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Fiser's ABSITE Review > Chapter 16 - Critical Care II > Flashcards

Chapter 16 - Critical Care II Flashcards

1
Q

Diagnosis for significant organ failure of lung?

A

need for meghanical fentilation

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 for significant organ failure of kidney?

A

creatinine >2x baseline on 2 consecutive days
OR
dialysis

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4
Q

Diagnosis for significant organ failure of Liver?

A

bilirubin >3 on 2 consevutive days or 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 causes injury?

A

pH,2.5 and volume >0.4cc/kg causes incrased 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 drugs cause pulmonary shunting?

A

Nipride
nitroglycerin
nifedipine

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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

urine NA/urine CR X plasma Na/urine Cr

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20
Q

what are the findings in prerenal acute renal failure?

A

FeNa 20
urine osmolality >500mOsm
otherwise consider renal cause

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 
converts angiotensinogen (from liver) to angiotensin I
ACE converts angiotensin I to II
Adrenal cortex releases aldosterone in response to angiotensin II
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 
vasoconstricts
increases HR
contractility
permeability
glycogenolysis
gluconeogenesis
inhibits 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 kidney 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
temp <70/40
desaturation with apnea test
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 or MRA 
**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% O2on 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

Fiser's ABSITE Review (50 decks)

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