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crit care Flashcards

1
Q

Causes of obstructive lung disease

A

Asthma
bronchiectasis COPD
bronchiolitis obliterans

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2
Q

Causes of restrictive lung disease

A

pulmonary fibrosis
kyphsclerosis
ARDS
neuromuscular causes

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3
Q

Spirometry findings in obstructive LD:
FEV1
FVC
FEV1/FVC

A

Reduction in FEV1>FVC
hence FEV1:FVC reduced <70%

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4
Q

Spirometry findings in RESTRICTIVE LD:
FEV1
FVC
FEV1/FVC

A

Reduction in FEV1<FVC
hence FEV1:FVC normal/ raised >70%

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5
Q

Anaesthetic agent that has both anaesthetic and analgesic properties but causes dissociative anaesthetic effect (hallucinations/ nightmares)

A

Ketamine

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6
Q

Anaesthetic agent causing the most and least myocardial depression

A

most= sodium thiopentone (squeezy)
least= Etomidate

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7
Q

Anaesthetic agent causing adrenal suppression

A

Etomidate

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8
Q

Anaesthetic agent that has anti-emetic properties

A

Propofol

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9
Q

Anaesthetic agent which is used in RSI

A

Sodium thiopentone (speedy)

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10
Q

Why are sodium thiopentone and etomidate unsuitable for maintaining sedation

A

ST= metabolites build up quickly
E= causes adrenal suppression even with brief use

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11
Q

Side effect of using Etomidate

A

PONV

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12
Q

Causes of neuropathic pain

A

damage to nervous system:

diabetic neuropathy
trigeminal neuralgia
post-herpetic neuralgia
prolapsed IV disc

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13
Q

First and second line mx of neuropathic pain

A

1= amitriptyline/ pregabalin
2= add amitriptyline/ pregabalin
3= refer to pain specialist, neurectomy

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14
Q

Mx of diabetic neuropathy

A

Duloxetine

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15
Q

Mx of trigeminal neuralgia

A

Carbamazepine

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16
Q

How much calories should be given to a non-severely ill patient with BMI<25

A

25-35kcal/kg/day

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17
Q

What is the daily requirement of protein

A

0.8-1.5g/kg/day

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18
Q

How much calories should be given to a severely ill patient

A

50% of 25-35kcal/kg/day in the first 24-48hrs

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19
Q

How many calories should be given to a patient at risk of refeeding syndrome

A

10kcal/kg/day

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20
Q

What other supplements should be given to those at risk of refeeding syndrome

A

Pre-feeding and during feeding:
Thiamine (200-300mg)
Vitamin B complex strong 1tab TDS

Potassium (2-4)
Magnesium (0.2-0.4)
Phosphate (0.3-0.6)

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21
Q

causes of refeeding syndrome

A

reduced intake:
eating disorders
chemo
vomiting
post-op
fasting
prolonged NBM

reduced absorption
chemo
IBD
short bowel syndrome
pancreatitis
cystic fibrosis

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22
Q

describe the pathophysiology of refeeding syndrome

A

prolonged reduced nutrients= reduced levels of body phosphate, K, Mg (serum levels normal)

Start eating= increase in glucose + insulin= rapid shift of phosphate, Mg, K into cells for use= decrease in serum phos, Mg, K levels= seizures, arrthymias

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23
Q

What are the types of muscles relaxants

A

(all end in -ium)

Suxamethonium
Atracurium
Vecuronium
Pancuronium

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24
Q

Which muscle relaxant causes generalised muscle contractions and why

A

Suxamethonium

Because it is a depolarizing Neuromuscular blocker hence prior to paralysis the depolarization of the NM membrane causes muscle fasciculations

