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Fa: Coexisting 2 > 5. Critical Care > Flashcards

5. Critical Care Flashcards

1
Q

essence of critical care

A

correcting the imbalance of disordered perfusion

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2
Q

shock

A

abnormality of circulatory system that causes inadequate organ perfusion and tissue oxygenation

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3
Q

hypodynamic shock

A

low cardiac index
vasoconstriction
inadequate BF

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4
Q

hyperdynamic shock

A

high cardia index
vasodilation
maldistribution of blood

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5
Q

types of hypodynamic shock

A

hypovolemic
cardiogenic
obstructive

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6
Q

hypovolemic shock

A

decr cardiac filling pressures

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7
Q

causes of hypovolemic shock

A

hemorrhage
dehydration
massive capillary leak

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8
Q

cardiogenic shock

A

normal cardiac filling pressures

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9
Q

most common cause of cardiogenic shock

A

acute MI involving 40% L ventricular mass

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10
Q

other causes of cardiogenic shock

A

cardiomyopathies
valvular lesions

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11
Q

obstructive shock

A

incr cardiac filling pressures

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12
Q

what causes change to cardiac filling pressure in obstructive shock?

A

incr cardiac filling pressures due to:
- outflow obstruction
- decr ventricular compliance

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13
Q

causes of obstructive shock

A

pericardial tamponade
acute pulm embolism
tension pneumothorax

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14
Q

type of hyperdynamic shock

A

septic
traumatic

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15
Q

septic shock

A

direct mediators of inflammation and tissue hyperperfusion result in cellular injury/organ dysfunction

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16
Q

traumatic shock

A

inflammatory mechanism
distributive immunologically mediated response to injury

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17
Q

traumatic shock results from

A

hemorrhage

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18
Q

what do sepsis and severe trauma have in common?

A

systemic inflammation

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19
Q

if you have a localized infection/trauma is the response localized or systemic?

A

typically localized

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20
Q

sepsis

A

life-threatening
organ dysfunction causes by dysregulated host response to infection

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21
Q

what type of dysfunction is sepsis?

A

circulatory
cellular/metabolic

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22
Q

sepsis hypoperfusion resuscitation

A

30 ml/kg over 3 hours

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23
Q

additional sepsis resuscitation is guided by

A

reassessment of vitals

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24
Q

with sepsis you need to ______ to guide treatment

A

diagnose the source of the sepsis to guide abx therapy

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25
Q

sepsis infection treatment

A

empirical broad-spectrum abx

within 1 hr of diagnosis

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26
Q

how often should you reasses abx choice in sepsis

A

1x daily

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27
Q

sepsis treatment is focused on

A

source control
(origin of infection)

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28
Q

when should you continue volume resuscitation in sepsis pts?

A

if the pt is responsive

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29
Q

what fluids should you not give sepsis pts

A

HES can cause renal injury
black box warning

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30
Q

what fluid do you want to give sepsis pts?

A

albumin to incr oncotic pressure

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31
Q

MAP goal in sepsis

A

65

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32
Q

vasopressor priority for sepsis pts

A

1: NE (beta/alpha)
2: epi (alpha/beta)
3: vasopressin

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33
Q

which drug to avoid in sepsis

A

dopamine causes arrythmias

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34
Q

inotrope of choice in sepsis

A

dobutamine

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35
Q

steroids _____ immune response

A

decr immune response

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36
Q

should you give steroids to sepsis pts who are stable?

A

NO

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37
Q

should you give steroids to sepsis pts who are unstable?

A

maybe - decr immune response may help curb sepsis symptoms

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38
Q

hb target for transfusion

A

7-10 g/dL

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39
Q

ventilator goals in sepsis-ARDS

A

normal CO2
SpO2 > 93%

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40
Q

sepsis-ARDS TV

A

4-6 mL/kg

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41
Q

sepsis-ARD RR

A

incr

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42
Q

sepsis-ARDS PEEP

A

increased

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43
Q

CVVH

A

continuous renal replacement therapy
(continuous dialysis commonly used in ICU)

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44
Q

CVVH rate

A

slower rate of solute and fluid removal

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45
Q

sepsis blood glu goal

A

Glu < 180 mg/dL

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46
Q

systemic inflammatory response syndrome (SIRS)

