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ÅJJB 5th year > A&E > Flashcards

A&E Flashcards

1
Q

3 complications with central venous catheter

A

infection
rupture of artery
PTX

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2
Q

Daily protein calorie intake

A

daily requirement in critical care - 1.5-2 g/kg/day

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3
Q

What are the typical symptoms of a patient with renal failure?

A
  • metabolic acidosis, hyperkalemia
  • pulmonary edema
  • increase in BUN
  • loss of consciousness
  • uremic encephalopathy
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4
Q

When a patient has DKA when should we stop giving insulin?

A

when blood glucose becomes normal

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5
Q

When a patient has hyperkalemia, what doe we see on the ECG?

A
  • peaked T waves on preicordial leads
  • Lengthening of QRS interval
  • U waves
  • Widening and flattening of P wave, which eventually disappears
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6
Q

Lethal triad

A

coagulopathy
hypothermia
metabolic acidosis

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7
Q

What is the lethal triad?

A
  • coagulopathy
  • hypothermia
  • metabolic acidosis
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8
Q

Treatment for hyperkalemia

A
  • insulin glucose
  • calcium-gluconate IV
  • hemodialysis
  • beta agonist - activates Na/K pump moving K into the cells
  • if there is metabolic acidosis give sodium bicarbonate
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9
Q

Post-op how to decrease O2 demand to brain

A

cannot

  • maintain BP
  • control pain
  • minimize sediation
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10
Q

Symptomatic treatment o bradycardia

A
  • Atropine 500 mcg IV (0.5mg) for a max 3 times
  • isoprenaline
  • adrenaline
  • glycopyrrole
  • dopamine
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11
Q

what are 3 applications of EtCO2

A
  • noninvasive technique which measures the partial pressure or maximal concentration of CO at the end of the exhaled breath (normal 35-45mmHg)
  • can be used to detect metabolic acidosis
  • used during CPR for assessment of ROSC
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12
Q

What is the treatment for DKA?

A

fluid resuscitation - isotonic saline (crystalline) soln - IV 0.9% NaCl

potassium repletion when under < 5.3 mEq/L

insulin therapy - short acting once the potassium level is >3.3 mEq/L

treat reciprocating causes

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13
Q

When does Low anion gap metabolic acidosis occurr?

A

It is very rare

eg.
- low albumin levels
- hypophosphatemia
- bromide intoxication
- high concentration of lithium
- very high concentration of positive ion
e.g. hypercalemia, hyperkalemia, hypermagnesmia, hypercholesterolemia

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14
Q

Name 3 antibiotics used to treat Pseudomonoas

A
  • piperacilin-Tazobactam
  • carbapenems
  • fluroquinolones
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15
Q

5 reasons AMI can cause cardiogenic shock

A

wall rupture (late phase)
arrhythmia
valvular dysfn (papillary muscle necrosis)
decreased contractility
wall rupture –> tamponade

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16
Q

How to calculate pulmonary MAP

A

1/2 SBP + 2/3 DAP

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17
Q

4 IV anesthetics

A

Thiopental - barbituate 3-6mg/kg
Midazolam - benzodiazapem - 0.01 - 0.1 mg/kg
Propofol - 2-4 mg/kg
Ketamine - 1-5mg/kg

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18
Q

Caloric value of carbohydrates

A

should be 60-80% of nutrition
4.3 Kcal/g

max glucose for ICU patient is 5 mg/kg/min

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19
Q

How many joules do we use of the defribillator for infants/children

A

4 Joules/kg

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20
Q

Normal ABG values

A

pH 7.35 - 7.45
PaO2 75 - 100 mmhg
PaCO2 34 - 35 mmHg
HCO3- 22 - 28 mmol/L
BE 2 - -2 mEq/L

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21
Q

First line tx for PTX

A

respiratory support and tx dyspnea
immediate tube thoracostomy

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22
Q

Formula for Cardiac Output

A

CO = SV x HR

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23
Q

3 antibiotics against MRSA

A

vancomycin
doxycycline (skin MRSA)
linezold
trobamycin

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24
Q

What are the 4 T’s

A

tension pneumothorax
cardiac tamponade
thrombosis - coronary or pulmonary
toxins

They are reverisble

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25
Q

first choice treatment for bradycardia

A

atropine - 500 mcg

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26
Q

Name preemptive analgesics

A

opioid
NSAID

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27
Q

Indications to give Bicarbonate

A

CPR when there is severe acidosis : pH < 7.1
Strong suspicion of metabolic acidosis
correct hyperkalemia

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28
Q

What are 5 uses of end tidal CO2 during CPR?

