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5th year blocks > ANE topic Q's > Flashcards

ANE topic Q's Flashcards

1
Q

what determines distribution of water between IC and EC?
And what distributes the water between IC and EC?

A

Osmotic equilibrium and onconit pressure desides
Na+ K+ Cl- distributes

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2
Q

hormone increasing water reabsorption in kidneys?

A

ADH

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3
Q

normal plasma osmolarity?

A

280mOsm/L

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4
Q

daily requirements of Na

A

1,5-2,5 mmol/kg

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5
Q

max Na C kidney can handle

A

> 1500 mOSm/kg in healthy
600-800 mOsm/kg in ICU patients

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6
Q

what happens to renal perfusion pressure in ICU patiens?

A

In healthy individuals without systemic hypertension, intrarenal blood flow is auto-regulated at renal perfusion pressures between 60 and 100 mmHg. During critical illness, these processes may be compromised.

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7
Q

How does pressure affect filtration rate i the kidneys?

A

The glomerular filtration rate is directly proportional to the pressure gradient in the glomerulus, so changes in pressure will change GFR. GFR is also an indicator of urine production, increased GFR will increase urine production, and vice versa

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8
Q

mechanical ventilation effect on kidneys?

A

increase renal perfusion pressure by increasing preload on the heart

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9
Q

what effect does hyperthermia have on fluid loss`

A

increases insensible fluid loss with 2,5 L/day

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10
Q

what effect does hyperventilation have on fluid loss`

A

increase insensible fluid loss by 0,5-2 L/day

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11
Q

what effect does tracheotomy have on fluid loss?

A

increase insensible fluid loss by 0,7 L/day

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12
Q

hypovolemia can cause

A

*Decreased tissue perfusion
*Tissue hypoxia
*Anaerob metabolism
*Inflammatory cascade↑
*Neutrophil oxidative killing↓
*Wound healing disorder
*Organ dysfunction

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13
Q

hypervolemia can cause

A

*Oedema
*Anastomosis insufficiency
*Bowel dysfunction, PONV
*Coagulation disorder
*Renal insufficiency
*Cardiopulm. complications
*Organ dysfunction

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14
Q

fluid compartments in the body

A

─ Intracellular fluid (ICF): 40% of body weight
─ Extracellular fluid (ECF): 20% of body weight
─ Interstitial fluid: 15% of body weight
─ Intravascular fluid: 5% of body weight

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15
Q

how can you increase Preload?

A

Colloid and Crystaloid solutions

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16
Q

how can you decrease Preload?

A

diuretics

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17
Q

How to measure CVP?

A

in SVC and tells us what the preload is

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18
Q

3 methods of measuring SV

A

PICCO
Swan-Gaz catheter
Echochardiography

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19
Q

best way to measure fluid responsivness?

A

measuring SV and change in the stroke volume

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20
Q

Normal value of IVC diameter?

A

1,5-2,5 cm

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21
Q

what can IVC tell us about volume status?

A

IVC < 1,5cm => volume depletion
IVC > 2,5cm => volume overload

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22
Q

what is the problem with using the gold standars SV to assess fluid response?
What is another option to increase fluids with 300ml withoud actullay giving fluids?

A

If the patient is already in a good fluid state giving 300ml crystalloid can cause edema

The led raise test because lower extremity containe about 300-400ml fluids

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23
Q

does the acute management of hyperkalemia solve the problem?

A

No, we need to do hemodialysis to actually remove the K+ from the body

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24
Q

what is the dose of IV K?
what can you do if you want to give a higher dose?

A

MAX 2g/h!!!! - IV 2g/500ml in a PVK
if you want to give a higher dose use CVK

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25
Q

what is the exception to giving max 2g/h of K+?

A

Ketoacidosis

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26
Q

how to find the albumin corrected Ca2+ concentration

A

measured Ca2+ + 0,02 x (40- Se Albumin)

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27
Q

what should you NOT give as a diuretic in hypercalcemia?

A

Thiazide

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28
Q

can you give calcitonin alone?

A

No, always with bisphosphonates

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29
Q

what is the absolute limit of giving Na? and why must it not exceed this level?

A

0.5 mmol/h
can cause pontine myelolysis

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30
Q

management of hyponatremia below 115 mmol/L1

A

First give 3% NaCl then give 0.9% NaCl

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31
Q

what is the first step of evaluating metabolic acidosis?

A

calculate anion gap

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32
Q

what is the reference range of anion gap?

A

6-10 is normal

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33
Q

calculating anion gap?

A

Na - (Cl+HCO3)

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34
Q

what does it tell you if the anion gap is normal in a metabolic acidosis?

A

its due to primary loss of HCO3 with a Cl- compensation

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35
Q

drugs causing resp acidosis?

A

due to CNS depression
Benzos
Opiates
Barbiturates

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36
Q

acute lung diseases causing resp acidosis?

