ARDs, CNS, Trauma - Block 4 Flashcards

1
Q

What is ARDs

A

Inflammatory pulmonary edema -> severe hypoxemia

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1
Q

What is PEEP?

A

Posititve end expiratory pressure: amount of presure left in the alvoli after expiration

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2
Q

What is the pathology of ARDs??

A

Imbalance between ventilation x perfusion -> MODs -> deoxygenated blood

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3
Q

What are the primary ARDs?

A
  1. Aspiration
  2. Pulmonary contusion
  3. Pneumonia
  4. Drowning
  5. Toxic inhalation
  6. Burns
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4
Q

What are causes of secondary ARDs?

A
  1. Sepsis
  2. Hypovolemic shock
  3. Acute pancreatitis
  4. Trauma
  5. TRALI
  6. DIC
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5
Q

What is a strong recommendation to treat ARDs?

A
  1. Mechanical ventilation
  2. Prone positioning for more than 12 h/d in severe ARDs
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6
Q

What are conditional tx for ARDs?

A
  1. CS
  2. NMB in early severe
  3. Higher PEEP without lung recruitment maneuvers for mod-severe
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7
Q

What are treatments that should not be used in ARDs?

A
  1. High frequency oscillation ventilation
  2. Prolonged lung recruitment maneuvers in mod-severe
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8
Q

When are CS used in ARDs?

A

Septic shock or pneumonia
* Increase hyperglycemia and GI bleeding

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9
Q

What are the benefits of using NMBAs for ARDs?

A
  1. Decreased mortality and ventilation
  2. Reduction of ventilation injuries
  3. Reduced O2 consumption
  4. Reduced inflammation
  5. Reduced alveolar fluid
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10
Q

What are the concerns of using NMBAs?

A
  1. Deep sedation
  2. ICU-acquired weakness
  3. Unclear long term outcomes
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11
Q

What is the difference between primary and secondary traumatic brain injury?

A

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

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12
Q

What are sx of TBI?

A
  1. Posttraumatic amnesia
  2. DZ
  3. Severe HA
  4. N/V
  5. Limb weakness
  6. Parestheisa
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13
Q

What are the signs of TBI?

A
  1. CSF otorrhea or rhinorrhea
  2. SZ
  3. Unreactive pupils
  4. Rapid mental deterioration
  5. Alterations in vital signs
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14
Q

How do we assess TBI mental status?

A

Gasgow Coma Scale

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15
Q

What are we assessing in GCS?

A

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

16
Q

What are diagnostic test we use for TBI?

A

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

17
Q

Tx goals for TBI?

A

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

18
Q

What are recommendations for TBI?

A
  1. Decompressive craniectomy
  2. Hyperosmolar tx (hypertonic saline 3%, 23.4%; mannitol)
  3. CSF drainage
  4. Nutrition
  5. DVT prophylaxis
  6. Sz prophylaxis
19
Q

What is the intitial tx for TBI?

20
Q

How is ICP managed?

21
Q

What do you give if patient is refractory to mannitol or hypertonic saline?

A

Phenobarbitol

22
Q

What are the components of CAB?

A

COmpression, airway, rescue breaths

23
Q

Directions for proper compressions?

A
  1. 100-120 compressions/minute
  2. Depth of 2-2.4 inches
  3. Allow chest recoil after each compression
24
Factors that can effect airway?
1. Foreign body airway obstrction 2. Advanced airway 3. Drug induced respiratry depression
25
What are rescue breaths?
1. Assist in maintaining oxygenation and eliminating CO2 2. 30 compressions to 2 breaths or 1 breath every 6 seconds (10 breaths/minute)
26
What are the characterisitcs of normal heart rate and rhythm?
1. Normal PQRST deflections and intervals 2. Rate: 60-100 at rest
27
What constitutes bradycardia?
HR: <50 bpm
28
What are infusions that induce bradycardia?
Non-DHP, beta blockers
29
What drugs that can reverse bradycarda?
CCB and beta blocker: glucogon 1. Atrpine 2. Dopamine 3. Epinehrine
30
How do we treat tachycardia in ALS?
1. Adenosine 2. Cardioversion ANtiarrhytmic: 1. Pocainamide 2. Amiodarone 3. Sotalol
31
How do we treat cardiac arrest?
32
How is adenosine given?
Left arm: 1. Rapid push 2. Rapid flush 3. Arm elevation * Due to short half-life
33
What is V fib?
Disorganized
34
WHat is pVT features?
Pulseless Sawtooth
35
What is asystole?