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Surgery final (Sabiston) > 21 - Surgical critical care > Flashcards

21 - Surgical critical care Flashcards

1
Q

What is the noninvasive monitoring performed in the ICU?

A

signs
ETCO2
MAP

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2
Q

When measuring CVP (normal 2-6 mmHg)- high values suggest: 4

A

cardiogenic shock
fluids surplus
considerable vasoconstriction
tamponed

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3
Q

When measuring CVP (normal 2-6 mmHg)- low values suggest __ shock.

A

hypovolemic

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4
Q

When measuring PCWP (normal values 8-12 mmHg), high values may suggest __/__

A

left heart failure / tamponed

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5
Q

What are the 4 component of treating a patient in shock?

A

oxygen + fluids
blood (1:1:1 of PRBC: plasma: thrombocytes)
vasopressors and inotropes (NE/dopamine/dobutamine)
ventilation

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6
Q

What is the recommended fluids for a patient in shock?

A

NS 0.9% 20cc/kg push

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7
Q

What is the most common type of shcok?

A

hypovolemic

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8
Q

What are the etiologies of hypovolemic shock? 3

A

bleeding
extravascular fluid sequestration
insensible loss

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9
Q

What are the characteristics of hypovolemic shock? 6

A 
low CO
hypotension
tachycardia
high PVR (Post-Void Residual)
decreased preload
cold periphery
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10
Q

Hypovolemic shock can be classified into 3 categories:

A

mild
moderate
sever

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11
Q

Mild hypovolemic shock is defined by blood loss of < __% and 4.

A 
20
tachycardia
sweating 
anxiety
collapsed veins
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12
Q

Moderate hypovolemic shock is defined by blood loss of -% and 4.

A 
20-40
tachycardia
tachypnea
oliguria
orthostatic hypotension
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13
Q

Severe hypovolemic shock is defined by blood loss of > __% and 5.

A 
40
hemodynamic instability
hypotension
significant hypotension
oliguria
agitation/confusion
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14
Q

In hypovolemic shock rapid __ of __ saline with - L within __ minutes.

A

transfusion
isotonic
2-3
30

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15
Q

Blood transfusion in hypovolemic shock patients is recommended when bleeding + hemoglobin < __g/dL

A

10

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16
Q

Which types of shock do you know?

A

hypovolemic
cardiogenic
obstructive
distributive

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17
Q

Cardiogenic shock is a severe disfunction of the __ heart, leading to __ edema and systemic __.

A

left
pulmonary
hypoperfusion

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18
Q

What are the characteristics of cardiogenic shock? 6

A 
decreased CO
hypotension and bradycardia
elevated PVR
elevated preload+ congestion 
elevated PCWP and CVP
cold periphery
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19
Q

What are the clinical signs of cardiogenic shock? 6

A 
chest pain
dyspnea
pallor
sweating
oliguria
mental status changes
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20
Q

When treating cardiogenic shock- avoid giving __ hydration. Use __ (1st line), and __ (2nd).

A

aggressive
dobutamine
IABP

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21
Q

What are the etiologies of obstructive shock? 4

A

PE
tamponade
tension pneumothorax
positive pressure mechanical ventilation

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22
Q

In distributive shock significant __ -> low __ - > __.

A

vasodilation
SVR (systemic vascular resistance)
hypotension

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23
Q

Which types of distributive shock do you know? 4

A

neurogenic
anaphylactic
sepsis
Addisonian crisis (hypoadrenal shock)

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24
Q

Neurogenic shock caused by __/__ trauma is characterized by: 4

A 
head/spine
hypotension
bradycardia
pallor
warm periphery
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25
Q

What is the treatment for neurogenic shock? 4

A

massive hydration + Vasopressors
fixation
steroids
surgery

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26
Q

What are the characteristics of septic shock?5

A 
tachycardia
elevated CO
hypotension
decreased preload
warm periphery
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27
Q

What noninvasive ventilations techniques do you know?

A

CPAP (continuous positive airway pressure)

BiPAP (Bilevel Positive Airway Pressure)

28
Q

CPAP is given when PCO2 is __. Good for __ problems but not for __ problems.

A

normal
oxygenic
ventilation

29
Q

In CPAP the __ and __ pressure is equal. There is no changes in __.

A

inspiratory
expiratory
TV

30
Q

BiPAP adds __ pressure to encourage ventilation.

31
Q

BiPAP is good for patients with __ failure, __ PCO2, and combined problems of __ and __.

A

respiratory
elevated
oxygenation
ventilation

32
Q

In BiPAP the __ pressure is higher than the __. We want to increase the __ and __.

A

inspiratory
expiratory
TV
FRC

33
Q

Invasive ventilation is always with __ pressure.

