Crit Care: 1 pages 58-66

Question 1

Guidelines recommend that supplemental parenteral nutrition should be considered only after ___ to ___ days of meeting less than ___% of energy and protein requirements by the enteral route alone.

Answer 1

7-10

60%

Question 2

Why is early mobilization important in the ICU?

Answer 2

long-term follow-up of patients with critical illness demonstrates persistent weakness at 1 and 5 year

Question 3

Admission to the ICU for respiratory insufficiency is prompted by what three basic conditions/categories

Answer 3

1. hypoxemic respiratory failure,
2. hypercapnic respiratory (ventilatory) failure
3. upper airway impairment

Question 4

Therapies for hypoxemia include ____ or ____

Answer 4

1. increasing the inhaled oxygen concentration

2. applying positive end-expiratory pressure to open up flooded or collapsed alveoli.

Question 5

Upper airway impairment is usually a manifestation of

either ___ or ___

Answer 5

1. obstruction of the airway (e.g., angioedema)

2. inability to protect the airway (e.g., opiate intoxication).

Question 6

Evidence now suggests that supplementing oxygen for patients whose oxygen saturation is already ___ or higher actually increases mortality.

Answer 6

96%

Question 7

Recommendations include both that an SpO2 of 1.___or lower should be maintained in patients receiving oxygen therapy and that oxygen therapy should not be started for patients with acute myocardial infarction or stroke and an SpO2 of 2.___ or higher

Answer 7

1. 96%

2. 93%

Question 8

What conditions may benefit from SaO2 over 96% ( 4 examples)

Answer 8

1. carbon monoxide poisoning (a specific case in which SpO2 may be unreliable and SaO2 should be used instead),
2. cluster headache
3. sickle cell crisis
4. pneumothorax.

Question 9

Evidence favors the use of NPPV in the critical care setting in patients with what 5 conditions?

Answer 9

1. COPD exacerbations
2. cardiogenic pulmonary edema
3. neuromuscular disease
4. obesity hypoventilation syndrome
5. patients at high risk of failing extubation (e.g., those >65 years old or with heart failure or COPD).

Question 10

How often to monitor or adjust NPPV

Answer 10

At least every 2 hours

Question 11

Contraindications to the use of NPPV (8)

Answer 11

1. persistent altered mental status
2. increased airway secretions
3. emesis, gastric distention
4. airway obstruction
5. recent esophageal surgery
6. cardiac arrest
7. inability to protect the airway, facial trauma/surgery (including oral, nasal, or sinus),
8. patient intolerance of the mask.

Question 12

over distension of alveoli causes

Answer 12

volutrauma

Question 13

collapse of alveoli with expiration causes

Answer 13

atelectrauma

Question 14

SBT length

Answer 14

at least 30 minutes and no more than 2 hours in length

Question 15

SBT PEEP

Answer 15

≤8 cm H2O

Question 16

VC:
Control Variable:
Breath Sequence:

Answer 16

Control Variable: The ventilator controls the flow (volume) during the mandatory breath. If the patient’s effort, lung compliance, or resistance changes, the ventilator will still deliver the set tidal volume.
Breath Sequence: All breaths are mandatory. The patient may or may not trigger the breath, but the ventilator always ends (cycles) the breath when the tidal volume is delivered.

Question 17

PC
Control Variable:
Breath Sequence:

Answer 17

Control Variable: The ventilator controls the pressure during the mandatory breath. If the patient’s effort, lung compliance, or resistance changes, the ventilator will still deliver the set inspiratory pressure (but the tidal volume delivered will change).
Breath Sequence: All breaths are mandatory. The patient may or may not trigger the breath, but the ventilator always ends the breath when the preset inspiratory time elapses.

Question 18

PS
Control Variable:
Breath Sequence:

Answer 18

Control Variable: The ventilator controls the pressure during the breath.
Breath Sequence: All breaths are spontaneous. The patient triggers and cycles the breath.

Question 19

Benefits of VC

Answer 19

Ensures minimum minute ventilation
Ability to limit tidal volume delivered
Serves the goal of safety

Question 20

Drawback to VC

Answer 20

Least likely to allow comfort for patient because of limitation in flow

Question 21

Benefits of PC

Answer 21

Prevents barrotruama

Comfort

Question 22

Drawback of PC

Answer 22

tidal volume delivery will increase and decrease with changes with patient compliance (can cause volutruama)

Question 23

IO lines should be removed within

Answer 23

24 hours

Question 24

Criteria to Perform SBT (5)

Answer 24

1. Cause of respiratory failure improved
2. FIO2 ≤40% and PEEP ≤5-8 cm H2O
3. pH >7.25

4, Hemodynamic stability

5. Able to spontaneously breathe

Question 25

Dobutamine: Type of shock to use for, Receptor Target, Primary Effect

Answer 25

Type of shock: Cardiogenic, Cardiogenic
Receptor Target: β1, β2
Primary Effect: ↑Inotropy

First choice for cardiogenic shock without hypotension

Add-on therapy for distributive shock with depressed cardiac function

Question 26

Criteria to pass SBT

At Least 30 Minutes Without the Following (6)

Answer 26

Clinical evidence of respiratory distress

SpO2 <90%

Respiration rate >35/min

New arrhythmias

Tachycardia

Hypotension or hypertension

Question 27

Dopamine: Type of shock to use for, Receptor Target, Primary Effect

Answer 27

Type of Shock: Cardiogenic only in cases of severe bradycardia in septic shock !
Receptor Target: D, α1, β1
Primary Effect: ↑ SVR, ↑ inotropy -

Not going to do the high vs low thing since no one uses dopamine and that’s probably not even real

Question 28

Epinephrine: Type of shock to use for, Receptor Target, Primary Effect

Answer 28

Type of Shock: Cardiogenic, Distributive, Hypovolemic
Receptor Target: α1, α2, β1, β2
Primary Effect: ↑ SVR, ↑ inotropy

First choice anaphylactic (distributive) shock

Question 29

Norepi: Type of shock to use for, Receptor Target, Primary Effect

Answer 29

Type of Shock: Cardiogenic, Distributive, Hypovolemic
Receptor Target: α1, α2, β1
Primary Effect: ↑ SVR, ↑ inotropy

First choice in cardiogenic, distributive, and hypovolemic shock

Question 30

Phenylephrine: Type of shock to use for, Receptor Target, Primary Effect

Answer 30

Type of Shock: Distributive
Receptor Target: α1
Primary Effect: ↑ SVR

May be used when norepinephrine is contraindicated (tachyarrhythmias) or after failure of first-line drugs; may depress cardiac output by causing reflex bradycardia

Question 31

Vasopressin: Type of shock to use for, Receptor Target, Primary Effect

Answer 31

Type of Shock: Distributive
Hypovolemic
Receptor Target: V
Primary Effect: ↑ SVR