Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

review cards > Chapter 16 - Critical Care > Flashcards

Chapter 16 - Critical Care Flashcards

1
Q

How do you calculate MAP?

A

CO x SV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you calculate CI?

A

CO/BSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you calculate SVRI?

A

SVR x BSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what percentage of CO does the brain, kidney, heart get?

A

Brain 15%
Kidney 25%
Heart 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Preload is linearly related to what?

A

end diastolic volume and filling pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is afterload?

A

resistance against the ventricle contracting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is stroke volume determined by?

A

LVEDV, contractility and afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you calculate ejection fraction?

A

stroke volume/end diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is end systolic volume determined by?

A

contractility and afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what heart rated does CO start to decrease?

A

150- decreased diastolic filling time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What % of LVEDV does atrial kick account for?

A

15-30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the Anrep effect?

A

automatic increase in contractility secondary to increased afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Bowditch effect?

A

automatic increase in contractility secondary to heart rate increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the radial diastolic and systolic pressure in relationship to aortic mean pressures?

A

diastolic slightly lower, systolic slightly higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you calculate O2 consumption (VO2)

A

CO x (CaO2 - Cvo2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the normal O2 delivery to consumption ratio?

A

5:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Is O2 consumption supply dependent?

A

No, does not change until levels of delivery are very low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What causes a right shift in the O2 dissociation curve?

A 
increased CO2
increased temperature
Increased ATP production
increased 2,3-DPG production
increased H+ (decreased pH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the normal p50 (O2 at which 50% of O2 receptors are saturated)?

A

27mmhg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When does SvO2 go up?

A

shunting or decreased extraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When does SvO2 go down?

A

increased extraction, decreased delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can make wedge pressures inaccurate?

A 
pulmonary htn
aortic regurg
mitral stenosis/regurg
high peep
poor LV compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where should a swan-ganz catheter be placed?

A

zone III (lower) lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do you do with hemoptysis after flushing a swan-ganz catheter?