A

pneumonia
pulmonary edema
acute exacerbation of COPD or asthma

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37
Q

which part of our circulation is the main thing in shock?

A

microcirculation due to shunting and skipping this part causing hypoxia

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38
Q

what are the hypodynamic shocks?
what do they all have in common)

A

cardiogenic
hypovolemic
obstructive
all: cold and clammy

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39
Q

what are the hyperdynamic shocks?
what do they have in common?

A

The three distributiv shocks
All: flushed, warm

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40
Q

what is the supportive care in shock?

A

Recognizing homeostasis
Removing metabolic acidosis
Securing oxygen

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41
Q

what affects oxygen delivery?

A

Hb
SaO2
CO

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42
Q

why do we do mechanical ventilation in shock?

A

To decrease WOB

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43
Q

Drug of choice in anaphylaxis/CPR resuscitation

A

Epinephrine/Adrenalin

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44
Q

Drug of choice in Septic shock?

A

Norepinephrine

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45
Q

Drug used in Cardiogenic shock?

A

Dobutamine

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46
Q

what to give if refractory to NE of in severe pulmonary hypertension?

A

Argipressin

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47
Q

Hemodynamic parameters you look at in shock?

A

CVP
CO
PCWP
SVR
HR
SVO2

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48
Q

Why is temperature important in bleeding?

A

Temperature affects coagulation
Hypothermia decreases coagulation!!!!

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49
Q

what is the deal with distributive shock?

A

there is a loss of vasoconstriction and blood is going “everywhere” and not to the tissue really needing it

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50
Q

what does CVP tell you about fluid status when giving fluids?

A

Rapid increase means normal volume
Slow increase means hypovolemia

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51
Q

3 Parameters telling us about fluid status?

A
  1. urin output
  2. Urin Na concentration
  3. Hct if normal value is known (high in hypovolemia) ( low in hypervolemia)
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52
Q

hemodynamic monitors for fluid status?

A
  1. PICCO - looking at pulse pressure, SV,
  2. US
  3. passive leg raise test
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53
Q

how to think when giving fluids

A
  1. which compartment do I have to replace
  2. what type of fluid am I replacing
  3. what lead to the fluid loss
  4. How much is lost/must be replaced
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54
Q

Mechanical circulatory support?

A

Aortic balloon pump
ECCMO

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55
Q

Isotonic crystalloids?

A

0.9% saline solution
Lactate ringer
Isolyte

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56
Q

characteristics of Colloid fluids?

A
  • contains large proteins
  • cause 1:1 ration of volume increase
  • increase IV oncotic pressure
  • risk of fluid overload
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57
Q

hypertonic crystalloids?

A

3% NaCl
5% NaCl

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58
Q

hypotonic crystalloid

A

Saline solution (0.45% and 0,22%)
Dextrose Solution (5% and 10%)

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59
Q

things about 9% NaCl solution?

A

Isotonic
Acidic
Resuscitation fluid

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60
Q

2 things about 0.45% NaCl fluid

A

Hypotonic
Used in hypernatremia

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61
Q

3 things about Dextrose 5%

A

Hypotonic
Suger water
Used in hypernatremia

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62
Q

3 things about Lactate ringer?

A

Isotonic
Used in surgery
Resuscitation fluid

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63
Q

Fluids in hypovolemic patient?

A

Isotonic fluid
Normal Saline
Switch to plasmalyte or LR if high volume

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64
Q

Fluids in hyponatremia

A

Hypertonic saline solution (3%)
Normal Saline

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65
Q

type 1 resp failure?

A

hypoxemia Pa02 < 60 mmhg

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66
Q

type 2 resp failure

A

hypercapnia PaCO2 > 50 mmhg

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67
Q

4 main causes of respiratory failure?

A
  1. impaired ventilation
  2. impaired gas exchange
  3. airway obstruction
  4. V/Q missmatch
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68
Q

define dead space in the lungs?

A

good ventilation but no perfusion

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69
Q

define cause of shunting in the lung

A

good perfusion but bad ventilation

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70
Q

what does the V/Q stand for?

A

V for ventilation of alveoli
Q for perfusion of the capillaries

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71
Q

type of resp failure in AECOPD?

A

type 2

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72
Q

type of rest failure in Acute exas asthma?

A

type 1

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73
Q

treatment of AECOPD?

A

Bronchodilators: Inhaled SABA: albuterol/SAMA: ipratropium bromide
Corticosteroids: prednisolone, methylprednisolone
Antibiotics: must cover gra+ and gram - (Quinolones: levofloxin)

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74
Q

target oxygen therapy in AECOPD?

A

Target SpO2 88–92%

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75
Q

Indication of switching to BiPAP?

A

RR > 25
Resp Acidosis
Hypercapnea
despite giving oxygen

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76
Q

what is PEFR and when is it used?

