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review cards > 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
What are the disadvantages of intermittent dialysis?
``` 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
what are the benefits of continuous renal replacement therapy?
``` better hemodynamic stability fewer cardiac arrhythmias improved nutritional support better pulmonary gas exchange better fluid control ```
27
disadvantages of continuous renal replacement therapy?
``` vascular access problems higher risk of systemic bleeding long term immobilization more filter problems cost ```
28
What causes release of renin?
decreased pressure sensed by juxtaglomerular apperatus increased NA sensed by macula densa beta adrenergic stimulation hyperkalemia
29
What does renin cause?
``` converts angiotensinogen (from liver) to angiotensin I ACE converts angiotensin I to II Adrenal cortex releases aldosterone in response to angiotensin II ```
30
Where does aldosterone act?
distal convoluted tubule. Reabsorbs more water by increased Na/K ATPase on membrane- potassium secreted
31
What are other effects of angiotensin II?
``` vasoconstricts increases HR contractility permeability glycogenolysis gluconeogenesis inhibits renin ```
32
What is atrial natriuretic peptide?
released from atrial wall with dilation inhibits Na and water resorption in the collecting ducts vasodilator
33
What is ADH
vasopressin. released by posterior pituitary gland when osmolality is high - acts on collecting ducts - vasoconstrictor
34
What part of kidney controls GFR?
efferent limb
35
How are NSAID's nephrotoxic?
inhibit prostaglandin synthesis resulting in renal arteriole vasoconstriction
36
How are aminoglycosides nephrotoxic?
direct tubular injury and later renal vasoconstriction
37
How is myoglobin nephrotoxic?
direct tubular injury | tx by alkalinizing urine
38
How is contrast dye nephrotoxic?
direct tubular injury | premedicate with fluid, N-acetylcysteine
39
What precludes dx of brain death?
``` uremia temp <70/40 desaturation with apnea test phenobarbitol/pentobarbitol metabolic derangements ```
40
What must you have for brain death?
``` 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
What is the apnea test?
disconnect from ventilation CO2>60 or increase >20 is positive if arterial pressure drops to <60 or desaturates, test terminated
42
How is carbon monoxide dangerous?
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
What else can cause methemoglobinemia other then CO?
nitrites | tx with methylene blue
44
What is the order of clinical illness polyneuropathy?
motor>sensory | occurs with sepsis, can lead to failure to wean from vent
45
What does xanthine oxidase do? where is it from?
in endothelial cells, forms toxic oxyten radicals with reperfusion also involved in metabolism of purines and breakdown to uric acid
46
DKA sx?
nausea, vomiting, thirst, polyuria abdominal pain, increased glucose, increased ketones, decreased Na, increased K tx w bicarb for pH>7.25
47
EtOH withdrawal?
``` HTN tachycardia delirium seizures Tx: thiamine, folate, Mg, K, B12, ativan ```
48
ICU psychosis?
generally occurs after third post op day, preceded by lucid interval need to rule out metabolic and organic causes

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