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25
How is sux broken down in the body
By cholinesterase and acetylcholinesterase
26
What does sux act on to produce muscle paralysis
Acetylcholine receptors at the NM junction
27
What are the adverse effects of sux
-malignant hyperthermia -increased intraocular pressure -prolonged paralysis (in those with reduced pseudocholinesterase levels ) -hyperkalaemia (not good in burns/ necrosis pt= hyperk= cardiac arrest)
28
Which muscles relaxant is the quickest acting and shortest duration
suxamethonium
29
How quickly do atracurium, vecuronium and pancuronium act
atra + vecronium= 30-40mins pancuronium= 2-3mins
30
Which muscle relaxant is broken down in the liver/ kidneys
pancuronium + vecuronium
31
How is atracurium broken down
by hydrolysis in tissues and causes histamine release
32
Adverse effects of atracurium
Histamine release= flushing, tachycardia, hypotension
33
Reversal agent for non-depolarizing muscle relaxants
non-depolarizing= neostigmine
34
Which muscle relaxant is the only depolarising neuromuscular blocker
suxamethonium
35
Sx of malignant hyperthermia
hyperpyrexia muscle rigidity
36
Pathophysiology of malignant hyperthermia
genetic defect: administration of anaesthetic/ anti-psychotic/ anti-emetic= excessive release of Ca from sarcoplasmic reticulum in skeletal muscles= muscle rigidity + pyrexia
37
Mx of malignant hyperthermia
Dantrolene-inhibits ca release from sarcoplasmic reticulum
38
Drugs that can cause malignant hyperthermia
anaesthetic/ muscle relaxants/ anti-psychotic/ anti-emetic haloperidol prochloperazine metaclopramide risperidone
39
What is the gene + chromosome involved in malignant hyperthermia
Chromosome 19, ryanodine receptor (controls Ca release from SR)
40
How can malignant hyperthermia be diagnosed
raised CK Contracture tests on muscle biopsy exposed to halothane/ caffeine
41
Side effect of neostigmine and how can this SE be countered
SE= Bradycardia Given with atropine
42
WHat is cryoppt made of?
Factor 8 Factor 13 vWB factor fibrinogen
43
Pathophysiological changes seen in ARDS
b/l pulmonary infiltrates (non-cardiogenic) hypoxaemia (due to reduced diffusion)
44
Causes of ARDS
sepsis pancreatitis directly injury/ trauma fat embolism (long bone/ multiple #) aspiration
45
Features of ARDS
hypoxia tachypnoea tachycardia
46
Mx of ARDS
treat underlying problem: sepsis= IV ABx negative fluid balances (diuretics) recruitment manoeuvres (prone ventilation/ positive and expiratory ventilation) mechanical ventilation with low tidal volumes (prevent alveolar damage)
47
Why is midazolam preferred as a procedural sedative
amnaesia effect
48
What class of drug is flumazenil
selective GABA receptor antagonist
49
How is midazolam excreted
in the liver (via cytochrome P450 path)
50
What does TPN consist of
lipids glucose electrolytes (NO FIBRE)
51
complications of TPN
fatty liver + deranged LFT thrombophlebitis (if admin through small vessels) sepsis refeeding syndrome
52
What are the 2 types of neuromuscular blocking drugs and what is their MOA
deplorazing and non-depolarizing neuromuscular agents block Ach from acting on receptor at the NM junction
53
What is the pulmonary artery occlusion pressure
Measures the pressure of the LEFT atrium
54
Target values for: urine output MAP CVP
URINE O/P: 0.5ml/kg/hr MAP >65 CVP 8-12
55
What are the different vassopressors available
Adrenaline noradrenaliine dopamine dobutamine metaraminol milrinone
56
Which vasopressors are alpha agonists
noradrenaline, metaraminol
57
Which vasopressors are alpha and beta agonists
adrenaline
58
Which vasopressors are beta 1 agonists
dopamine
59
Which vasopressors are beta 1 & 2 agonists
dobutamine
60
Which vasopressors cause increased SVR
adrenaline, noradrenaline (those that DO NOT act on beta receptors)
61
Which vasopressors cause increased cardiac output
all that act on beta receptors adrenaline dopamine dobutamine
62
What effect does dobutamine have on cardiac output and SVR
b1 +b2 agonist: increases cardiac contractility + rate+ BP =increased cardiac output vasodilation= reduced SVR
63
What is the MOA of Milrinone and what are its effects
phosphodiesterease inhibitor = increased muscle contractility + vasodilator (same as dobutamine)
64
What are the effects of alpha agonists on the heart and SVR
no effect on cardiac output increase SVR
65
What variables can the swan ganz catheter be used to measure
oxygen delivery pulmoary artery resistance systemic vascular resistance stroke volume
66
Where would a swan ganz catheter be sited
pulmonary artery
67
Adverse effects of Dextrans for fluid resuscitation
Anaphylaxis Acute renal failure
68
Indication for using an uncuffed ET tube
in children to prevent damage to larynx
69
Which ionotrope can be given through a peripheral vein
metaraminol
70
How long does the effect of clopidogrel last
120 days (need to stop 5-7 days pre-op)
71
MOA of clopidogrel
anti platelet= acts on ADP to inhibit plt aggregation
72
ECG features of hyperkalaemia
Tall T waves broad QRS flattened P waves VF
73
When would you test for brain stem death
-Unexplained deep coma -reversible causes have been excluded -normal electrolytes -not under sedation
74
What is involved in testing for brain stem death
-fixed pupils, not reactive to light -no corneal reflex -no rxn to supra-orbital pressure -no oculo-vestibular reflex* -no cough reflex to bronchial stimulation -no gag reflex to pharyngeal stimulation -no visible respiratory effort when taken off ventilator for atleast 5min (to allow for adequate arterial partial pressure of CO2 -6-6.5kPa) *no eye movements to the slow injection of atleast 50ml of ice-cold water into each ear in turn
75
Who can test for brain stem death
need 2 doctors to carrying out test on 2 separate occaisions -Both need to be >5yrs post grad -1 needs to be a cons -neither can be part of the transplant team
76
Complications caused by massive transfusion
hypothermia (blood stored in the cold) hypocalcaemia (FFP + plt have citrate antioaoagulant= causes chelation of Ca) hyperkalaemia (older blood= higher K) transfusion associated lung injury coagulopathy (causes dilution and reduced plt, fibrinogen, clotting factors)
77
Describe the pathophysiology of transfusion associated lung injury
transfused plasma contains antibodies to leukocytes leukocytes aggregate and breakdown in the lungs causing damage to alveoli Inflammatory infiltrates in b/l pleura
78
Which anaesthetic agent is associated with hepatotoxicity
halothane
79
Patient presents with an acute dystonic rxn (due to anti-psychotic meds + metoclopramide given), what meds can reverse this
procyclidine benzhexol
80
What are the features seen in an acute dystonic rxn
acute torticolis oculogyric crisis oromandibular dystonia
81
What is included in the enhanced recovery programmes
Admission on the day of surgery Reduced starvation times (if under GA= carbohydrate loading drink 2 hrs pre-op) Not for diabetics with complex insulin regimens Intra-op DO NOT give IV fluids= can cause interstitial oedema and increase complication rates Post-op: early ambulation eat orally within 24hrs reduced IV fluids= ileus take out IV/ drains/ catheters encourage getting dressed and walking around ward

MRCS (22 decks)

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