321 Approach to the Patient with Critical Illness
 Flashcards

1
Q

It is the presence of multisystem end-organ hypoperfusion

A

Shock

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2
Q

What are the clinical indicators of shock?

A
Reduced mean arterial pressure (MAP)
Tachycardia
Tachypnea
Cool skin and extremities
Acute altered mental status
Oliguria
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3
Q

Clinical evidence of diminished cardiac output

A

Narrow pulse pressure

Cool extremities with delayed capillary refill

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4
Q

Clinical evidence of increased cardiac output

A

Widened pulse pressure (particularly with a reduced diastolic pressure)
Warm extremities with bounding pulses
Rapid capillary refill

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5
Q

It is a better predictor of fluid responsiveness

A

Change in right atrial pressure as a function of spontaneous respiration

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6
Q

It is the most common cause of high-cardiac-output hypotension

A

Sepsis

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7
Q

Other causes of high cardiac hypotension

A
Liver failure,
Severe pancreatitis
Burns and other trauma that elicit the systemic inflammatory response syndrome (SIRS)
Anaphylaxis
Thyrotoxicosis
Peripheral arteriovenous shunts
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8
Q

Reasons for the institution of endotracheal intubation and mechanical ventilation

A

Acute hypoxemic respiratory failure

Ventilatory failure

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9
Q

It often occurs as a consequence of an increased load on the respiratory system in the form of acute metabolic (often lactic) acidosis or decreased lung compliance due to pulmonary edema

A

Ventilatory Failure

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10
Q

This type of respiratory failure occurs with alveolar flooding and sub- sequent intrapulmonary shunt physiology

A

TYPE I: ACUTE HYPOXEMIC RESPIRATORY FAILURE

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11
Q

This type of respiratory failure is seen in sepsis, gastric aspiration, pneumonia, near drowning, multiple blood transfusions, and pancreatitis

A

TYPE I: ACUTE HYPOXEMIC RESPIRATORY FAILURE

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12
Q

This syndrome is defined by acute onset (≤1 week) of bilateral opacities on chest imaging that are not fully explained by cardiac failure or fluid overload and of shunt physiology requiring positive end-expiratory pressure (PEEP)

A

ARDS

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13
Q

This type of respiratory failure is a consequence of alveolar hypoventilation and results from the inability to eliminate carbon dioxide effectively

A

TYPE II RESPIRATORY FAILURE

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14
Q

The mechanisms involved in this type of respiratory failure are categorized by impaired central nervous system (CNS) drive to breathe, impaired strength with failure of neuromuscular function in the respiratory system, and increased load(s) on the respiratory system

A

TYPE II RESPIRATORY FAILURE

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15
Q

Examples of conditions in this type of respiratory failure are drug overdose, brainstem injury, sleep disordered breathing, and severe hypothyroidism, myasthenia gravis, Guillain-Barré syndrome, amyotrophic lateral sclerosis, myopathy, electrolyte derangements, and fatigue

A

TYPE II RESPIRATORY FAILURE

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16
Q

What is the mainstays of therapy for type II respiratory failure?

A

Reverse the underlying cause(s) of ventilatory failure

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17
Q

Subclassification of overall load on the respiratory system

A

Resistive Loads (bronchospasm)

Loads due to reduced lung compliance (e.g., alveolar edema, atelectasis, intrinsic positive end-expiratory pressure [auto-PEEP]

Loads due to reduced chest wall compliance (e.g., pneumothorax, pleural effusion, abdominal disten- tion)

Loads due to increased minute ventilation requirements (e.g., pulmonary embolus with increased dead-space fraction, sepsis)

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18
Q

This form of respiratory failure results from lung atelectasis

A

TYPE III RESPIRATORY FAILURE

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19
Q

This is also called preoperative respiratory failure

A

TYPE III RESPIRATORY FAILURE

20
Q

This form of respiratory failure results from hypoperfusion of respiratory muscles in patients in shock

