basic critical care

Question 1

What vessels provide the easiest access for a Swan-Ganz catheter?

Answer 1

left subclavian and right internal jugular

Question 2

What is a nonhemolytic febrile transfusion reaction?

Answer 2

reaction caused by antibodies to HLA types on donated blood; occurs in 3% of transfusions. usually occurs 1-6 hrs after the transfusion and may result in fever, rigors, malaise. treated with tylenol; recurrence uncommon

Question 3

What is an acute hemolytic trasnfusion reaction?

Answer 3

caused by ABO incompatibility. onset during transfusion with fevers, chills, nausea, flushing, tachycardia, tachypnea, hypotension. severe destruction of donor RBC requiring aggressive supportive care

Question 4

What is a delayed hemolytic transfusion reaction?

Answer 4

caused by antibodies to Kidd or D antigens; onset 2-10 days after transfusion with slight fever, falling H/H, mild incr. in unconjugated bilirubin. determine responsible ab type to prevent rxn in future

Question 5

What is post-transfusion purpura?

Answer 5

trhombocytopenia developing 5-10 days after transfusion, usually in women sensitized by pregnancy. tx: IVIG or plasmapheresis

Question 6

What is the tx for severe transfusion rxns?

Answer 6

acetaminophen, diphenhydramine, stop transfusion. mannitol ro bicarb needed in severe reactions to prevent hemolytic debris from clogging vessels. possible need for vasopressors

Question 7

What is cryoprecipitate?

Answer 7

clotting factor and von Willebrand factor-rich precipitate collected during thawing of FFP. used for warfarin overdose, DIC, TTP, clotting factor deficiencies when large volume transfusion would be a problem

Question 8

phenylephrine: MOA, effects

Answer 8

agonist for alpha receptors, alpha 1 more than alpha 2. causes vasoconstriction and reflex bradycardia

Question 9

norepinephrine: MOA, effects

Answer 9

agonist for alpha 1 and beta 1 adrenergic receptors. causes vasoconstriction and mildly increased contractility

Question 10

epinephrine: MOA, effects

Answer 10

agonist for beta 1 and, to some extent alpha 1 and beta 2 receptors at low doses; at high doses, alpha 1 effects predominate. causes incr. contractility and vasoconstriction

Question 11

dopamine effects

Answer 11

low does: beta 1 agonist
high dose: alpha agonist
incr. HR, incr contractility, vasoconstriction (at high doses only)

Question 12

isoproterenol effects and MOA

Answer 12

beta 1 and beta 2 agonist. incr. HR and contractility, vasodilation. useful for cardiac arrest

Question 13

vasopressin

Answer 13

ADH analogue with weak pressor effect; causes vasoconstriction. secondary pressor med

Question 14

dobutamine MOA, effects

Answer 14

agonist for beta 1 adronergic receptors- increases HR and contractility. may cause mild reflex vasodilation