A

increase PEEP which will tamponade the pulmonary arter bleed, mainstem intubate non-affected side
can try to place fogarty balloon down the affected side- may need thoracotomy and lobectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are contraindications to swan?
previous pneumonectomy, left bundle branch block
26
What is the only way to measure pulmonary vascular resistance?
swan
27
What are the primary determinants of myocardial O2 consumption?
ventricular wall tension and HR
28
what has a higher PO2- pulmonary capillaries or LV?
pulmonary capillaries- LV gets unsaturated bronchial blood
29
what is the normal aa gradient?
10-15mmhg
30
What blood has the lowest venous saturation?
coronary venous (30%)
31
What are the signs of acute adrenal insufficiency?
cardiovascular collapse | unresponsive to fluids and pressors
32
signs of chronic adrenal insufficiency?
hyperpigmentation, weakness, weight loss, GI sx decreased K increased Na fever, hypotension
33
what steroids are at 1x potency of endogenous?
cortisone, hydrocortisone
34
What steroids are at 5x potency of endogenous?
prednisone prednisolone methylprednisolone
35
What steroids are at 30x strength of endogenous steroids?
dexamethasone
36
What do you get with neurogenic shock?
``` loss of sympathetic tone decreased HR decreased BP warm skin tx: volume then phenylephrine steroids for blunt spinal trauma ```
37
what is the initial alteration in hemorrhagic shock?
increased diastolic pressure
38
what is beck's triad?
hypotension, jugular venous distention, muffled heart sounds
39
what does echo show in tamponade?
decreased RA filling pressures
40
What is the early sepsis triad?
hyperventilation, confusion, respiratory alkalosis
41
what do you get in early gram negative sepsis?
decreased insulin, increased glucose | impaired utilization
42
What do you get in late gram negative sepsis?
increased insulin, increased glucose | secondary to insulin resistance
43
what is the MOA of Xigris?
fibrinolysis (activated protein C)
44
What are the signs of fat emboli? where do they usually come from?
``` petechia hypoxia confusion sudan red may show fat in sputum and urine lower extremity fx ```
45
What will echo show in pulmonary thromboemboli?
RV strain
46
When do you suspect PE?
``` PA systolic >40 decreased PO2 and PCO2 respiratory alkalosis chest pain cough dyspnea, increased heart rate ```
47
Air Emboli- what do you do?
place pt. head down and roll to left, aspirate air out with central line or PA catheter to RA/RV
48
When does an intra-aortic balloon pump inflate, deflate?
Inflates on T-wave (diastole); deflates on P-wave or start of q wave (systole)
49
What is a contraindication for an IABP?
Aortic regurgitation
50
When is an IABP placed?
Cardiogenic shock after CABG, MI or in patients with refractory angina. Decreases afterload. Improves systolic blood pressure which improves coronary perfusion
51
Where are alpha-1 receptors
Vascular smooth muscle constriction; gluconeogenesis, glycogenolysis
52
What do alpha-2 receptors do?
Venous smooth muscle constriction
53
What do beta-1 receptors do?
Increase myocardial contraction and rate
54
What do beta-2 receptors do?
Relaxes bronchial smooth muscle, relaxes vascular smooth muscle, increases insulin, glucagon, rennin
55
What do dopamine receptors do?
Relax renal and splanchnic smooth muscle
56
What is the rate of low dopamine administration and what does it affect?
05 µg per kilogram per minute acts on dopamine receptors -renal
57
What is the medium dose for dopamine drip and what does it affect?
6 to 10 µg per kilogram per minute-beta-adrenergic acts on heart contractility
58
What is the dose for high-dose dopamine and what does it affect?
Greater than 10 µg per kilogram per minute acts on alpha-adrenergic receptors causes vasoconstriction and increased blood pressure
59
What is the initial drip rates for dobutamine and what does it do?
3 µg per kilogram per minute initially. 5 to 10 µg per kilogram per minute causes beta-1 activation increasing contractility. Greater than 15 µg per kilogram per minute causes alpha adrenergic activation -vasodilation and increased heart rate
60
What does milrinone do?
Phosphodiesterase inhibitor increases cAMP Results in increased calcium influx and increased myocardial contractility Also causes vascular smooth muscle relaxation and vasodilation
61
What does phenylephrine do?
Acts on alpha-1 receptors causes vasoconstriction
62
What does norepinephrine do?
Low-dose causes beta-1 activation increasing contractility High-dose causes alpha-1 and alpha-2 activation Potent splanchnic vasoconstrictor
63
What does epinephrine do?
Low-dose causes beta-1 and beta-2 activation causing increased contractility and vasodilation. Can decrease blood pressure at low doses High-dose causes activation of alpha-1 and alpha-2 causing vasoconstriction. Increased cardiac ectopic pacer activity and myocardial O2 demand
64
What does isoproterenol do?
Beta-1 and beta-2 activation, increases heart rate and contractility, vasodilates. Side effects are extremely arrhythmogenic, increased heart metabolic demand, may actually lower blood pressure
65
What does vasopressin do?
V1 receptors cause vasoconstriction of vascular smooth muscle V2 receptors are intrarenal and cause water reabsorption at collecting ducts V2 receptors are extrarenal and mediate release of factor VIII and von Willebrand factor
66
What does nipride to do?
Arterial and venous dilator. Can cause cyanide toxicity. Check thiocyanate levels
67
What does nitroglycerin do?
Predominantly veno dilation, modest effect on coronaries; decreased myocardial wall tension by decreasing preload
68
What does hydralazine do?
Alpha blocker
69
How do you measure lung compliance?
Change in volume divided by change in pressure. High compliance means lungs easy to ventilate. Pulmonary compliance decreases in patients with ARDS, fibrotic lung disease, reperfusion injury, pulmonary edema.
70
What does aging do to lungs?
Decreases FEV1 and vital capacity, increases functional residual capacity
71
Where is the V/Q ratio highest?
Highest in upper lobes, lowest in lower lobes
72
What does increasing peep do?
Improves oxygenation through alveoli recruitment. Improves FRC.
73
How do you decrease CO2 on a ventilator?
Increase rate or volume
74
What does pressure support do?
Decreases the work of breathing
75
Why do you want to keep FI O2 below 60%?
Prevent 02 radical toxicity
76
When do you have a risk of barotrauma?
Plateaus greater than 30 and peaks greater than 50
77
What are the complications of hi Peep?
``` Decreased right atrial filling Decreased cardiac output Decreased renal bloodflow Decreased urine output Increased pulmonary vascular resistance ```
78
When do you use high-frequency ventilation?
Kids; tracheoesophageal fistula, bronchopleural fistula
79
What does inverse ratio ventilation do?
Helps reduce barotrauma
80
What is total lung capacity?
Lung volume after maximal inspiration. TLC equals FVC plus RV
81
What is forced vital capacity
Maximal exhalation after maximal inhalation
82
What is residual volume
Lung volume after maximal expiration
83
What is tidal volume?
Volume of air with normal inspiration and expiration
84
What is functional residual capacity?
Long volume after normal exhalation. FRC equals ERV plus RV | Surgery, sepsis, trauma all decrease FTC
85
What is expiratory reserve volume?
volume of air that can be forcefully expired after normal expiration
86
What is inspiratory capacity
maximum air breathed in from FRC
87
What is FEV1?
forced expiratory volume in 1 second after maximal inhalation
88
What is minute ventilation?
TV x RR
89
What does restrictive lung disease do to lung function tests?
decreased TLC decreased RV Decreased FVC FEV1 can be normal or increased
90
What does obstructive lung disease do to lung function tests?
increased TLC increased RV decreased FEV1 FVC can be normal or decreased
91
What is dead space?
normally to the level of the bronciole (150mL) increases with drop in cardiac output, PE, pulmonary HTN, ARDS, excessive PEEP can lead to high CO2 buildup -area of lung that is ventilated but not perfused
92
What does COPD do to lung function?
increases work of breathing because of prolonged expiratory phase work of breathing normally 2% of total body VO2
93
what is ARDS and what does it do to lungs?
``` mediated by cellular inflammatory process increased proteinaceous material increased gradient increased shunt most common in sepsis ```
94
Diagnosis of Acute lung injury?
acute onset bilateral pulmonary infiltrates paO2/FiO2 = 18 or no clinical evidence of LAH
95
Diagnosis of ARDS
acute onset bilateral pulmonary infiltrates PaO2/FiO2 <200
96
What is SIRS mediated by? Criteria?
TNF alpha and IL-1 | temp >38 or 12 or 90
97
Most potent stimulus for SIRS?
lipopolysacharide (Lipid A)
98
Diagnosis of Sepsis?
SIRS with clinical evidence of infection | sepsis with organ disfunction
99
Septic shock?
Sepsis and arterial hypotension despite adequate volume resuscitation
100
Muti organ dysfunction?
progressive but reversible dysfunction of 2 or more organs

review cards (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions