Crit care

Question 1

What is the associated mortality rate with DTs?

Answer 1

15%

Question 2

When using a benzodiazepine for EtOH withdrawal what agent can be added to prevent respiratory depression in pts needing escalating doses of benzos?

Answer 2

a barbiturate (phenobarb specifically)

Question 3

What neurotransmitter receptor does propofol act on?

Answer 3

GABA

Question 4

What is the MOA of dexmedetomidine?

Answer 4

alpha-2 agonist

Question 5

What therapy for ARDS and sepsis did the CITRIS-ALI trial study?

Answer 5

Vit C 50mg/kg q6hr x96hrs
-shown to decrease both 96hr (4% vs 23%) and 28 day (30% vs 44%) mortality
-interestingly SESAP made a point of saying the most recent Surviving Sepsis suggested not using vit C, but admitted it was weak evidence

Question 6

What is one common ICU study that should be avoided in pts receiving vit C for ARDS and sepsis?

Answer 6

POC glucometer for glucose measurements
-will be falsely elevated

Question 7

What is the anatomic landmark that delineates a Standford type A thoracic aorta dissection versus a type B?

Answer 7

Type A is proximal to the lateral border of the L subclavian

Question 8

What anti-hypertensive should be used in pts w/ thoracic aorta dissection when a beta blocker (typically esmolol) is contraindicated?

Answer 8

dilatiazem (nondihydropyridine Ca channel blocker)

Question 9

What are the goals for heart rate and blood pressure in pts w/ thoracic aorta dissection?

Answer 9

HR 60-80 and SBP 100-120

Question 10

What is the treatment for hepatorenal syndrome?

Answer 10

-IV vasoconstrictors (norepi)
-counteract the splanchnic vasodilation
-octreotide
-can use midodrine instead of norepi but less predictable

Question 11

Which is more efficacious for VTE prophy in an injured pt, unfractionated heparin or low molecular weight heparin?

Answer 11

LMWH

Question 12

What are the recommended weight based doses for LMWH for VTE prophylaxis in trauma?

Answer 12

-50 - 60kg = 30mg q12hr
-61 - 99kg = 40mg q12hr
->100kg = 50mg q12hr

Question 13

What are the rates of VTE and PE in high risk pts on both LMWH and SCDs?

Answer 13

-VTE = 0.5% vs 16.7% (when not using one? or both? didn’t specify)
-PE = 0 vs 2.5%

Question 14

What is the typical caloric and protein need for a trauma pt/severly ill pt?

Answer 14

25kcal/kg/day calories and 2-2.5g/kg/day protein

Question 15

What is one side effect of epidural analgesia that needs to be considered in traumatic rib fx pts?

Answer 15

it has been known to cause hypotension

Question 16

What concomitant injury with rib fx is a contraindication for epidural analgesia?

Answer 16

spinal fractures, especially in the vicinity of the insertion site

Question 17

What does heparin bind to?

Answer 17

antithrombin

Question 18

When a pt is showing heparin resistance, what level should be checked?

Answer 18

antithrombin

Question 19

What is the treatment for antithrombin deficiency?

Answer 19

administration of FFP
-contain antithrombin to supplement the deficiency and allows heparin to work
-can also give a direct thrombin inhibitor (argatroban, bivalirudin)