A
  • acute proinflammatory response mediated by incr in innate immune gene expression (SIRS)
  • anti-inflammatory response that modulate proinflammatory response (CARS)
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47
Q

proinflammatory response

A

cytokines

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48
Q

SIRS diagnosis

A

2+:
temp > 36-38C
HR > 90 bpm
RR > 20
PCO2 < 32 mmHg
WBC > 12 or < 4

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49
Q

SIRS pts ventialtion

A

hyperventilation
- respiratory compensation for metabolic process

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50
Q

how many stages of SIRS

A

5 (SIRS -> MODS)

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51
Q

MODS

A

multiorgan dysfucntion syndrome

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52
Q

Compensatory anti-inflammatory response syndrome (CARS)

A

body tries to regain immunological balance but overcompensates

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53
Q

CARS pts have incr susceptibility to

A

nosocomial infections

54
Q

Persistent inflammation, Immunosuppresion, and catabolism syndrome (PICS)

A

pt never fully recovers and requires constant ICU care

persistent genomic changes

55
Q

what equation is used to determine basal energy expenditure

A

Harris-Benedict equation
(BEE)

56
Q

stress _____ BEE

A

stress increases BEE

57
Q

minimally stressed

A

25 kcal/kg/day
~ 1.1 BEE

58
Q

post surgical stressed

A

30 kcal/kg/day

59
Q

sepsis stressed

A

30-35 kcal/kg/day

60
Q

burn stressed

A

35-40 kcal/kg/day
~ 2 BEE

61
Q

minimal stress protein need

A

1 g protein/kg/day

62
Q

burn pt protein need

A

2.5 g protein/kg/day

63
Q

ICU nutrition intake options

A

enteral
parenteral

64
Q

enteral nutrition

A

through gut
NG or nasojejunal tube

65
Q

parenteral nutrition

A

through vein
PICC line

66
Q

what % of calories needed to admin into gut to mx gut integrity?

A

50-60%

67
Q

overfeeding risks

A

incr O2 consumption
incr CO2 production
prolonged vent
immune suppression
hyperglycemia
incr infection risk

68
Q

when is overfeeding risk higher

A

actual body weight is&raquo_space; IBW

69
Q

refeeding syndrome

A

rapid initiation of enteral/parenteral feeding in malnourished pt

70
Q

refeeding syndrome SE

A

arrythmias
confusion
respiratory failure
death

71
Q

refeeding syndrome treatment

A

correct electrolyte and volume deficits
give thiamine before feeding
slow initiation of feeding

72
Q

Glu range

A

80-110 mg/dL (Van de berge)
140-180 mg/dL

73
Q

NICE-SUGAR result

A

incr in hypoglycemia
incr in mortality
due to too tight blood sugar control

74
Q

sick euthyroid syndrome

A

Low T3 state (acute)
Low T4 state

75
Q

Low T3 in sick euthyroid timeline

A

< 24 hrs

76
Q

Low T4 in sick euthyroid timeline

A

T4 decline correlates with more severe illness

77
Q

mortality and T4 levels

A

T4 levels < 2 ug/dL indicate 80% risk of mortality

78
Q

can you treat sick euthyroid w/thyroid hormones?

A

no indication that hormone replacement helps

79
Q

Relative adrenal insufficiency

A

inability of adrenal gland to produce enough adrenocortical steroids to supply need

80
Q

primary adrenal insufficiency

A

autoimmune system destroys 90% of adrenal cortex

81
Q

secondary adrenal insufficiency

A

low ACTH levels

82
Q

primary cause of secondary adrenal insufficiency

A

sepsis

83
Q

other causes of secondary adrenal insufficiency

A

impaired pituitary ACTH release
reduction in cortisol synth
impaired cortisol transport
impaired response to cortisol

