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Semmelweis Yeet > Anaesthesiology/Intensive Treatment Prac. Exam > Flashcards

Anaesthesiology/Intensive Treatment Prac. Exam Flashcards

1
Q

Name 3 antibiotics for pseudomonas coverage (just the classes)

A
  • Extended spectrum penicillin with B-lactamase inhibitors (Piperacilin-Tazobactam = antipseudo penicillin)
  • Cephalosporins
  • Fluoroquinolones

Additional from amboss:

  • Carbapenems
  • Aminoglycosides
  • Monobactams
  • Polymyxins
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2
Q

What are 5 indications for dialysis?

A

AEIOU:

  • Acidosis(certain ph or refractory to therapy)
  • Electrolytes(K+ over 7)
  • Intoxication,
  • Overloaded with fluid,
  • Uremia/uremic symptoms
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3
Q

Child CPR/ALS difference from adults?

A

15:2 ratio.

From Amboss:
· Children older than 1 year
o 5 initial rescue breaths → CPR
o Compression rate: 100-120/min
o Compression-to-ventilation ratio:
- § Medical professionals: 15:2
- § Lay rescuers: 30:2
o Further management should follow the guidelines for adults.
· Defibrillation: monophasic and biphasic waveforms: 2–4 J/kg of body weight
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4
Q

Symptomatic treatment of bradycardia, top 3 pharmacological agents.

A
  • Atropine (he asked dose, 500mcg IV each time for max 3mg),
  • isoprenaline,
  • adrenaline,
  • glycopyrrolate,
  • dopamin.
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5
Q

Ultrasound during CPR, you can investigate:

A

1 H, 3 Ts.

H
- Hypovolemia (collapsing IVC)

T

  • Tamponade (Collapsed RV + fluid filled pericardium),
  • PE (Enlarged RV and RA),
  • PTX (Lack of lung sliding and B-lines).
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6
Q

How many joules for infants/children with the defib?

A

4 J/KG

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7
Q

Dose of Epinephrine and how do you give a patient in ICU?

A

Infusion, he was happy with 0.01-0.03 mcg/KG/min

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8
Q

5 uses of end tidal CO2 during CPR? (capnography)

A

PQRST: Placement of ETT (endotracheal tube?),
Quality of compressions,
ROSC also know the values whats normal, what’s bad, and what is terminate-CPR bad.
Situation
Termination

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9
Q

etCO2 ROSC values

A

> 24
- stop CC, look for ROSC

<24
- CC is effective

<20
- improve CC quality

=<10
- Poor prognosis

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10
Q

3 indications for systemic thrombolysis?

A

I said PE, Ischemic stroke and early MI. He said MI is very rare and he wasn’t 100% happy

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11
Q

Top nosocomial bacterias?

A

Pseudomonas, MRSA, Klebsiella, Acinetobacter

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12
Q

3 symptoms of hypoglycemia:

A

CNS(agitation, coordination, sleepiness)
pale,
sweating,
tachycardia

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13
Q

Basic difference between CRRT and IRRT? What do you use when?

A

CRRT= Continuous Renal Replacement Therapy, done over 24 hours, and is a slow type of
dialysis

IRRT= Intermittent Renal Replacement Therapy: performed for less than 24 hours in each 24
hour period, two to seven times per week

CRRT has better haemodynamic stability (BP control) and improved survival and greater
likelihood of renal recovery.

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14
Q

Name 5 opioids commonly used?

A

Morphine, fentanyl, sufentanyl, Remifentanil, tramadol, codeine

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15
Q

Name 3 non invasive airway measures?

