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Current Diagnosis & Treatment Surgery Test bank
Current Diagnosis & Treatment Surgery Test bank
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Current Diagnosis & Treatment SurgeryLarge transfusions are at risk for what electrolyte abnormalities? - ANSStored blood products
are anticoagulated with trisodium citrate, which chelates
Ca2+ from stored blood, disrupting the clotting cascade. In the setting of massive transfusion,
such as
this patient has undergone, normal hepatic metabolism of trisodium citrate may be
overwhelmed, and
Ca2+ (along with Mg2+) may be chelated from the blood, leading to hypocoagulability,
hypocalcemia,
and hypomagnesemia. Furthermore, stored pRBCs contain high levels of K+, the result of lysis
of red
blood cells. This is especially true of the older pRBCs often utilized in massive transfusion
situations. For
these reasons, serum electrolytes must be closely monitored and controlled in the setting of
massive
transfusion
The preoperative assessment by an anesthesiologist includes an assessment of a patient's risk
for an
intraoperative cardiac event. The RCRI factors include all of the following except
A A history of ischemic heart disease
B Diabetes mellitus
C Obesity
D Renal insufficiency
E High-risk surgery
F Heart failure - ANSC. Obesity. The RCRI factors of (1) ischemic heart disease, (2) heart
failure, (3) high-risk surgery, (4)
diabetes mellitus, (5) renal insufficiency, and (6) cerebral vascular diseases are a validated set
of
independent predictors of cardiac risk for patients. There RCRIs were derived from a
single-center
prospective group of patients undergoing elective major noncardiac surgery. The
anesthesiologist in a
pre-op clinic will screen for these factors and recommend further studies based on the presence
or
absence of RCRIs. Patients with no RCRIs had a very low (0.4%) cardiac risk while patients
with three or
more risk factors have a 5.4% risk of an adverse cardiac event and warrant further testing or
optimization of the factor(s
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