34
Q

PEEP= __. Normally at the end of expiration pulmonary pressure=external pressure, PEEP keeps higher pressure in the lungs, preventing __ and __.

A

positive end expiratory pressure
collapse
FRC (Functional residual capacity)

35
Q

Minutes ventilation=+. We use it to control the __.

A

TV + RR

ventilation

36
Q

What are the 3 types of invasive mechanical ventilation?

A

volume controlled
pressure controlled
pressure support

37
Q

In volume controlled ventilation we set the maximum levels of __X liter/min (flow) X time. The volume dictates the length of the __. It can cause __.

A

TV
inspiration
barotrauma

38
Q

In pressure controlled ventilation we set the __ pressure. In this case we decide the __, __, __. The TV is determined by the chest __. less barotrauma.

A 
peak airway
TV
RR
FiO2 (Fraction of inspired oxygen)
PEEP
compliance
39
Q

In pressure support ventilation the __ dictate the __ and __ (the ventilation __ is of the __ alone).

A 
patient
RR
TV
trigger
patient
40
Q

In pressure support ventilation we control only the __ pressure and __.

A

inspiratory

FiO2

41
Q

Pressure support ventilation is for the following patients: 3

A

mild sedation

spontaneous breathing

42
Q

ECMO (__) is used for patients with severe __.

A

Extracorporeal membrane oxygenation

ARDS

43
Q

What is the main indications for tracheostomy?

A

> 7 days of mechanical ventilation

44
Q

What are the main neurological system disorders in the surgical ICU?

A 
confusion
delirium
encephalopathy
catatonic 
alcohol withdrawal syndrome
45
Q

Confusion is the most __neurological disorder in the surgical ICU, and is defined by __/__ disorientation, inability to perform ___, prolonged __.

A

common
time/place
simple tasks
drowsiness

46
Q

Delirium is in -% of a all patients in the ICU. Treatment involves ___ or other antipsychotic + treating the cause + avoiding __.

A

60-80
Haldol
benzodiazepine

47
Q

What are the three levels of encephalopathy?

A

obtundation (fatigue)
stupor- no response to deep stimuli
coma- keep airway and intubate

48
Q

Catatonic state is a risk factor for: 5

A 
MI
pneumonia
VTE
infections
pressure ulcer
49
Q

Delirium tremens occurs in __ withdrawal syndrome - days after. Symptoms include: 4

A 
alcohol
2-14
shivering
fever
tachycardia 
confusion/psychosis
seizures
50
Q

How do you treat alcohol withdrawal syndrome?

A

benzodiazepine

51
Q

Cardiovascular complications are very common in the surgical ICU, and appear in the first _ days post op.

52
Q

What are the common cardiovascular disorders found in the surgical ICU?

A 
ischemia/MI
cardiac arrest
tachyarrhythmia 
bradycardia
cardiogenic shock
53
Q

What is the most common respiratory disorder in the surgical ICU?

54
Q

How can you try and prevent VAP? 5

A 
Bed head elevation to 30 degrees
reduce sedation for spontaneous breathing  
mouth wash with chlorhexidine
prevent pressure ulcers
prevent VTE
55
Q

ARDS appears - hours after initial insult.

56
Q

ARDS is CXr will show __ __.

A

bilateral infiltrates

57
Q

How can you differentiate ARDS from a cardiogenic pulmonary edema?

A

PCWP<18 mmHg (feeling pressure is low/noraml)

58
Q

What are the 3 levels of ARDS?
mild- __
moderate- __
severe- __

A

PaO2/FiO2 < 300
PaO2/FiO2 < 200
PaO2/FiO2 <100

59
Q

What are the 3 stages of ARDS?

A

exudative (1-7 days)
proliferative (7-12)
fibrotic (late)

60
Q

What is the management of ARDS? 5

A 
minimal procedures
preventive VTE/aspiration/GIB
mechanical ventilation- + pressure, low volumes 
high PEEP to prevent alveolar collapse
limit hydration and diuresis
61
Q

What are the C/I for enteral feeding in the ICU? 4

A

bowel obstruction
enterocutaneous fistula
peritonitis
acute GIB

62
Q

Gastric residual volume > __ ml increases the risk for __.

A

500

aspiration

63
Q

What are the possible complications from TPN? 5

A 
hypertriglyceridemia
hyperglycemia
cholestasis
CLABSI (central line bloodstream infection)
refeeding syndrome
64
Q

What are the refeeding syndrome symptoms? 4

A

neuromuscular symptoms
rhabdomyolysis
cardiorespiratory failure
pancytopenia

65
Q

What TPN is made of? 5

A 
amino acids
lipids (omega 3)
dextrose
electrolytes/vitamins/minerals
glutamine
66
Q

עצרתי ברנלי

A

עצרתי ברנלי

Surgery final (Sabiston) (54 decks)

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