ARDs, CNS, Trauma - Block 4 Flashcards
What is ARDs
Inflammatory pulmonary edema -> severe hypoxemia
What is PEEP?
Posititve end expiratory pressure: amount of presure left in the alvoli after expiration
What is the pathology of ARDs??
Imbalance between ventilation x perfusion -> MODs -> deoxygenated blood
What are the primary ARDs?
- Aspiration
- Pulmonary contusion
- Pneumonia
- Drowning
- Toxic inhalation
- Burns
What are causes of secondary ARDs?
- Sepsis
- Hypovolemic shock
- Acute pancreatitis
- Trauma
- TRALI
- DIC
What is a strong recommendation to treat ARDs?
- Mechanical ventilation
- Prone positioning for more than 12 h/d in severe ARDs
What are conditional tx for ARDs?
- CS
- NMB in early severe
- Higher PEEP without lung recruitment maneuvers for mod-severe
What are treatments that should not be used in ARDs?
- High frequency oscillation ventilation
- Prolonged lung recruitment maneuvers in mod-severe
When are CS used in ARDs?
Septic shock or pneumonia
* Increase hyperglycemia and GI bleeding
What are the benefits of using NMBAs for ARDs?
- Decreased mortality and ventilation
- Reduction of ventilation injuries
- Reduced O2 consumption
- Reduced inflammation
- Reduced alveolar fluid
What are the concerns of using NMBAs?
- Deep sedation
- ICU-acquired weakness
- Unclear long term outcomes
What is the difference between primary and secondary traumatic brain injury?
Primary: external transfer of kinetic energy to various structural components of the brain -> contact, acceleration/develeration
Secondary: imbalnaces in cerebral o2 delivery (CDO2) and cerebral metabolic rate of o2 (CMRO2) consumption -> ischemia -> cell death
What are sx of TBI?
- Posttraumatic amnesia
- DZ
- Severe HA
- N/V
- Limb weakness
- Parestheisa
What are the signs of TBI?
- CSF otorrhea or rhinorrhea
- SZ
- Unreactive pupils
- Rapid mental deterioration
- Alterations in vital signs
How do we assess TBI mental status?
Gasgow Coma Scale
What are we assessing in GCS?
Level of consciousness:
1. Eye opening
2. Motor response
3. Verbal response
Scoring:
3 to 8 = severe brain injury
9 to 12 = moderate brain injury
13 to 15 = mild or minor brain injury
What are diagnostic test we use for TBI?
Labs:
1. ABG (pH, pCO2, HCO3)
2. Alcohol levels
3. Urine tox
4. CMP (LFT, BMP)
CT Scan:
1. Mass lesion
2. Midline shift
3. Compressed ventricles
Tx goals for TBI?
Short term:
1. Perfusion/airway -> balace cerebral O2
2. Prevention of complications
3. Prevention of secondary injuries
Long term:
1. Reduction of morbidity and mortality
2. Functional status
What are recommendations for TBI?
- Decompressive craniectomy
- Hyperosmolar tx (hypertonic saline 3%, 23.4%; mannitol)
- CSF drainage
- Nutrition
- DVT prophylaxis
- Sz prophylaxis
What is the intitial tx for TBI?
How is ICP managed?
What do you give if patient is refractory to mannitol or hypertonic saline?
Phenobarbitol
What are the components of CAB?
COmpression, airway, rescue breaths
Directions for proper compressions?
- 100-120 compressions/minute
- Depth of 2-2.4 inches
- Allow chest recoil after each compression
Factors that can effect airway?
- Foreign body airway obstrction
- Advanced airway
- Drug induced respiratry depression
What are rescue breaths?
- Assist in maintaining oxygenation and eliminating CO2
- 30 compressions to 2 breaths or 1 breath every 6 seconds (10 breaths/minute)
What are the characterisitcs of normal heart rate and rhythm?
- Normal PQRST deflections and intervals
- Rate: 60-100 at rest
What constitutes bradycardia?
HR: <50 bpm
What are infusions that induce bradycardia?
Non-DHP, beta blockers
What drugs that can reverse bradycarda?
CCB and beta blocker: glucogon
1. Atrpine
2. Dopamine
3. Epinehrine
How do we treat tachycardia in ALS?
- Adenosine
- Cardioversion
ANtiarrhytmic:
1. Pocainamide
2. Amiodarone
3. Sotalol
How do we treat cardiac arrest?
How is adenosine given?
Left arm:
1. Rapid push
2. Rapid flush
3. Arm elevation
- Due to short half-life
What is V fib?
Disorganized
WHat is pVT features?
Pulseless
Sawtooth
What is asystole?
