is no pulmonary disease

SVR

800-1200 dynes/sec/cm

resistance blood must flow against

high- too much pressure, need diuretics, dilators, things to lower BP or reduce volume

low- need pressors, fluid, things to constrict vessels and increase pressure

80 X (MAP-RAP)/CO

see a weird heart rhythm like bigeminy?

12 Lead EKG

CVP

2-6

CO

4-8 L/min

SV X HR

CI

2.5-4 L/min/m2

EKG changes with hyperkalemia

- Peaked T waves

- Wide QRS

- Flat P

- Prolonged PR interval

-asystole

-give IV calcium to cardioprotect

What is an action potential?

the change in electrical potential associated with the passage of an impulse along the membrane of a muscle cell or nerve cell

-polarity changes that travel along the neuron until it reaches the end

-Na is the major extracellular

-K is the major intracellular

-pumps in the cell membrane maintain these levels in the ECF and ICF

what is depolarization?

Loss of a state of polarity; loss or reduction of negative membrane potential

-due to change in permeability and migration of Na ions inside the cell

what is hyperpolarization?

Hyperpolarization refers to a state where the potential across the membrane is more negative than the resting potential

-increases the stimulus required to move the membrane potential to the action potential threshold

what is dead space?

volume air inhaled that does not take place in gas exchange; area of the lung is not perfused

what is cushings triad?

increased ICP, widening pulse pressure, bradycardia, and irregular respirations

CPP

MAP-ICP, want above 60

PAWP

6-12

assess left ventricular preload

MAP

(systolic + 2diastolic)/3