A

PQRST
P - placement of endotracheal tube
Q - quality of compressions
R - ROSC - return of spontaneous circulation
S - situation
T - termination

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29
Q

Anaphylatic shock symptoms

A

ABCDE

A - wheezing (broncoconstriction)
B - dyspnea
C - hypotension, skin: hives, itching, urticaria, angioedema
D - dizziness, fainting
E - nausea, vomitting

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30
Q

Formula for Mean Arterial Pressure

A

SBP + 2DBP. / 3

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31
Q

Type 1 respiratory failure

A

hypoxemia without hypercapnia

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32
Q

Difference between CRRT and IRRT

A

CRRT - continuous renal replacement therapy
- over 24 hours
- slow type of dialysis
- better hemodynamic stability

IRRT - intermittant renal replacement therapy
- performed for less than 24 hours, 2-7 times per week

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33
Q

Antidote for opiates,

A

naloxone

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34
Q

what are the 5 P’s in the circulation part of ABCDE

A

pain
pallor
pulse
paresthesia
paralysis

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35
Q

What is the dose of epinephrine and how do you give it to a patient in the ICU?

A

infusion
0.01-0.03 microgram/Kg/min

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36
Q

formula for oxygen delivery

A

DO2 = [(1.34 x Hgb x SaO2) + (PaO2 x .003)] x CO

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37
Q

What is the EtCO2?

A

35-45 mmHg

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38
Q

3 sublingual antihypertensive drugs and their doses

A

nitrates, ACEi, niflodipine
- captopril - 25 mg
- nifedipine - 10 mg
- prozasin - 2 mg

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39
Q

What is Euglycemic Ketoacidosis?

A

some of the newer antidiabetic drugs such as Empagliflozin (SGLT2i) are causing it

same symptoms as DKA but normal blood sugar

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40
Q

Bicarbonate dosage for DKA

A

100 mmol/L

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41
Q

4 symptoms of shock

A

MOF
urine output <0.5 mL/kg/hr
loss of consciousness
confused
GI: absent bowel sounds

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42
Q

Name 3 non-invasive airway measures

A

Head Chin tilt
Eschmark
CPAP
BiPAP
Bg mask

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43
Q

Injection site for spinal anesthesia

A
  • usually below L2 to avoid damage to spinal cord
  • needle is inserted into subarachnoid space between arachnoid and pia mater
44
Q

When can we determine that the patient has renal failure?

A

We check the urine output - if it is lower than 1/2 mL/kg/hr - that means that the GFR is taking too long

45
Q

When treating for DKA when should the patient be given sugar (glucose)?

A

when the blood glucose level is below 15 - then continue the insulin therapy and start glucose
afterwards it should be slowed down and be stopped when blood glucose becomes normal

46
Q

Tx for acute hyperkalemia

A

IV calcium gluconate

with more time:
- insulin + glucose
- NaHCO3-
- loop diuretics (furosemide)

47
Q

What are the 3 types of renal failure?

A
  1. Prerenal failure - decrease in blood flow to kidney causing a decrease in intraglomerular pressure
  2. Intrarenal/Intrinsic failure - intrinsic renal damage
  3. Postrenal failure - obstructive causes, which lead to congestion of the filtration system leading to a shift in the filtration driving forces
48
Q

What are the 5 indications for dialysis?

A

AEIOU
- acidosis
- electrolytes (K>7 mmol/L)
- intoxication
- overload with fluid
- uremia

49
Q

Largest peripheral Needle

A

14 G

50
Q

Describe interosseous line

A

used in emergencies (burns, dehydration, heart attack) needle inserted through the bone cortex into the marrow
in the anteriormedial tibia or humus or femur

51
Q

Caloric value for lipids

A

9.1 kcal/g

lipid oxidation is limited

52
Q

Formula for osmolarity

A

osmolarity = 2 Na + glucose + urea (mmol/L)

53
Q

name 5 opiods commonly used

A

sufentanyl
rumifentanyl
tramadol
morphine
fentanyl

54
Q

3 ways to measure cardiac output

A

doppler ultrasound
pulse pressure methods
impedence cardiography
MRI
transpulmonary thermodilution

calculate CO=SV x HR

55
Q

4 IV anesthetics

A

thiopental (barbituate)
Midazolam (benzodiazepem)
Propofol
Ketamine

56
Q

How do you know a patients airway is obstructed?

A

paradoxical movment

57
Q

What is the definition of shock?