A

used in Asthma to assess severity of exacerbation
Peak Expiratory Flow Rate

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77
Q

PEFR in astma tells us (peak expiratory flow rate)

A

> 70% Mild asthma exacerbation
40-69% Moderate asthma exacerbation
< 40% Severe asthma exacerbation
< 25% Life threatening asthma exacerbation with respiratory failure

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78
Q

what is status asthmatics?

A

Patient not responding to standard medications

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79
Q

what scoring system is used for pneumonia assessment of in or out patient?

A

CURB-65 score and PSI
BUT clinical picture and your judgment is the most important

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80
Q

what is CURB-65 score?

A

used to decide of pneumonia is ICU or not
Confusion
Serum urea > 7 mmol/L
Respiratory rate > 30/min
Blood pressure < 90 mmHg
Age > 65
More than 2 - inpatient

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81
Q

Pneumonia treatment if outpatient + comorbidities?

A

Combined therapy
B-lactam: Cefuroxime PO
Macrolide: Azithromycin PO

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82
Q

Pneumonia treatment if outpatient with no comorbidities

A

Monotherapy of one of these:
Amoxicillin PO
Doxycycline PO

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83
Q

Pneumonia treatment if Inpatient

A

Combined:
B-Lactam: Ceftriaxone/Ampicillin IV
Azithromycin/Clarithromycin/Doxycycline PO

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84
Q

what decides if a pneumonia patient is ICU or non-ICU

A

Hypotension needing vasopressors
Respiratory failure requiring mechanical ventilation

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85
Q

Pneumonia treatment if Inpatient with suspicion of pseudomonas

A

Antipseudomonal: Piperacillin-tazobactam/Cefepime/Ceftazidime IV
PLUSS ONE OF THESE PO:
A macrolide: Azithromycin/Clarithromycin
OR Doxycycline
OR A respiratory fluoroquinolone: Moxifloxacin/Levofloxacin

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86
Q

4 clinical feauters of ARDS

A

Acute dyspnea
Tachypnea
Cyanosis
Diffused crackles

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87
Q

what is the most common cause of ARDS

A

Sepsis

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88
Q

Define ARDS

A

Acute diffuse alveolar inflammation leading to tissue damage

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89
Q

what is the acute timeframe of ARDS?

A

In this case acute is within 7 days of known suspected trigger

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90
Q

what are the 3 stages of ARDS pathophysiology

A
  1. Exudate phase
  2. Hyalin membrane phase
  3. Reorganizing phase
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91
Q

what is the Berlin criteria?

A

Diagnosis of ARDS
- Acute onset
- Bilateral pulmonary infiltrates on imaging
- PaO2/FIO2 ratio > 300 mmHg
- Resp failure is not due to HF or fluid overload

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92
Q

What acid base state is an ARDS patient in?

A

Alkalosis due to Tachypnea in early phase
Late phase type 2 resp failure and acidosis

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93
Q

what are the 5 managment strategies in ARDS?

A
  1. Fluids
  2. Steroids
  3. Ventilation
  4. Lung protective ventilation
  5. Paralysis
  6. Inhaled vasodilators
  7. ECMO
  8. Nutrition
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94
Q

Goal spO2 in ARDS?

A

88%

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95
Q

lung protective ventilation volume in ARDS?

A

6ml/kg of IDEAL bodyweight
remember that it is the ideal body weight not the actual bodyweight of the patient!!!!!

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96
Q

goal pH in ARDS

A

7,25 so we allow hypercapnea and acidosis

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97
Q

causes of PO resp failure?

A
  1. decreased respiration due to sedation and CNS suppression
  2. decreased respiration due to prolonged muscle relaxants
  3. Inhaled anesthetics causing accumulatio of secretion - atelectasis
  4. PO pain failure to cough our secretions
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98
Q

clinical presentation casing resp failure PO?

A

Atelectasis or pneumonia

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99
Q

what is the frequecy of giving epinephrin in ALS?

A

every 3-5 min

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100
Q

what are the three endpoints of BLS

A
  1. Patient shows clear signs of life
  2. Rescuers are to fatigue to continue
  3. ACLS trained providers arrive
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101
Q

how long do you do the first round of CPR in ALS before rhythm analysing?

A

2 min

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102
Q

do you continue checking rhythms in a non-shockable state?

A

yes, every 2 min

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103
Q

Post resuscitation 4 things to do?

A
  1. airway
  2. Resp parameters
  3. Hemodynamic parameters
  4. ECG
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104
Q

what are the 4 interventions that should be done post resuscitation?

A
  1. Coronary angiography
  2. EEG for diagnosing seizures
  3. Temperature management (TTM) (32-36)
  4. Neuroprotective measures
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105
Q

Post resuscitation Neuroprotective measures?

A
  1. EEG
  2. Neurological examination
  3. Brain death assessment after 72h
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106
Q

Classification of malnutrition?

A

In the last 6 months:
Mild: 10% loss of TBW
Moderate: 10-19% loss of TBW
Severe > 20% loss of TBW

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107
Q

what laboratory parameters are we looking at to assess malnutrition?

