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Copy ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn > Chapter 16 - Critical Care II > Flashcards

Chapter 16 - Critical Care II Flashcards

1
Q

Diagnosis of significant organ failure of the lung?

A
  • need for mechanical ventilation
  • PaO2/FiO2 ratio <300 for 24 hours
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2
Q

Diagnosis for significant organ failure of cardiovascular?

A

need for pressors to maintain adequate tissue perfusion Or Cardiac Index <2.5

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3
Q

Diagnosis of significant organ failure of the kidney?

A
  • creatinine >2x baseline on 2 consecutive days
  • dialysis
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4
Q

Diagnosis of significant organ failure of Liver?

A

bilirubin >3 on 2 consecutive days

PT >1.5 control

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5
Q

Diagnosis for significant organ failure of CNS?

A

glasgow coma scale <10 without sedation

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6
Q

Diagnosis for significant organ failure of coagulation?

A

platelets <100 need for factor replacement

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7
Q

Diagnosis for significant organ failure of host defenses?

A

WBC <1000 OR invasive infection including bacteremia

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8
Q

aspiration of what pH causes injury?

A

pH 2.5 and volume >0.4cc/kg causes increased damage

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9
Q

what is Mendelson’s Syndrome?

A

chemical pneumonitis from aspiration of gastric secretions most common site is posterior portion of RUL and superior portion of RLL

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10
Q

What is atelectasis?

A

bronchial obstruction and respiratory failure main causes most common cause of fever in first 48h fever tachycardia increased in pts with COPD, upper abdominal surgery tx with incentive spirometer

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11
Q

What can throw off pulse ox?

A
  • nail polish
  • dark skin
  • low-flow states
  • ambient light
  • anemia
  • vital dyes
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12
Q

What causes pulmonary vasodilation?

A

bradykinin PGE1 prostacyclin NO

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13
Q

What causes pulmonary vasoconstriction?

A
  • histamine
  • serotonin
  • TXA2
  • epinephrine
  • norepinephrine
  • hypoxia
  • acidosis
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14
Q

how do you alkalosis via lungs?

A

pulmonary vasodilator

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15
Q

how do you treat acidosis via lungs?

A

pulmonary vasoconstrictor

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16
Q

What vasodilatory drugs cause pulmonary shunting?

A

Nipride, nitroglycerin, nifedipine

Increases in NO cause vasodilation. In the lungs, this causes an increase in flow w/o increasing oxygenation, ie shunting.

An important side effect is cyanide toxicity - tx amyl nitrite, sodium nitrate, sodium thiosulfate

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17
Q

What is the most common cause of postoperative renal failure?

A

hypotension

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18
Q

What percentage of nephrons need to be damaged before you have renal dysfunction?

A

70%

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19
Q

What is FeNa?

A

(Naurine/Naplasma) / (Crurine/Crplasma)

  • < 1% is prerenal - the kidney is working, it is still trying to hold Na in response to a decrease of flow into the glomeruli
  • > 2% is ATN or postrenal - the kidney is not working well
  • intermediate could be either
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20
Q

what are the findings in prerenal acute renal failure?

A
  • FeNa < 1% (aldosterone)
  • urine osmolality >500 mOsm (ADH)
  • BUN/Cr ratino >20
21
Q

What do do with oliguria?

A

1st- make sure patient is volume loaded 2nd- try diuretic trial 3rd dialysis if needed

22
Q

What are the indications for dialysis?

A

fluid overload increasing K metabolic acidosis uremic encephalopathic uremic coagulopathy poisoning

23
Q

What is the benefit of CVVH?

A
  • slower
  • good for ill patients who cannot tolerate volume shifts
  • Hct increases by 5-8 for each liter taken off
24
Q

What are the advantages of intermittent hemodialysis?

A
  • lower risk of systemic bleeding
  • facilitates transport for other interventions
  • more suitable for severe hyper K
  • lower cost
25
Q

What are the disadvantages of intermittent dialysis?