A

Acute hemodynamic disorder (micro and macrocirculatory) independent of the cause which leads to insufficient oxygen supply and tissue hypoxia

58
Q

What is the correction for symptomatic bradycardia?

A
  • isoprenaline 5 microg/min
  • adrenaline 2-5 microg

atropine - 0.5 mg
maximum of 3mg
every bolus can only be 0.5 mg

59
Q

3 symptoms of upper GI bleeding

A
  • hematemesis
  • melena
  • drop of BP, lightheadedness
60
Q

Caloric value of protein

A

4 kcal/gram

61
Q

What is the 60-40-20 rule?

A

total body water 60% of weight in kg
intracellular fluid 40%
extracellular fluid 20%

62
Q

Criteria for empty stomach before surgery

A

clear fluids - 2 hours

breast milk - 4 hours

nutritional drinks, solid foods - 6 hours

63
Q

formula of osmolarity

A

Calculated osmolarity = 2 (Na+) + 2 (K+) + Glucose + Urea (all in mmol/L)

64
Q

What is different about child CPR and adult CPR?

A

Compression rate: 100–120/minute

Compression-to-breath ratio:
Single rescuer: 30:2
Two rescuers: 15:2

Postpubertal children/ adolescents: Same CPR technique as for adults

Children ≥ 1 year of age until puberty
Chest compressions: Deliver with one hand/2 fingers for smaller children.
Compression depth: 5 cm

Infants < 1 year old
Compression depth: 4 cm
Rescue breaths: Form a seal over both the nose and mouth.

hypoxia is the main cause of cardiac arrest in children

65
Q

Why is there metabolic acidosis in renal failure?

A

loss of bicarbonate and low filtration of acids
e.g. uric acids

66
Q

Difference between dehydration and hypovolemia

A

Hypovolemia - intravascular fluid is lost
- a condition where the extracellular fluid volume is reduced and it sresults in decreased tissue perfusion. It can be caused by salt and water loss

Dehydration - intravascular and extravascular is lost

67
Q

What are we investigating when we do an ultrasound during CPR?

A

1 H and 3 T’s - reversible causes

  • Subxiphodial/substernal are for cardiac tamponade and Pulmonary embolism
  • pleural sliding for PTX
  • IVC for hypovolemia
  • dilation of right side of heart for hypervolemia
68
Q

What are some non-nephrological indications for hemodialysis?

A
  • intoxication
  • hypothermia
69
Q

What does metabolic alkalosis cause

A

vomit
diarrhea

70
Q

3 indications of central venous line

A

fluids
dialysis
long hospital stay
icu

71
Q

Give 4 indications for acute renal dialysis

A
  • hyperkalemia
  • uremic encephalopathy or cardiomyopathy
  • persistent metabolic acidosis
  • fluid overload
72
Q

Gynecological emergencies in ICU

A

placental abruption
miscarriage
ectopic pregnancy
acute PID
pelvic endometriosis

73
Q

How do you differentiate between high and non-high metabolic acidosis?

A
  • anion gap
  • renal function – for osmolarity and for oxylate crystals - indicator for intoxication)
  • hepatic function
74
Q

Why do patients with DKA need lots of fluids?

A

due to the high glucose that goes to the kidney tubules –> there is osmotic activity and lots of water is pulled with the glucose that is being urinated

75
Q

3 inotropes

A

Dobutamine
Milirone
Dopamine
E
NE

76
Q

HCO3- dosage for DKA

A

100 mmol

77
Q

3 indications for systemic thrombolysis

A
  • Massive PE and acceptable risk of bleeding complications
  • Ischemic Stroke
  • New hemodynamic instability
  • Severe right ventricular (RV) dysfunction by chest CT scan (RV:LV ratio > 0.9)
78
Q

IV antihypertensives

A
  • CCB - Nicardipine
  • nitroglycerin
  • direct acting vasodilator - hydralazine
  • selective beta 1 blocker - esmolol
  • ACE inhibitor: enalaprilat
79
Q

Normal range of Lactic Acid

A

< 2 mmol/L

80
Q

Name 3 non-invasive airway measurements

A
  • head chin tilt
  • eschmark
  • bipap or cpap
  • oxygen
  • bag mask
81
Q

What are the top nosocomial bacterias?

