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BTK Review 2023 > Crit Care > Flashcards

Crit Care Flashcards

1
Q

What is the difference between peak and plateau pressure?

A
  • peak reflects pressure in large airways
  • plateau reflects alveolar pressure
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2
Q

Describe continuous mandatory ventilation. What are potential problems with this?

A
  • a vent mode in which the RR and volume are set and every breath is fully supported
  • potential hyperventilation if patient RR is too high and barotrauma since pressure isn’t capped
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3
Q

What is synchronous intermittent mandatory ventilation?

A
  • RR and volume are set
  • patient can breath over the vent but spontaneous breaths are not fully supported
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4
Q

What is the best predictor of successful extubation?

A

an RSBI < 100 (RR/TV in liters)

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5
Q

How is NIF useful as an extubation predictor?

A

those with a NIF < 20 are likely to fail, but for those with a NIV > 20 little can be said

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6
Q

What are the Berlin criteria for ARDS?

A
  • P/F ratio < 300
  • characteristic radiographic findings
  • cardiac causes ruled out
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7
Q

What did the ARDSNET trial show?

A
  • that 4-6cc/kg TV was protective in those with ARDS
  • that hypercapnia with a pH > 7.2 is generally acceptable
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8
Q

What vent mode is a rescue therapy for those with ARDS?

A

APRV: long inhalation period with high baseline pressure and short exhalation with low baseline pressure

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9
Q

What are the ventilation strategies and rescue therapies for those with ARDS?

A
  • low TV ventilation (4-6cc/kg) with permissive hypercapnia
  • APRV
  • proning
  • paralysis
  • NO
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10
Q

What is the utility of procalcitonin?

A

when it normalizes, it can be an indicator to stop antibiotics

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11
Q

What test would look for fungal infections?

A

a 1,3 beta-d-glucan assaay

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12
Q

What is a manna antigen/antibody test?

A

looks for invasive candidiasis

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13
Q

What is a 1,3 beta-d-glucan assay?

A

a test that looks for a fungal infection without speciation

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14
Q

What are the surviving sepsis guidelines?

A
  • send cultures before starting antibiotics
  • within 3hrs, start antibiotics and bolus with > 30cc/kg
  • within 6hrs, start pressor if needed and repeat lactate
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15
Q

What is the activity of dopamine as a pressor?

A
  • low dose stimulates receptors in the kidny
  • medium dose: B1
  • high dose: alpha1
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16
Q

Which has more B1 activity, levo or epi?

A

epi

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17
Q

What is the preferred pressor for those in neurogenic shock?

A

phenylephrine (look out for a bradycardic response)

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18
Q

What is the mechanism of dobutamine as a pressor?

A

has strong B1 activity but can also have vasodilatory effects

19
Q

How does milrinone work?

A

it is a PDE inhibitor which increases cardiac output while also causing vasodilatation

20
Q

What would the gas look like for someone with a PE?

A

hypoxia with a respiratory alkalosis

21
Q

What is the most common EKG finding with a PE?

A

sinus tachycardia

22
Q

What ECG findings are pathognomonic for PE?

A

S1Q3T3:
- S waves in I
- Q waves in III
- inverted T waves in III

23
Q

What is the goal PTT for a VTE protocol hep gtt?

A

60-90

24
Q

What are the indications for thrombolytics in someone with PE?

A

evidence of hemodynamic instability or right heart strain

25
Q

What is a Trendelenburg procedure?

A

a pulmonary embolectomy

26
Q

What is pulmonary wedge pressure measuring?

A

the end diastolic left ventricular volume (i.e. preload)

27
Q

What is the difference between cardiac output and cardiac index?

A
  • output is SV x HR
  • index is CO/BSA
28
Q

Give the cardiac output, SVR, and PWP for people with the following types of shock:
- hemorrhagic
- septic
- cardiogenic

A
  • hemorrhagic: CO low, SVR high, PWP low
  • septic: CO high, SVR low, PWP low/normal
  • cardiogenic: CO low, SVR high, PWP high
29
Q

How is oxygen delivery calculated?

A

CO x (Hgb x SaO2 x 1.34 + (PaO2 x 0.003))

30
Q

How is oxygen consumption calculated?

A

CO x (PaO2-PvO2)

31
Q

How is oxygen extraction radio calculated?

A
  • equals O2 consumption / O2 delivery
  • equals [CO x (PaO2-PvO2)] / [CO x (Hgb x SaO2 x 1.34 + (PaO2 x 0.003))]
32
Q

How is dabigatran reversed?

A

it is a direct thrombin inhibitor that can be reversed with dialysis or praxbind

33
Q

PCC gives partial reversal of which anticoagulants?

A

the factor Xa inhibitors (apixaban and rivaroxaban)

34
Q

How is respiratory quotient calculated?

A

RQ = CO2 production / O2 consumption

35
Q

How is respiratory quotient helpful?

A

identifies carbohydrate overfeeding in intubated patients which results in higher CO2 production and difficulty weaning

36
Q

What do respiratory quotients of 0.7, 0.8, and 1.0 indicate?

A

fat, protein, and carbohydrate metabolism respectively

37
Q

How is nitrogen balance calculated and interpreted?

A
  • NB = protein intake/6.25 - (urine nitrogen + 4)
  • negative balance indicates a catabolic state
  • positive balance indicates an anabolic state
38
Q

How many calories per gram are in the following:
- carb
- dextrose
- lipid
- protein

A
  • carb: 4
  • dextrose: 3.4
  • lipid: 9
  • protein: 4
39
Q

Which fatty acids are essential?

A

linoleic acid and alpha-linoleic acid

40
Q

Which lipids are less inflammatory and immunogenic?

A

omega 3 fatty acids

41
Q

Which micronutrients are associated with lower infectious complications in ICU patients?

A

omega 3 fatty acids, glutamine, and arginine

42
Q

What should you think about if a patient develops hemoptysis after Swan Ganz balloon inflation?

A

a ruptured pulmonary artery

43
Q

What is the treatment for tornadoes de pointes?

A

IV magnesium

44
Q

What should you suspect in a critically ill patient who has a sudden drop in ETCO2?

A

decreased cardiac output or cardiac arrest

BTK Review 2023 (18 decks)

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