A

availability of dialysis staff more difficult hemodynamic control inadequate frequency fluid control nutrition issues not good for increased ICP no removal of cytokines complement activation

26
Q

what are the benefits of continuous renal replacement therapy?

A

better hemodynamic stability fewer cardiac arrhythmias improved nutritional support better pulmonary gas exchange better fluid control

27
Q

disadvantages of continuous renal replacement therapy?

A

vascular access problems higher risk of systemic bleeding long term immobilization more filter problems cost

28
Q

What causes release of renin?

A
  • decreased pressure sensed by juxtaglomerular apperatus
  • increased NA sensed by macula densa
  • beta adrenergic stimulation
  • hyperkalemia
29
Q

What does renin cause?

A
  • renin - angiotensinogen (from liver) to angiotensin I
  • ACE - angiotensin I to II
  • angiotensin II - adrenal cortex release of aldosterone
30
Q

Where does aldosterone act?

A

distal convoluted tubule. Reabsorbs more water by increased Na/K ATPase on membrane- potassium secreted

31
Q

What are other effects of angiotensin II?

A

Everything to increase BP and blood glucose

  • inc vasoconstriction
  • inc HR and contractility
  • inc vascular permeability
  • inc glycogenolysis and gluconeogenesis
  • inh renin
32
Q

What is atrial natriuretic peptide?

A

released from atrial wall with dilation inhibits Na and water resorption in the collecting ducts vasodilator

33
Q

What is ADH

A

vasopressin. released by posterior pituitary gland when osmolality is high -acts on collecting ducts -vasoconstrictor

34
Q

What part of nephron controls GFR?

A

efferent limb

35
Q

How are NSAID’s nephrotoxic?

A

inhibit prostaglandin synthesis resulting in renal arteriole vasoconstriction

36
Q

How are aminoglycosides nephrotoxic?

A

direct tubular injury and later renal vasoconstriction

37
Q

How is myoglobin nephrotoxic?

A

direct tubular injury tx by alkalinizing urine

38
Q

How is contrast dye nephrotoxic?

A

direct tubular injury premedicate with fluid, N-acetylcysteine

39
Q

What precludes dx of brain death?

A
  • uremia
  • low temp
  • BP <70/40
  • apnea test failure
  • phenobarbitol/pentobarbitol
  • metabolic derangements
40
Q

What must you have for brain death?

A
  • must exist for 6-12 hours
  • unresponsive to pain
  • absent caloric oculovestibular reflex
  • absent oculocephalic reflex + apnea test
  • no corneal reflex/gag reflex
  • fixed/dilated pupils
  • EEG - electrical silence
  • MRA - no flow
  • Can still have deep tendon reflexes
41
Q

What is the apnea test?

A
  • disconnect from ventilation
  • CO2>60 or increase >20 is positive
  • if arterial pressure drops to <60 or desaturates, test terminated
42
Q

How is carbon monoxide dangerous?

A
  • falsely increase O2 sat reading on pulse ox
  • binds hemoglobin directly
  • can usually correct with 100% O2 on ventilator
  • abdnormal carboxyhemoglobin is >10%, >20% in smokers
43
Q

What else can cause methemoglobinemia other then CO?

A

nitrites tx with methylene blue

44
Q

What is the order of clinical illness polyneuropathy?

A

motor>sensory occurs with sepsis, can lead to failure to wean from vent

45
Q

What does xanthine oxidase do? where is it from?

A

in endothelial cells, forms toxic oxyten radicals with reperfusion also involved in metabolism of purines and breakdown to uric acid

46
Q

DKA sx?

A

nausea, vomiting, thirst, polyuria abdominal pain, increased glucose, increased ketones, decreased Na, increased K tx w bicarb for pH>7.25

47
Q

EtOH withdrawal?

A

HTN tachycardia delirium seizures Tx: thiamine, folate, Mg, K, B12, ativan

48
Q

ICU psychosis?

A

generally occurs after third post op day, preceded by lucid interval need to rule out metabolic and organic causes

Copy ABSITE Review: Fiser, Decker, SCORE, UpToDate, TrueLearn (50 decks)

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