A

Serum albumin
Serum transferrin
Serum Prealbumin

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108
Q

what’s the ideal fraction of the different diet components in an ICU patient?

A

Carbohydrates 60-80%
Lipids 10-40%
Protein 1,5-2g/kg

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109
Q

Max glucose doese of an ICU patient?

A

5mg/kg/min

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110
Q

daily minimum of glucose for an ICU patient?

A

150g

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111
Q

first choice of feedin for ICU patients?

A

Enteral, also known as tube feeding: delivering nutrition directly to stomach or small intestine.

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112
Q

what is parenteral feeding and when to use it?

A

Parenteral nutrition is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding

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113
Q

complications of ENTERAL feeding?

A

Gastric residual volume
Gastric bacterial colonization
Aspiration pneumonia
Enteral ischemia

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114
Q

complications of PARENTERAL feeding

A

Bowl mucosal atrophy
overfeeding
hyperglycemia
infection risk
permanent line is needed
more expensive

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115
Q

tube feeding problems?

A

Vomiting: to fast, too large, position
Diarrhea: too fast, intolerance, too high osmo,
Constipation: Lack of fiber, fluid and activity

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116
Q

Inoconstrictor drugs

A

NE
Epi
Dopamin

117
Q

Inoconstrictor mechanism of action

A

Vasoconstriction - increased SVR and BP
Inotropy: increased cardiac contractility and CO

118
Q

Inodilators

A

Milrinone: positive inotropic and vasodilatory effects
Dobutamine

119
Q

pure vasoconstrictors

A

vasopressin
Phenylephrine

120
Q

Inodilators mechanism of action

A

increased cardiac contractility and CO
Peripheral vasodilation and decreased SVR, afterload and improved BF and perfusion

121
Q

Stages of renal failure: risk

A

creatinine x 1.5 BL
UO < 0.5 ml/kg for 6h
GFR loss 25%

122
Q

Stages of renal failure: injury

A

creatinine x 2 BL
UO < 0.5 ml/kg for 12h
GFR loss 50%

123
Q

Stages of renal failure: failure

A

creatinine x 3 BL
UO < 0.3 ml/kg 24H and Anuria 12h
GFR loss 75%

124
Q

Prerenal causes of AKI

A

dehydration
hypovolemia
HF
Sepsis
vascular occluson

125
Q

Intrarenal causes of AKI

A

drugs
toxins
prolonged hypotension
ATN
GN
small vessel vasculitis

126
Q

post renal causes of AKI

A

benign prostate hyperplasia
cervical neoplasm
stenosis
retroperitoneal fibrosis
urinary stones

127
Q

criteria used to classify stage of AKI

A

RIFLE criteria

128
Q

drugs causing AKI

A

NSAIDS
Cyclosporins
Tacrolimus
ACEI

129
Q

2 indications of dialysis?

A

K+ > 5
Diuresis < 5 ml/kg/t

130
Q

what metabolic state is AKI patient normally in?

A

Hyperkalemia
Acidosis

131
Q

when can you not use LR solution in pancreatitis?

A

if the cause is hypercalcemia because the solution contains Ca
use saline solution

132
Q

when to use Ab in pancreatitis?

A

Acute necrotic collection or walled off necrosis

133
Q

Diagnostic criteria for pancreatitis?

A

2/3 following:
1. Pain
2. Enzymes x3 BL
3. CT

134
Q

Atlanta scores of severity in pancreatitis?

A

mild: no organ failure
moderate: organ failure less then 48h
Severe: persistent organ failure for ore then 48h

135
Q

infusion rates in pancreatitis?

A

mild to moderate: 5-10ml/kg/h
severe: 500-1000 ml IV over 10-30 min

136
Q

when do we do ERCP in pancreatitis?

A

Biliary pancreatitis

137
Q

when does pancreatitis become an ICU case?

A
  1. Organ dysfunction
  2. SIRS
  3. significant need of fluids
  4. old age and comorbidities
138
Q

what type of acidosis is DKA?

A

high aniongap metabolic acidosis because HCO3 is consumed as a buffer

139
Q

what is the K+ state in DKA?

A

hypokalemia but may be masked as elevated or normal because it is the IC that is depleted

140
Q

what fluids to use in rehydration in a DKA

A

if Na > 135 mmol/L use 0.45 NaCl
if Na < 135 mmol/L use 0.9 NaCl

141
Q

symptoms of DKA vs HHS

A

DKA
- Dehydration
- Delirium
- Kussmals breathing
- Abdominal pain
- Nausea/vomiting
- Aceton breath

HHS
- Severe dehydration
- Polyuria
- Polydipsia
- lethargy
- Neurological deficits
- Seizures

142
Q

blood used in acute hemorrhage

A

O Rh negative and switch to the right one ASAP

143
Q

what should be in the transfusion package of a massive hemorrhage?