A 
Head chin tilt, 
eschmark, 
cpap bipap, 
oxygen, 
bag mask stuff.
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16
Q

4 symptoms of shock:

A 
MOF, 
Urine output<0,5ml/kg, 
loss of consciousness, 
confused, 
GI: absent bowel sounds

(adding)
Paleness
Cold-sweat
Cold skin (warm skin if distributive shock like sepsis/anaphylactic)

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17
Q

Lethal triad:

A

Coagulopathy, Hypothermia, metabolic acidosis

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18
Q

4 iv anesthetics

A
  • Thiopental (= barbiturate 3-6mg/kg)
  • Midazolam (= benzodiazepines 0.01-0.1 mg/kg)
  • Propofol (2-4mg/kg) most popular
  • Ketamine (1-5mg/kg)
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19
Q

3 inotropes:

A
  • Norepinephrine
  • Epinephrine
  • Dobutamine
  • Dopamine
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20
Q

Side affects of local anesthetics:

A
  • Bradycardia and ventricular arrhythmias
  • Hematoma → nerve compression→ neurological symptoms
  • Infections
  • Allergic reactions
  • Spinal/epidural: Headache, bradycardia, hypotension…
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21
Q

How do you diagnose airway at risk

A

Listening for snoring, gurgling, choking + paradoxical movement

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22
Q

Criteria for empty stomach (how long do you need to fast):

A 
Clear fluids (water, tea) = 2h
Breast milk = 4h
Nutritional drinks –cow milk – solid food = 6h
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23
Q

First line treatment of tpx:

A

Provide respiratory support and treat dyspnea + immediate tube thoracostomy

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24
Q

Caloric value of carbohydrates lipids protein and alcohol

A
  • Carbohydrate (60-80% of nutrition): Glucose = 4,2Kcal/g ; Max glucose dose of
    ICU patients 5mg/kg/min
  • Lipid (20-40% of nutrition): 9,1Kcal/g; lipid oxidation is limited, max dose = 1-1,5g/kg/day
  • Protein: daily requirement in critical care =1,5-2 g/kg/day
  • Alcohol: I guess 0 because the patient is in critical care ???
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25
Q

Formula of osmolality:

A

= 2[Na+] +[Glucose]/18 +[BUN]/2.8

In case: Osmolarity = 2Na + Glucose + Urea (mmol/L)

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26
Q

Shock definition:

A

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

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27
Q

3 Application of ETCO2:

A

noninvasive technique which measures the partial pressure or maximal concentration of carbon
dioxide (CO2) at the end of an exhaled breath (N: 35-45 mmHg). Can be used to detect
metabolic acidosis (but ABG is the gold standard)

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28
Q

3 SUBLINGUAL antihypertensive drugs and their dose –

A

nitrates, ACEI, niflodipin.
Captopril = 25mg
Nifedipine = 10mg
Prozasin = 2mg

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29
Q

First choice of bradycardia treatment

A

Atropin

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30
Q

How to calculate PULMONARY MAP

A

= 1/3SBP + 2/3DBP

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31
Q

Atmospheric pressure in mmHg and mmH2O

A

760mmHg or 10332,276 mmH2O

32
Q

5 reasons AMI can cause cardiogenic shock

A
  • Wall rupture (late phase)
  • Arrhythmia
  • Valvular dysfunction (e.g papillary muscle necrosis)
  • Decreased contractility
  • Wall rupture → tamponade
33
Q

3 complications with Central venous catheter

A

Infection
Rupture of Artery
pneumothorax

34
Q

4H & 4T

A

H:Hypoxia
H: Hypovolemia
H: Hypo/HyperKalemia
H: Hypo/hyperthermia

T: toxins
T:tamponade
T: Tension PTX
T: Thrombosis

35
Q

Gynecological emergencies in ICU

A

Placental abruption, miscarriage, ectopic pregnancy, Acute PID, Pelvic endometriosis…

36
Q

Difference between dehydration and hypovolemia

A

Hypovolemia is a condition where the extracellular fluid volume is reduced and it results in
decreased tissue perfusion. It can be produced by either salt and water loss.

Dehydration: Is when there is only water loss.

37
Q

Respiratory failure classes

A

Type I - hypoxemic failure
Type II - hypercapnic failure
Type III - post-operative failure
Type IV - CV-associated failure

38
Q

Type 1 respiratory failure values

A

decreased arterial oxygen = PaO2 < 60 mmHg

(SaO2 < 90%, PaCO2 decreased/normal, pH increased/normal).

