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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?

24
Q

What are the indications for thrombolytics in someone with PE?

A

evidence of hemodynamic instability or right heart strain

25
What is a Trendelenburg procedure?
a pulmonary embolectomy
26
What is pulmonary wedge pressure measuring?
the end diastolic left ventricular volume (i.e. preload)
27
What is the difference between cardiac output and cardiac index?
- output is SV x HR - index is CO/BSA
28
Give the cardiac output, SVR, and PWP for people with the following types of shock: - hemorrhagic - septic - cardiogenic
- hemorrhagic: CO low, SVR high, PWP low - septic: CO high, SVR low, PWP low/normal - cardiogenic: CO low, SVR high, PWP high
29
How is oxygen delivery calculated?
CO x (Hgb x SaO2 x 1.34 + (PaO2 x 0.003))
30
How is oxygen consumption calculated?
CO x (PaO2-PvO2)
31
How is oxygen extraction radio calculated?
- equals O2 consumption / O2 delivery - equals [CO x (PaO2-PvO2)] / [CO x (Hgb x SaO2 x 1.34 + (PaO2 x 0.003))]
32
How is dabigatran reversed?
it is a direct thrombin inhibitor that can be reversed with dialysis or praxbind
33
PCC gives partial reversal of which anticoagulants?
the factor Xa inhibitors (apixaban and rivaroxaban)
34
How is respiratory quotient calculated?
RQ = CO2 production / O2 consumption
35
How is respiratory quotient helpful?
identifies carbohydrate overfeeding in intubated patients which results in higher CO2 production and difficulty weaning
36
What do respiratory quotients of 0.7, 0.8, and 1.0 indicate?
fat, protein, and carbohydrate metabolism respectively
37
How is nitrogen balance calculated and interpreted?
- NB = protein intake/6.25 - (urine nitrogen + 4) - negative balance indicates a catabolic state - positive balance indicates an anabolic state
38
How many calories per gram are in the following: - carb - dextrose - lipid - protein
- carb: 4 - dextrose: 3.4 - lipid: 9 - protein: 4
39
Which fatty acids are essential?
linoleic acid and alpha-linoleic acid
40
Which lipids are less inflammatory and immunogenic?
omega 3 fatty acids
41
Which micronutrients are associated with lower infectious complications in ICU patients?
omega 3 fatty acids, glutamine, and arginine
42
What should you think about if a patient develops hemoptysis after Swan Ganz balloon inflation?
a ruptured pulmonary artery
43
What is the treatment for tornadoes de pointes?
IV magnesium
44
What should you suspect in a critically ill patient who has a sudden drop in ETCO2?
decreased cardiac output or cardiac arrest

BTK Review 2023 (18 decks)

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