A

ratio 1:1:1 of
RBC
Platelets
FFP

144
Q

Classification of hemorrhagic shock based on % blood loss?

A

I. <15% 750ml
II. 15-30% 750-1500ml
III. 30-40% 1500-2000ml
IV. > 40% > 2000ml

145
Q

4 jobs of the liver and its complication in failure

A

Ammonia - urea (brain)
Stores glycogen (hypoglycemia)
Immune Kuffer cells (increased infection)
CF and Anti Coagulants (increased bleeding and coagulation

146
Q

hepatotoxic medication

A

acetaminophen
Antimicrobials
Anticonvulsants
Chemo

147
Q

infections causing hepatic failure

A

CMV
HSV
EBV
Toxoplasmosis
Hepatitis ABE

148
Q

vascular diseases causing hepatic failure

A

Budd chiari syndrom
Ischemia

149
Q

different classifications of hepatic failure?

A

Hyperacute within 0-1w
Acute within 1-3w
subacute within 3-26w

150
Q

symptoms of liver failure

A

encephalopathy
cerebral edema
nausea/vomiting/anorexia/fatigue/malaise/lethargy
Jaundice
Pruritis
RUQ pain

151
Q

management of hepatic failure

A
  1. fluids for volume status
  2. vasopressors if fluid non-responsive
  3. hydrocortisone if persistent Hypotension
  4. hemodynamic monitoring
  5. consider early intubation
  6. ABG
152
Q

causes of HF

A

Myocarditis
Drug induced
Peripartum cardiomyopathy
Thyroid storm
Tachycardia induced
Valvular insufficiency
Bacterial endocarditis
Thrombotic endocarditis
Pulmonary embolism
Tamponade
Aortic dissection

153
Q

drugs with negative inoropic properties

A

Non-dihydropyridines CCB

154
Q

etiology of AHF

A

(CHAMPS)
Coronary syndrom
Hypertensive crisis
Arrhythmia
Mechanical cause
PE

155
Q

presence of congestion/perfusion state in AHF clinical assessment?

A

Congestion:
Wet - yes
Dry - no
Next sted is to determine perfusion
yes - warm
no - cold

156
Q

loop diuretics in HF?

A

Furosemide
If resistant edema combine Furosemide with thiazide or spironolactone

157
Q

when can we not give vasodilators if AHF

A

if systolic BP is < 90 mmHg

158
Q

vasodilators in HF

A

nitroglycerin, nitroprusside, and nesiritide.

159
Q

when to give inotropic agents in HF

A

when systolic BP is < 90 mmHg and hypoperfusion despite fluid
Adenosin
Dopamin
Levosimendan
Phosphodiesterase III inhibitor

160
Q

what is the antidote to B-blockers if that is suspected to be the cause of HF

A

Iv infusion of levosimendan and PDE III inhibitor

161
Q

What is the most common cause of early mortality (<48h) after severe injury?

A

Severe cerebral/brain stem injury

162
Q

what can cause a dysregulated high amplitude immune response in trauma?

A

tissue injuries like surgeries, second trauma, long duration shock

163
Q

what is damage control surgery?

A

minimal invasive surgery to stabilize the patient (like external fixation)

164
Q

is normovolemia or normotension the goal in fluid therapy in trauma?

A

Normovolemia

165
Q

In trauma fluid therapy is crystalloid enough?

A

No, because it cannot transport oxygen and doesn’t help hemostasis, blood and blood products must also be given

166
Q

How to assess bleeding risk and blood transfusion in a trauma patient?

A

TASH scoring system

167
Q

What do you check in the TASH scoring system?

A

Hb
BP
BE
HR
Major bleeding sources

168
Q

In traumatic coagulopathy what is most commonly seen?

A

Hypofibrinemia - give fibrin substitution
Hyperfibrinolysis - give tranexamic acid

169
Q

normal value of ICP?
goal for trauma patients?

A

< 10 mmHg
< 20 mmHg

170
Q

Cerebral perfusion pressure?

A

60-80 mmHg

171
Q

Platelet activation inhibitors

A

Clopidogrel
Ticagrelor
Vorapaxar
Abciximab
COX1 inhibitor NSAID

172
Q

is there a drug activting platelets?

A

No

173
Q

What activates platelets?

A

vWF
Collagen
Thrombin
Fibrinogen
TXA2

174
Q

what should you give to substitute fibrinogen in low levels?

A

Use fibrinogen concentrate instead of FFP (FFP has very low levels of Fi)

175
Q

first thing to do if suspected PE with hemodynamic instability?

A

Bedside transthoracic echocardiography - if RV dysfunction do a CTPA (CT pulmonary angiogram), if positive treat as high-risk PE thrombolysis

176
Q

What parameters are looked at in PE risk stratification?

A
  1. Hemodynamic instability
  2. PESI score
  3. RV dysfunction
  4. Elevated cardiac troponin levels
177
Q

3 definitions of polutrauma?