39
Q

Type 2 respiratory failure values

A

increased arterial carbon dioxide = PaCO2 > 50 mmHg or pH < 7.3 (respiratory acidosis).

40
Q

Anaphylactic shock symptoms (give the answer in ABCDE order)

A 
A: Wheezing (bronchoconstriction)
B: dyspnea
C: Hypotension, Skin: hives, itching, urticaria, Angioedema
D: dizziness, fainting
E: nausea, vomiting
41
Q

Define septic shock

A

Is a type of distributive shock caused by an excessive inflammatory response to disseminated
infection, which leads to extravasation from the vascular space and loss of intravascular
volume.

42
Q

3 indications of central vein

A
  • Fluids,
  • Dialysis
  • Longer hospital stay
  • ICU
43
Q

What is 60-40-20 rule

A

Total body water = 60% of body weight
Intracellular fluid = 40% of body weight
Extracellular fluid= 20% of body weight

44
Q

Antidotes for opiates, benzodiazepine and non depolarizing muscle relaxant

A
  • Opiates= Naloxone
  • BZ= Flumazenile
  • Non depolarizing muscle= Neostigmine (cholinestherase ihibitors)
45
Q

3 ways to measure cardiac output

A
  • Doppler ultrasound
  • Pulse pressure methods
  • Impedance cardiography
  • MRI
  • Calculate = SV x HR
46
Q

Puncture in ribs

A
  • 4-5 intercostal space midaxillary line, or

- in the 2 intercostal space for needle decompression (faster)

47
Q

Parameters in mechanical ventilation

A

Mode (Assisted control),
Intermediate mandatory ventilation or pressure support which is CPAP and BiPAP,
FiO2,
Tidal volume and respiratory rate which will change the alveolar ventilation and positive end expiratory pressure which is the PEEP

48
Q

Horowitz index

A

ratio of partial pressure of oxygen in blood (PaO2), in millimeters of mercury, and the fraction of
oxygen in the inhaled air (FIO2) — the PaO2/FiO2 ratio.

→ used to assess the lung function in patients, especially those under ventilators.

49
Q

Treatment protocol for tachycardia

A
  • Beta Blockers,
  • vagal maneuvers,
  • cardioversion electrical or chemical
  • ICD,
  • PM,
  • ablation
50
Q

Hyperkalemia : ECG

A
  • Peaked T waves on prechordial leads
  • Shortened QT interval
  • ST-segment depression
51
Q

Treatment for hyperkalemia?

A

Mention 5:

  • Insulin-glucose
  • Ca-gluconate I.V,
  • Haemodialysis
  • B-agonist (activates Na/K pump moving K into cells)
  • NaHCO3- (if metabolic acidosis)
52
Q

Indications for HCO3-:

A
  • CPR when severe acidosis pH<7,1
  • strong suspicion of metabolic acidosis,
  • Correct hyperkalaemia (K+ + HCO3+), pH < 7,1
53
Q

Correction of symptomatic bradycardia:

A

Atropine 0,5mg —> 3mg (0,5 every bolus)

54
Q

Layers for spinal anesthesia

A

Injection site:
Injection usually performed below L2 to avoid damage to the spinal cord
Needle inserted into subarachnoid space between the arachnoid and pia mater

Layers the needle goes through:
Skin
Subcutaneous fat
Supraspinal ligament
Interspinal ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Subarachnoid space
55
Q

Epidural anesthesia layers

A

Can be used for acute pancreatitis → Increased blood flow to the pancreas for healing.
No parasympathetic fibers in epidural anesthesis

Injection site:
May be performed at any vertebral level (cervical, thoracic and lumbar spine)
Needle inserted into the epidural space between the ligamentum flavum and dura mater

56
Q

HCO3- dosage for DKA

57
Q

3 symptoms of upper GI bleeding:

A
  • Hematemesis
  • Melena (digested blood)
  • Drop of BP, lightheadedness
58
Q

EtCO2 normal value?