A

Pseudomonas
MRSA
Klebsiella
Acinetobacter

82
Q

Antidote for Benzodiazepine

A

Flumazenile

83
Q

NSAID Side effects

A

ulcer
renal function impairment
heart attack or stroke
aplastic anemia
allergy

84
Q

Parameters in mechanical ventilation

A

FIo2 - fraction of inspired O2
PEEP - positive end expiratory Pressure - in the alveoli at end of expiration
Tidal Volume - normal breath

Mode:
- assisted control
- intermediate mandatory ventilation or pressure support
CPAP, BiPAP, FiO2, tidal volume and RR will change the alveolar ventilation and positive end expiratory pressure (PEEP)

85
Q

septic shock definition

A

a type of septic shock caused by excessive inflammatory response to disseminated infection, which leads to etravasation from the vascular space and loss of intravascular volume

86
Q

atmospheric pressure in mmHg and mmH2O

A

760 mmHg
10332.276 mmH2O

87
Q

What are the ways to decrease intracranial pressure

A

head elevation - venous return (15-30 degrees)
liquor drainage (ventricular drain)
MAP elevation
Mannitol

88
Q

General daily calorie intake

A

1600-2400 calories/day for women
2000-3000 calories/day for men

BMR men = 66 + (13.7 x weight) + (5 x height in cm) - (6.7 usage in year)
BMR women = 65.5 + (9.6 x weight in kg) + (1.7 x height) - (4.7 x age in years)

89
Q

4 organ systems in septic shock

A

kidney
liver
heart
brain

90
Q

Layers that must be penetrated for for spinal anesthesia

A

skin
subcutaneous fat
supraspinal ligament
intraspinal ligament
ligamentum flavum
epidural space
dura mater
arachnoid mater
subarachoid mater

91
Q

Definition of Shock

A

acute hemodynamic disorder (micro and macrociculatory) independent of the cause which leads to insufficient oxygen supply and tissue hypoxia

92
Q

What is an anion gap?

A

the difference between the positive ad negative ions

AG = [Na+] + [K+] - ([Cl-] + [HCO3-])

normal value is 10 - 16 mmol/L - dependent on if K is included in the calulation

helps to distinguish between High and Non-High Anion Gap Metabolic Acidosis

93
Q

4 indications for Central venous Catherter

A

-large volume resusscitation
- poor peripheral veins
- administration of irritant meds
- long term IV therpay

94
Q

Puncture in the ribs - PTX

A

Along upper edge of rib in the 4-5 intercostal space in the midaxillary line
OR
in in the 2nd intercostal space midclavicular line

95
Q

What are the main symptoms of DKA?

A
  • polyuria
  • polydipsia
  • lethargy
  • anorexia
  • hyperventilation (kussmal)
  • ketotic breath
  • dehydration
  • vomitting
  • abdominal pain
  • flushed face
96
Q

3 symptoms of hypoglycemia

A
  • pale
  • sweating
  • tachycardia
  • CNS
97
Q

Antidote for non-depolarizing muscle relaxant

A

Neostigmine (cholinesterase inhibitors)

98
Q

What is the Horowitz Index

A

ratio of partial pressure of oxygen in blood (paO2) in mmHg and the fraction of oxygen in the inhaled air (FIO2)

PaO2/FiO2

its used to assess the lung function in patients, esp those on ventilators

99
Q

ASA 1- 6 charactertistics

A

1 - healthy
2 - mild systemic disease (HTN, DM)
3 - severe systemic disease - functional limit
IV - severe systemic - threat to life
V - unlikely to survive next 24 hours
6 - brain dead

100
Q

When and how can we use epidural anaesthesia?

A

can be used for acute pancreatitis –> increased blood flow to pancreas for healing
no parasympathetic fibers are affected in epidural anesthesia

injection site:
- may be performed at any vertebral level
- needle is inserted into the epidural space between ligamentum flavum and dura mater

101
Q

Side effects of local anesthetics

A
  • bradycardia
  • ventricular arrhythmia
  • infections
  • allergic reactions
  • hypotension/headache
102
Q

What are the 4 H’s

A

hypoxia
hypovolemia
hypothermia/hyperthermia
hypokalemia/hyperkalemia

They are reversible

103
Q

what are the 5 P’s in the circulation part of ABCDE

A

pain
pallor
pulse
paresthesia
paralysis

104
Q

What is type 2 Respiratory Failure

A

PaCO2 > 50 mmHg
or pH < 7.3
and PaO2 < 60 mmHg

105
Q

Treatment for Tachycardia

A
  • beta-blockers
  • vagal maneuvers
  • cardioversion - electrical or chemical
  • Implantable cardioverter defibrillator
  • Ablation
  • Pacemaker
106
Q

DX airway at risk

A

listen for snoring
gurgling
choking
paradoxical movement

ÅJJB 5th year (5 decks)

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