A

Anatomical
Pathophysiological
Combined

178
Q

what is the 2 main problems in polytrauma?

A

Bleeding
Hyperinflammation

179
Q

what is important to consider in regards to inflammation in trauma?

A

the amplitude and length of the inflammation, if dysregulated higher chance of complications

180
Q

what 5 things decreases O2 delivery?

A

hypovolemia
bleeding
anemia
hypoxia

181
Q

cases of increased O2 demand in trauma?

A

Pain
Stress/Panick
Agitation
Hypothermia

182
Q

4 states causing instability?

A
  1. Organ dysfunction
  2. Severe resp insufficiency
  3. Major bleeding/shock
  4. Bleeding/coagulation disorders
183
Q

what is DIC (definition)

A

Acquired syndrom with IV activation of coagulation and loss of localization produce organ dysfunction and microvascular damage

184
Q

causes of DIC

A

Sepsis - monocyte TF presentation
Polytrauma
Obstetric catastrophe
Massiv tissue necrosis
Hepatic failure
Allergic reaction

185
Q

4 lab parameters required for diagnosis of DIC

A
  1. Pro coagulation (increased Fibrinopeptide A, B)
  2. Fibrinolytic activation (DD and FDP)
  3. Inhibitory consumption (AT III)
  4. End organ damage (LDH, Crt, pH, pO2)
186
Q

what is the main problem with DIC and what do we solve?

A

Main problem is the bleeding and coagulation happening simultaneously and our goal is always to threat CAUSE

187
Q

Order of EOF in DIC

A

Kidney
Lung
Brain
Heart
Liver
Spleen

188
Q

is there always bleeding in DIC?

A

Not all diseases bleed
No bleeding: sepsis cancer
Bleeding: Aortic aneurism, Abruption, APL, prostate cancer

189
Q

ECG signs of PE

A

S1Q3T3
RBBB
P-pulmonale

190
Q

Normal levels of fibrinogen?
Critical low levels?

A

2-4 g/L
< 2 g/L

191
Q

2 ICU states activating endothelia surface for coagulation?

A

Sepsis
Inflammation

192
Q

why is there an increase of coagulopathy in anemia?

A

Not enough RBC to push platelets to the sides of the vessels, so no contact with endothelial surface for activation

193
Q

what is TIA

A

Transient ischemic attack is a temporary focal cerebral ischemia with stroke like symptoms (lasts less then 24h)

194
Q

Imaging in hemorrhagic shock?

A

Non-contrast CT

195
Q

Imaging in Ischemic stroke

A

Diffusion weighted MRI because it shows ischemic damage after 3-30 min (CT shows after 6-24h)

196
Q

Etiology of ischemic stroke?

A

embolic stroke
Thrombotic stroke
Global cerebral ischemia

197
Q

reperfusion therapy in ischemic stroke?

A

IV Tissue plasminogen activator - ALTEPLASE

198
Q

subtypes of hemorrhagic stroke?

A

Intracerebral
Subarachnoid
Intraventricular

199
Q

BP in hemorrhagic stroke?

A

if > 220 mmHg promptly lower to 140-180 mmHg (LABETALOL)

200
Q

what do to with anticoagulants if hemorrhagic stroke?

A

STOPP all anticoagulant therapies and if INR > 1.4 give reversible treatment

201
Q

ICP and perfusion pressure in hemorrhagic shock?

A

ICP: < 20 mmHg
CPP: 60-70 mmHg

202
Q

What is Gullian-Barre syndrom? (GBS)

A

Postinfectious polyneuropathy with symmetrical ascending flaccid paralysis du to cross reaction Ab attacking the host axonal antigens

203
Q

GBS treatment?

A

IV immunoglobulins
Plasmapheresis

204
Q

Frequency is US?

A

High:
High resolution
Low depth
Better for superficial tissue

Low:
Low resolution
High depth
Better for deep tissue

205
Q

3 things to check in the RUSH protocol

A

Pump - heart
Tank - lungs, IVC, Abdomen
Pipes - aorta, deep veins

206
Q

what to check on US: heart

A

EF
Pericardial effusion
RV strain
Wall motion
CO

207
Q

what to check on US: IVC

A

Collapsable / non-collapsible

208
Q

what to check on US: Aorta

A

Dissection / Aneurysm

209
Q

what to check on US: lungs

A

B lines
A lines
Tension pneumothorax

210
Q

Definition of chronic pain

A

Pain lasting longer then tissue healing time (6 months)

211
Q

types of pain?

A

Nociceptive
Somatic
Visceral
Neuropathic
Central
Peripheral
Sympathetic

212
Q

Sensitization of pain (types)

A

Hyperalgesia (Increased neuronal sensitivity)
Allodynia (decreased neuronal threshold)

213
Q

steps of pain management?