A

TYPE IV RESPIRATORY FAILURE

21
Q

Screening criteria for spontaneous breathing trial

A

oxygenation is stable (i.e., PaO2/FIO2 [partial pressure of oxygen/fraction of inspired oxygen] >200 and PEEP ≤5 cmH2O)

Cough and airway reflexes are intact
No vasopressor agents or sedatives are being administered

22
Q

Criteria for failure of spontaneous breathing trial

A

(1) respiratory rate >35/min for >5 min
(2) O2 saturation <90%
(3) heart rate >140/min or a 20% increase or decrease from baseline
(4) systolic blood pressure <90 mmHg or >180 mmHg
(5) increased anxiety or diaphoresis.

23
Q

What is the mainstay of therapy for pain control in mechanically ventilated patients?

A

Opiates

24
Q

Indications for sedation

A

Anxiolysis

Treatment of subjective dyspnea

Psychosis

Facilitation of nursing care

Reduction of autonomic hyperactivity, which may precipitate myocardial ischemia

Reduction of total O2 consumption (VO2)

25
Q

It is defined by the simultaneous presence of physiologic dysfunction and/or failure of two or more organs

A

MULTIORGAN SYSTEM FAILURE

26
Q

It is the gold standard for evaluation of respiratory gas exchange

A

ABG

27
Q

Two variables that determine the peak airway pressure

A

Airway resistance

Respiratory system compliance

28
Q

The difference between the peak (airway resistance + respiratory system compliance) and plateau (respiratory system compliance only) airway pressures provides a quantitative assessment of?

A

Airway resistance

29
Q

It is defined by the change in pressure of the respiratory system per unit change in volume

A

Lung compliance

30
Q

Normal respiratory system compliance

A

~100 mL/cmH2O

31
Q

Processes that reduce chest wall compliance

A

Pleural effusions, pneumothorax, and increased abdominal girth

32
Q

Conditions that reduce lung compliance

A

Pneumonia, pulmonary edema, interstitial lung disease, or auto-PEEP

33
Q

It is determined by the hemoglobin concentration, the arterial hemoglobin saturation, and dissolved O2 not bound to hemoglobin

A

Content of O2 in the arterial blood (CaO2)

34
Q

Oxygen delivery (QO2) in normal adult is equal to

A

1058 mL O2 per min

35
Q

Conditions that reduced mixed venous O2 saturation

A

Inadequate cardiac output

Reduced hemoglobin concentration

Reduced arterial O2 saturation

36
Q

Conditions that may abnormally increased VO2 in peripheral tissues

A

Fever, agitation, shivering, and thyrotoxicosis

37
Q

It is defined as the presence of SIRS in the setting of known or suspected infection

A

Sepsis

38
Q

It is the leading cause of death in noncoronary ICUs in the United States

A

Sepsis

39
Q

All ICU patients are at high risk for this complication because of their predilection for immobility

A

DVT

40
Q

DVT Prophylaxis

A

Subcutaneous low-dose heparin injections and sequential compression devices for the lower extremities, Enoxaparin, Fondaparinux

41
Q

Stress ulcer prophylaxis

A

Histamine-2 antagonists or proton pump inhibitors

42
Q

These are important issues that may be associated with respiratory failure, impaired wound healing, and dysfunctional immune response in critically ill patients

A

NUTRITION AND GLYCEMIC CONTROL

43
Q

This state is defined by (1) an acute onset of changes or fluctuations in mental status, (2) inattention, (3) disorganized thinking, and (4) an altered level of consciousness (i.e., a state other than alertness)

A

Delirium

44
Q

True or False: Very early physical and occupational therapy in mechanically ventilated patients has been demonstrated to reduce delirium

A

True

45
Q

Treatment for vasospasm

A

Nimodipine, aggressive IV fluid administration, and therapy aimed at increasing blood pressure

46
Q

It is the most effective benzo- diazepine for treating status epilepticus and is the treatment of choice for controlling seizures acutely

A

Lorazepam