CHAPTER 57 | Critical Care Medicine Flashcards
The 28-day mortality rate for SEPTIC SHOCK
20-40%
What is the suggested temperature employed for Mild Therapeutic Hypothermia in ICU
33-35C
Which of the following hypotensive patients could potentially show
improvement in their hemodynamics with the administration of POSITIVE PRESSURE VENTILATION?
A. Large myocardial infarction in left anterior descending territory
B. Acute liver failure (ALF)
C. Acute pulmonary embolism
D. Induction of anesthesia
E. Sepsis
A. Large Myocardial Infarction in the LAD territory
Positive pressure ventilation can have significant hemodynamic effects through
changes in cardiac function and pulmonary vascular pressure. The overall effect on hemodynamic function depends on underlying pathology. An increase in
intrathoracic pressure reduces the gradient for venous return to the right heart and
therefore decreases right-sided preload. In patients with reduced preload due to
hypovolemia or decreased SVR (hemorrhage, sepsis, liver failure, anesthetic
agents), the addition of positive pressure ventilation will further decrease preload
and worsen hypotension. Increased alveolar pressure increases pulmonary vascular
resistance and therefore increases right heart afterload. In general, right-sided
cardiac output declines under positive pressure ventilation. Patients with pulmonary
hypertension and right ventricle (RV) failure (eg, acute PE) will therefore develop
worsening hemodynamics with positive pressure ventilation.
In contrast to the right heart, left heart function can improve with positive
pressure ventilation. Positive intrathoracic pressure decreases left ventricle (LV)
transmural pressure and wall tension according to the Law of Laplace. This in turn
reduces LV afterload. Assuming the LV preload is adequate, cardiac output may
improve due to reduced afterload. This becomes especially apparent in patients
with cardiogenic shock. LV failure should always be considered in the differential
of ventilator weaning failure.
Hemodynamic
Which of the following basic principles applied to all critical care patients, assuming initial surgical management are appropriate?
A. Head elevation more than 45 degrees
B. CPP <50 Torr
C. ICP <5 Torr
D. Mannitol, hyportonic saline
E. SaO2 ≥95%; PaCO2 35–40 Torr
E. SaO2 ≥95%; PaCO2 35–40 Torr
True or False
Administration of empiric broad-spectrum antibiotics within ONE HOUR of sepsis diagnosis is an essential component of the SEPSIS campaign.
TRUE
Administer empiric broad-spectrum antibiotics within 1 hour of sepsis diagnosis, and reassess appropriateness of antimicrobial therapy upon availability of microbiology results.
The primary 1st line vaso-pressor for sepsis:
NOREPINEPHRINE
The target MAP is > or = 65
The addition of Vasopressin is recommended when the Norepinephrine dose reaches 0.25 to 0.5 mg/kg/min
****TRUE
Vasopressin may be added at a fixed rate as an adjunct to norepinephrine, but should not be used alone. The addition of vasopressin is recommended instead of further norepinephrine dose escalation when the norepinephrine dose reaches 0.25–0.5 μg/kg/min
The target hgb in the absence of tissue hypoperfusion, CAD, or acute hemorrhage is:
A. <7 g/dL
B. >10 g/dL
C. 7-9 g/dL
D. < 8 g/dL
**C. 7-9 g/dL **
Target a hemoglobin of 7–9 g/dL in the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage
The recommended duration per day when employing PRONE positioning among sepsis-induced ARDS patients is:
A. 24 hrs
B. at least 12 hrs
C. at least 8 hrs
D. less than 8 hrs
B . At least 12 hours
For patients with moderate-to-severe sepsis-induced ARDS, prone positioning for at least 12 hrs per day is recommended
Which of the following interventions is TRUE in the sespis campaign guideline?
A. Intensive Care Unit admission within the FIRST hour of diagnosis
B. Use bicarbonate to correct arterial pH <7.2 in the setting of acute kidney injury
C. Use of procalcitonin levels to decide when to start antimicrobial therapy.
D. Use of Pulmonary artery catheters to assess the acuteness of lung injury
B. Use bicarbonate to correct arterial pH <7.2 in the setting of acute kidney injury
The following are the predictors of poor outcome in TBI except:
A. Age > 45
B. Blood Glucose of > 1,800 mg/dL
C. Poor GCS
D. Poor pupillary reaction
E. Age > 60
A. Age > 45