A
  1. non-opioids (NAIDS)
  2. Weak opioids
  3. Strong opioids
  4. Interventional treatment
214
Q

Name 6 NSAIDS

A

Aspirin
Ibuprofen
Diclofenac
Naproxen
Indomethacin
Meloxicam

215
Q

Name 3 opioids

A

Oxycodone
Hydromorphone
Tramadol
morphine
fentanyl
Buprenorphine

216
Q

name 3 anticonvulsants

A

Gabapentin
Pregabalin
Carbamazepine

217
Q

Name 3 muscle relaxants

A

Cyclobenzaprine
Methocarbamol
Baclofen

218
Q

Anesthesia (5)

A

Thiopental
Midazolam
Propofol
Ketamine
Etomidate

219
Q

Inhaled anesthetics

A

Isoflurane
Desflurane
Sevoflurane

220
Q

Onset of inhaled ANE

A

Blood soluble - Slow onset
Lipid soluble - Fast onset

221
Q

goal MAP in sepsis?

A

> 65 mmHg

222
Q

SIRS criteris?

A

Temp < 33 or > 38
Tachynea > 22 pCO2 < 36
HR > 90
WBC 12x109 or 4 X109

223
Q

Quick SOFA

A

Altered mental status
SBP < 90 mmHg
RF > 22

224
Q

SOFA

A

Resp PaO2/FiO2
CV MAP
Liver (bilirubin)
Kidney (crt)
Coagulation (platelets)
Neurologic GCS score

225
Q

1st line vasoconstrictors in septic shock?

A

NE then try Vasopressin then try Epi

226
Q

give in bradycardia sepsis?

A

Dobutamine

227
Q

fluid in sepsis?

A

30 ml/kg crystalloid

228
Q

oxygen level goal in sepsis?

A

> 90 %

229
Q

cause of type II resp failure?

A

Impaired ventilation (so movement of air in and our)

230
Q

causes of rest failure I

A

Impaired fass exchnage (O2 not crossing over)

231
Q

What is mechanical ventilation

A

Mechanical ventilation is a form of life support. A mechanical ventilator is a machine that takes over the work of breathing when a person is not able to breathe enough on their own. The mechanical ventilator is also called a ventilator, respirator, or breathing machine.

232
Q

On mechanical ventilator how do we increase ventilation?

A

increase RF
increase Tidal volume

233
Q

On mechanical ventilator how do we increase oxygenation?

A

Increase FiO2 and or PEEP (positive end expiratory pressure)

234
Q

Diagnosis of rest failure?

A

ABG
CXR
Echo
ECG
Microculture
CBC
Bronchoscopy

235
Q

two aspects of COPD?

A

Chronic bronchitis and emphysema

236
Q

two aspects of COPD?

A

Chronic bronchitis and emphysema

237
Q

define chronic bronchitis

A

Productive cough for 3 months for at least 2 years

238
Q

define Emphysemia

A

Alveolar wall and capillary destruction causing permanent dilation of air spaces

239
Q

how to know if emphysema or chronic bronchitis is the problem in COPD?

A

Pink puffers have emphysema
Blue bloaters have chronic bronchitis

240
Q

3 classifications of AECOPD

A

Mild: no hospitalization and standard dose bronchodilators
Moderate: No Hospitalization, bronchodilators + CS + AB
Severe: Hospitalization, high dose of all three + Resp failure

241
Q

what does crackles on auscultation during an acute ex of asthma mean?

A

etiology is due to viral or bacterial trigger

242
Q

acute ex of asthma treatment? (4)

A
  1. Inhaled SABA (albuterol) or LABA (ipratropium)
  2. IV CS Methylprednisolone
  3. IV Mg+ if severe
  4. Oxygen with goal of 92%
243
Q

when to give Mg2+ on acute ex asthma?

A

IF respiratory arrest with persistent hypoxia after treatment
Adults with FEV < 25-30
Children with FEV < 60% after 1h of treatment

244
Q

when to intubate in ex asthma?

A

If no response to treatment and resp arrest

245
Q

mild ex asthma treatment?

A

only SABA and O2 if needed

246
Q

Pneumonia monotherapy if no co-morbidities

A

Amoxicillin PO
Doxycycline PO

247
Q

outpatient Pneumonia monotherapy if co-morbidities

A

Ampicillin + macrolide OR mono therapy with a fluoroquinolone

248
Q

when id pneumonia an inpatient case?

A

CURB-65 > 2
PSI > 90

249
Q

how to keep alveoli open and not collaps in ARDS?

A

high PEEP

250
Q

respiratory failure in ARDS?

A

Type 1

251
Q

causes of ARDS?

A

Sepsis
Trauma
Shock
Acute pancreatitis
Pneumonia
Aspiration
Inhaled toxins

252
Q

short pathophysiology of ARDS?

