5- it's ok

Question 1

dose of steroids for shock

Answer 1

Dose: 50 IV q6hrs (for 200 total)

Question 2

why is there adrenal hemorrhage in sepsis

Answer 2

overstimulation and when the central vein is occluded

Question 3

1. Who is a bad candidate for POLST

Answer 3

Anyone who isn’t critically/seriously ill or frail 2/2 old age

Question 4

a. Considerations of ready to wean

Answer 4

i. Off pressors
ii. Fix cause of resp failure
iii. FiO2 <40 & PEEP 5 adequate oxygenation
iv. CNS intact (triggers, commands, airway protection)
v. no doom feels
vi. ABC, delirium, exercise = Loyola bundle

Question 5

if resistance high, consider: and tx:

Answer 5

i. DDx: clogged tubing, mucous plug, biting ETT, Bronchospasm 

ii. Tx possibilities: suction, nebs, call RT, increase sedation

Question 6

if compliance low, consider ddx: and tx:

Answer 6

i. DDx: Vt too high, ARDS, Infection, Pulm edema, PNA 


ii. Tx possibilities: get CXR, ↓Vt, treat cause 


Question 7

If ↑ Peak with normal Plateau=

Answer 7

↑ airway resistance problem

nl<10

Question 8

If ↑ Peak with ↑ Plateau=

Answer 8

↓compliance problem

nl > 60

Question 9

ARDS criteria

Answer 9

a. Diffuse bilateral patchy opacities

b. PaO2/FiO2 <300 (Berlin Criteria; nl =500)
i. <200 moderate
ii. <100 severe
iii. PaO2/0.21 = nonevent patient

c. Normal PCWP or no clinical evidence CHF/fluid overload

Question 10

1. Tidal volumes for ARDS

Answer 10

a. Low!

b. 6cc/kg IBW

Question 11

1. When to use Tylenol in ARDS

Answer 11

a. Fever reduction as part of salvage therapy or to decrease VO2

Question 12

1. CABG vs PCI indications

Answer 12

a. More than 2 areas to stent, critical left main or early RCA stenosis or unable to get sufficient TIMI flow CABG

Question 13

1. PCI vs thrombolytics

Answer 13

a. PCI unless in Podunk area without access
i. Don’t load with abciximab if going to cath lab in case they will need cabg
b. GOAL revascularize within 90 minutes ideally

Question 14

Which sedative doesn’t decrease respiratory drive

Answer 14

precedex

Question 15

dose for NE

Answer 15

i. Dose 0.01 – 3 mcg/kg/min

Question 16

receptor for NE

Answer 16

a. alpha 1 > B1 (INCR SVR w/ less CO change)

Question 17

1. Is dobutamine a inotrope, dilator, constrictor

Answer 17

a. Positive inotrope and vasodilator

Question 18

What to check after paralysis

Answer 18

a. Train of four (titrate to 1-2 twitches of 4 stimulations)

Peripheral nerve stimulation

Question 19

Normal MVPO2 and SVO2

Answer 19

a. mvPO2 = 40

b. SvO2 = 75%

Question 20

side effects NG tube

Answer 20

diarrhea, decreased GI motility

Question 21

side effects of TPN

Answer 21

infection/infiltration, rising LFTs, hyperglycemia

Question 22

1. What feeds to give if trying to decrease free water intake

Answer 22

Higher calorie density formulas (eg 2calHN) name indicates calories per mL

Question 23

1. Refeeding syndrome labs

Answer 23

a. Low phosphate, mag, K, thiamine
i. Check q12hrs
ii. K+, Phos, Mg with aggressive IV repletion if needed

b. Elevated glucose
c. decrease provision of kcals by ~ 50% until electrolytes are corrected

Question 24

Metabolic Alkalosis: (increased HCO3), d/t

Answer 24

1. Intravascular volume contraction (loss via GI, renal, resp, skin, or 3rd spacing)
2. Hypokalemia

3. Vomiting / NG suction

4. Increased glucocorticoids or mineralocorticoids
5. Alkali intake (HCO3 infusion, milk alkali syndrome)

6. Bartter’s syndrome (genetic defect in Na/Cl/K pump– acts as loop diuretic)

Question 25

i. Respiratory Alkalosis

Answer 25

(CHAMPS breathe fast): 1. CNS (catastrophic CVA) or Cirrhosis
 2. Hypoxia / Hyperventilation
 3. Anxiety / Pain 4. Mechanical ventilation
 5. Progesterone / pregnancy / pulmonary (fibrosis, edema, pneumonia) 6. Sepsis / salicylates