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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
What is the treatment for neurogenic shock? 4
massive hydration + Vasopressors fixation steroids surgery
26
What are the characteristics of septic shock?5
``` tachycardia elevated CO hypotension decreased preload warm periphery ```
27
What noninvasive ventilations techniques do you know?
CPAP (continuous positive airway pressure) | BiPAP (Bilevel Positive Airway Pressure)
28
CPAP is given when PCO2 is __. Good for __ problems but not for __ problems.
normal oxygenic ventilation
29
In CPAP the __ and __ pressure is equal. There is no changes in __.
inspiratory expiratory TV
30
BiPAP adds __ pressure to encourage ventilation.
driving
31
BiPAP is good for patients with __ failure, __ PCO2, and combined problems of __ and __.
respiratory elevated oxygenation ventilation
32
In BiPAP the __ pressure is higher than the __. We want to increase the __ and __.
inspiratory expiratory TV FRC
33
Invasive ventilation is always with __ pressure.
positive
34
PEEP= __. Normally at the end of expiration pulmonary pressure=external pressure, PEEP keeps higher pressure in the lungs, preventing __ and __.
positive end expiratory pressure collapse FRC (Functional residual capacity)
35
Minutes ventilation=_+_. We use it to control the __.
TV + RR | ventilation
36
What are the 3 types of invasive mechanical ventilation?
volume controlled pressure controlled pressure support
37
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 __.
TV inspiration barotrauma
38
In pressure controlled ventilation we set the __ pressure. In this case we decide the __, __, __. The TV is determined by the chest __. less barotrauma.
``` peak airway TV RR FiO2 (Fraction of inspired oxygen) PEEP compliance ```
39
In pressure support ventilation the __ dictate the __ and __ (the ventilation __ is of the __ alone).
``` patient RR TV trigger patient ```
40
In pressure support ventilation we control only the __ pressure and __.
inspiratory | FiO2
41
Pressure support ventilation is for the following patients: 3
mild sedation | spontaneous breathing
42
ECMO (__) is used for patients with severe __.
Extracorporeal membrane oxygenation | ARDS
43
What is the main indications for tracheostomy?
> 7 days of mechanical ventilation
44
What are the main neurological system disorders in the surgical ICU?
``` confusion delirium encephalopathy catatonic alcohol withdrawal syndrome ```
45
Confusion is the most __neurological disorder in the surgical ICU, and is defined by __/__ disorientation, inability to perform ___, prolonged __.
common time/place simple tasks drowsiness
46
Delirium is in _-_% of a all patients in the ICU. Treatment involves ___ or other antipsychotic + treating the cause + avoiding __.
60-80 Haldol benzodiazepine
47
What are the three levels of encephalopathy?
obtundation (fatigue) stupor- no response to deep stimuli coma- keep airway and intubate
48
Catatonic state is a risk factor for: 5
``` MI pneumonia VTE infections pressure ulcer ```
49
Delirium tremens occurs in __ withdrawal syndrome _-_ days after. Symptoms include: 4
``` alcohol 2-14 shivering fever tachycardia confusion/psychosis seizures ```
50
How do you treat alcohol withdrawal syndrome?
benzodiazepine
51
Cardiovascular complications are very common in the surgical ICU, and appear in the first _ days post op.
3
52
What are the common cardiovascular disorders found in the surgical ICU?
``` ischemia/MI cardiac arrest tachyarrhythmia bradycardia cardiogenic shock ```
53
What is the most common respiratory disorder in the surgical ICU?
VAP
54
How can you try and prevent VAP? 5
``` Bed head elevation to 30 degrees reduce sedation for spontaneous breathing mouth wash with chlorhexidine prevent pressure ulcers prevent VTE ```
55
ARDS appears _-_ hours after initial insult.
12-36
56
ARDS is CXr will show __ __.
bilateral infiltrates
57
How can you differentiate ARDS from a cardiogenic pulmonary edema?
PCWP<18 mmHg (feeling pressure is low/noraml)
58
What are the 3 levels of ARDS? mild- __ moderate- __ severe- __
PaO2/FiO2 < 300 PaO2/FiO2 < 200 PaO2/FiO2 <100
59
What are the 3 stages of ARDS?
exudative (1-7 days) proliferative (7-12) fibrotic (late)
60
What is the management of ARDS? 5
``` minimal procedures preventive VTE/aspiration/GIB mechanical ventilation- + pressure, low volumes high PEEP to prevent alveolar collapse limit hydration and diuresis ```
61
What are the C/I for enteral feeding in the ICU? 4
bowel obstruction enterocutaneous fistula peritonitis acute GIB
62
Gastric residual volume > __ ml increases the risk for __.
500 | aspiration
63
What are the possible complications from TPN? 5
``` hypertriglyceridemia hyperglycemia cholestasis CLABSI (central line bloodstream infection) refeeding syndrome ```
64
What are the refeeding syndrome symptoms? 4
neuromuscular symptoms rhabdomyolysis cardiorespiratory failure pancytopenia
65
What TPN is made of? 5
``` amino acids lipids (omega 3) dextrose electrolytes/vitamins/minerals glutamine ```
66
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Surgery final (Sabiston) (54 decks)

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