84
Q

acute renal dysfunction occurs in ____ of ICU pts

A

1/3 of ICU pts

85
Q

acute renal dusfunction S+S

A

hypotension
sepsis
nephrotoxic drugs

86
Q

acute renal dysfunction risks

A

age
kidney disease
oliguria < 400 ml/day
sepsis

87
Q

what scale defines severity of acute renal dysfucntion

A

KDIGO

88
Q

KDIGO 1

A

1.5-1.9 fold Cr
Cr > 0.3 mg/dL in 48hrs
urine < 0.5 ml/kg/hr 6 hrs

89
Q

KDIGO 2

A

2-2.9 fold Cr
< 0.5 ml/kg/hr 12 hrs

90
Q

KDIGO 3

A

> 3 fold cr
4 mg/dL cr
< 0.3 ml/kg/hr for 24 hrs

91
Q

scales used to direct sedation

A

RASS

Sedation-Agitation scale

92
Q

delerium

A

altered level of consciousness
decr ability to focus and change cognition

93
Q

resuscitation

A

treat deficit and ongoing losses

94
Q

maintenance

A

treat normal daily fluid lose

95
Q

Adjusted body weight =

A

IBW + 1/3*(ABW-IBW)

96
Q

ICU mx fluid

A

hypotonic
5% dextrose

97
Q

resuscitation fluids

A

crystalloids
dextroses free

98
Q

IV volume

A

25% of ECV

99
Q

interstitial volume

A

75% of ECV

100
Q

LR risks

A

hyponatremia in prolonged use

101
Q

LR Na+

A

130 mEq/L

102
Q

Normal saline Na+/Cl-

A

154 mEq/L

103
Q

NS risks

A

hyperchloremia metabolic acidosis

104
Q

hypertonic saline admin

A

central line

105
Q

3% saline risks

A

acid/base and electrolyte imbalances

106
Q

which pts cannot receive albumin

A

TBI

107
Q

enteral feeds pt NPO status

A

NPO bypass stomach

108
Q

TPN changes before surgery

A

cut rate by 1/4-1/2 prior to surgery
do not stop entirely

109
Q

universal donor

A

O-

110
Q

antibodies screened in cross match

A

kidd
kell
duffy

111
Q

pts with higher risk for transfusion complications

A

previous transfusions
prior pregnancy

112
Q

surgical site infections (SSI) types

A

superficial inciisional
deep incisional
organ/organ space

113
Q

SSI risk factors: pts

A

elderly
immunosuppression
obese
DM
smoking
renal failure
chronic inflammation
PVD
microbial carrier

114
Q

SSI risk factors: procedure

A

duration
hypoxemia
hyperthermia
abx
skin/instrument sterility

115
Q

SSI preventitive measures

A

skin prep
normoglycemia
normothermia
avoid hypoxemia
Abx

116
Q

SSI abx timeline

A

within 60 mins of SSI

117
Q

how long does it take abx to circulate

A

20 mins

118
Q

total joint VTE prophylaxis

A

10-14 days post-op

LMWH
fondaparinux
apixaban
dabigatran
rivaroxaban
warfarin
aspirin
compression

119
Q

hip fracture VTE prophylaxis

A

LMWH 12+ hrs prior to surgery

120
Q

high VTE risk / low bleed risk

A

LMWH + compression

121
Q

high bleed risk

A

compression only

122
Q

options if heparin is CI

A

aspirin
fondaparinux
compression

123
Q

DM and HbA1C

A

HbA1C has lower O2 carrying capacity in DM

124
Q

DM rirsk

A

incr CAD
incr PVD
decr GI motility
ETC

125
Q

elevated A1C correletes with

A

incr complication rates

126
Q

steroid dosing in OR

A

recommended for all pts who have received steroid in the last year

127
Q

glucocorticoid mech

A

mediate catecholamine induced incr in contractility and vascular tone

128
Q

glucocorticoid SE

A

abnormal would healing
incr infection

129
Q

body temp is controlled by

A

neg feedback loop in hypothalamus

130
Q

hypothermia complications

A

cardiac arrythmias
wound infection
coagulopathy
prolonged recovery

131
Q

ICU transport go bag

A

airway supply
vasopressors
atropine
sux
muscle relaxant
narcotic
sedative
flushes/alcohol

132
Q

CI to ICU transport

A

inability to adequately oxygenate/ventilate
HD unstable

Fa: Coexisting 2 (7 decks)

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