A

tissue damage in or outside lung causing inflammation resulting in diffuse alveolar damage

253
Q

leading complications of ANE causing postop resp failure

A

Atelectasis (due to using 100% O2)
Pneumonia

254
Q

what is atelectasis

A

It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. Atelectasis is one of the most common breathing (respiratory) complications after surgery

255
Q

post resuscitation hemodynamic parameters

A

MAP < 65 mmHg
SBP < 90 mmHg

256
Q

which patients are sendt to coronary angiography post resuscitation?

A

if ST elevation on ECG

257
Q

what are the post resuscitation ABC?

A

ABG
BP
CXR

258
Q

ICU caloric requirement?

A

25Kcal/kg

259
Q

how to calculate ICU nutrition need?

A

REE = BEE x Stress factor
*REE: (Resting energy expenditure) the amount of energy expended by a resting individual
*BEE: (Basal Energy Expenditure the minimum amount of energy expended compatible with life.

260
Q

Fluid therapy goals in pancreatitis

A

HR > 120
MAP 65-85
Urine > 0.5 -1 ml/kg/h
Hct 35-45%
CVP 8-12 mmHg

261
Q

antiemetics in pancreatitis?

A

Ondansetron
Metoclopramide

262
Q

what does HHS stand for?

A

hyperosmotic hyperglycemic state

263
Q

DKA complications

A

Cerebral edema
Heart failure
Arrythmias
Mucormycosis

264
Q

Symtomes of encephalopathy

A

altered mental status
asterixs

265
Q

what to give in hyperammonemia (hepatic encephalopathy)

A

Lactulose

266
Q

HFrEF
HFpEF

A

*HFpEF is defined as heart failure with a left ventricular ejection fraction, or LVEF, of 50% or greater.
*HFrEF, or heart failure with a reduced ejection fraction, is heart failure with an LVEF of less than 40%.

267
Q

what causes release of BNP from the heart and what does it do?

A

Increased preload causes BNP release which causes vasodilation and no Na and H2O retention

268
Q

what mechanism causes increased afterload?

A

vasoconstriction

269
Q

lab studies in AHF?

A

NT-ProBNP
< 300 HF unlikely
> 1000 likely

270
Q

2 Q’s to ask if suspected AHF?

A

Is the patient in cardiogenic shock
Does the patient have resp failure

if yes - ICU for treatment

271
Q

what to ask if known AHF

A

Is the patient wet/dry (congested/not-congested)
Is he patient hot or cold (perfused/non-perfused

272
Q

Three options of immediate treatment of periarrest arrhythmias

A
  1. anti-arrhythmic drugs
  2. Attempted electrical cardioversion
  3. Cardiac pacing
273
Q

adverse sings in peri-arrest arrhythmias

A
  1. HF (pulmonary edema or jugular distension)
  2. Chest pain
  3. Excessive tachycardia (>140)
  4. Excessive bradycardia (< 40)
  5. Clinical signs of low CO
274
Q

Cardioversion drug?

A

Amiodorane 300 mg IV over 10-20 min

275
Q

Adult tachycardia treatment algorithm?

A
  1. Unstable/Stable
  2. QRS narrow/wide
  3. QRS irregular/regular
276
Q

adult bradycardia algorithm?

A
  1. ABCDE
  2. Life threatening yes/no
  3. Risk of asystole yes/no
277
Q

Evidence of life threatening bradycardia?

A
  1. shock
  2. syncope
  3. myocardial ischemia
  4. HF
278
Q

Risk of asystole?

A
  1. Previous asystole
  2. Mobitz II
  3. Total heart block + wide QRS
  4. Ventricular pause > 3s
279
Q

life-threatening bradycardia treatment

A

Atropin 500ug IV (max out to 3g if no effect)
Isoprenaline
Adrenalin

280
Q

non-life threatening brady treatment

A

*If risk of asystole:
Aminophylline
Dopamin
Glucagon

*IF no risk of asystole just observe

281
Q

Treatment of tachycardia broad regular

A

amiodarone 300mg

282
Q

Treatment of tachycardia broad irregular

A

B-blocker + anticoagulants
if TdP Mg 2mg/10 min

283
Q

Treatment of tachycardia narrow regular

A

Vagal manuver
Then Adenosine
Then Verapamil

284
Q

Treatment of tachycardia narrow irregular

A

B-blocker + anticoagulants
IF HF give digoxin or amiodarone

285
Q

DD concentration in DVT?

A

> 500 mg/ml positive
< 500 ng/ml negative

286
Q

DVT Wells criteria (risk)

A
  1. Clinical symptoms - 3p
  2. PE most likely diagnosis 3p
  3. Tachycardia 1.5p
  4. immobilization 1.5p
  5. prior DVT 1.5p
  6. Hemoptysis 1p
  7. Malignancy 1p
287
Q

DVT treatment

A
  1. parenteral LMWH for the firt 5-10 days
  2. long term direct oral anticoagulants 3-6 months
  3. Individualized decisions to continue anticoagulants for extended period
288
Q

Vasodilators

A

Hydralazine
Minoxidil
Diazoxide
Nitro

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