59
Q

Reversible causes of cardiac arrest: Hypoxia signs and treatment

A

Signs
- colour of skin

Treatment
- Ventilation with suppl. O2

60
Q

Reversible causes of cardiac arrest: Hypovolaemia signs and treatment

A

Signs:

  • Pale skin
  • History
  • DRE
  • US findings (collapsed IVC)

Treatment:
- Volume therapy +/- transfusion (Hb <7 is transfusion indication)

61
Q

Reversible causes of cardiac arrest: Hypo- / hyperkalaemia signs and treatment

A

Signs:
- Identified by ABG/lab

Correction:

  • hypokalemia - Mg++ and K+
  • hyperkalenia - Calcium-gluconate IV
62
Q

Reversible causes of cardiac arrest: Hypo/hyperthermia signs and treatment

A

Signs
- Core temperature

Treatment

  • Active warming / cooling
  • Treat underlying issue
63
Q

Reversible causes of cardiac arrest: Thrombosis signs and treatment

A

Signs:

  • Chest pain
  • Difference in lower limbs
  • US findings

Treatment

  • ACS: PCI
  • PE: Fibrinolysis
64
Q

Reversible causes of cardiac arrest: Tension ptx signs and treatment

A

Signs:

  • dyspnea
  • assymetric chest
  • US pleural sliding sign

Treatment:
- Decompression

65
Q

Reversible causes of cardiac arrest: Tamponade signs and treatment

A

Signs:

  • US
  • > RV collapse in diastole
  • > RA collapse in systole
  • > Pericardial effusion

Treatment:
- Pericardiac puncture

66
Q

Reversible causes of cardiac arrest: Toxins signs and treatment

A

Signs:
- history, medical documents, enviroment

Treatment:

  • Elimination
  • Antidotes
67
Q

ABCDE: A

A
  • Patent airway
  • Airway in-danger?
  • Secretions
  • Foreign object
  • Snoring
  • Obstructed airway
    (paradoxical breathing)
68
Q

ABCDE: B

A
  • Rate (normal 12-20)
  • Work of breathing (accessory muscles)?
  • Symmetry of chest movement and sounds?
  • SaO2 % (normal > 94%)
69
Q

ABCDE: C (5p’s)

A
  • Pulse
  • P-QRS-T (rhythm)
  • Electrical activity present on ECG?
  • Frequency
  • Narrow/wide QRS?
  • Regular/irregular rhythm?
  • P waves present?
  • P waves followed by QRS complexes?
  • Pressure
  • Perfusion (peripheral circulation) - CRT
  • Preload
  • JVP
  • Lung crackles
70
Q

ABCDE: D

A
  • Mental status
  • AVPU scale (alert, voice, pain,
    unresponsive)
  • Glasgow coma scale (GCS) < 9
  • Symmetry
  • Pain localizing
  • Pupils
  • Blood sugar
71
Q

ABCDE: E

A

ƒ ‘RUSH’ exam - Rapid US in shock

ƒ Bleeding source?

ƒ Injury?

ƒ Temperature

ƒ ABG

ƒ Drugs

ƒ Toxicities

ƒ Further anamnesis

72
Q

Shockable and non-shockable rhythms

A

Shockable
- VF, pulseless VT

Non-shockable
- PEA, asystole

73
Q

Shockable rhythms - drug protocol

A

First dose

  • Adrenaline 1mg after 3rd shock
  • Amiodarone 300mg after 3rd shock

Additional doses

  • Adrenaline 1mg every 2nd shock (2-5min)
  • Amiodarone 150 mg after 5th shock
74
Q

Non-shockable rhythm - drug protocol

A

Adrenaline 1mg as soon as IV access

Additional adrenaline 1mg every 2nd cycle (3-5min)

75
Q

PE - US signs

A

Collapsed left ventricle

Grossly enlarged right ventricle

76
Q

US signs - hypovolemia

A

Collapsed left ventricle

Collapsed right ventricle

Collapsed IVC

Semmelweis Yeet (5 decks)

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