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Crit Care Flashcards

1
Q

New onset Afib in the icu post-op, with minimal symptoms is treated how?

A

Rate control with beta blocker

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2
Q

How do IABP help the heart?

A

Increase perfusion to the coronary arteries by increasing aortic diastolic pressure

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3
Q

Mainstay of therapy for Hepatorenal syndrome?

A

Albumin and vasoconstrictors like midodrine

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4
Q

O2 dissociation curve;

A
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5
Q

CO affinity and oxygen dissociation curve?

A

CO has >200x affinity for hemoglobin than O2

Will shift curve to the left

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6
Q

How does heparin work?

A

Activates antithrombin III which antagonizes thrombin and factor Xa

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7
Q

Signs of hypovolemic shock?

A

Dec CO
Inc SVR

Dec CVP, mixed venous O2, pulmonary artery occlusion pressure

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8
Q

Signs of cardiogenic shock?

A

Dec CO
Inc SVR

Inc pulm artery occlusion pressure

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9
Q

Classes of hemorrhagic shock;

A
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10
Q

Which med can we use in patient with cardiogenic shock due to hypertrophic cardiomyopathy?

A

Avoid inotropic agents

Use phenylephrine; purely alpha action

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11
Q

In hypovolemic shock what are the parameters?

A

Everything is decreased except SVR (its increased)

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12
Q

Tx of malignant hyperthermia?

A

IV Dantrolene

Muscle relaxant, works on ryanodine receptors to prevent release of Ca

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13
Q

Main difference between cerebral salt wasting and SIADH?

A

Tx for CSW: isotonic saline
Tx for SIADH: fluid restriction

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14
Q

Hard and soft signs of vascular injury;

A
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15
Q

Which compartments of leg more susceptible to compartment syndrome?

A

Anterior; more rigid boundaries

Superficial posterior; ;less likely to get compartment syndrome, no vascular structures that travel in it

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16
Q

Rutherford Classification of acute limb ischemia;

A
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17
Q

Grades of urethral injuries;

A
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18
Q

How do we approach a proximal right subclavian artery injury?

A

Median sternotomy

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19
Q

What nerve is injured with anterior shoulder dislocation?

A

Axillary n.

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20
Q

Grading of liver injuries;

A
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21
Q

When we advance a pulmonary PA catheter, how can we tell were in the PA?

A

Diastolic pressure rise
Dicrotic notch

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22
Q

Type I hypersensitivity rx (anaphylaxis):

A

Antigen binds to IgE

Mast cell/basophil degranulation ensues

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23
Q

How do IABP work?

A

Inflate during diastole
So peak diastolic pressure increases
Perfusion to coronary arteries thus improved

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24
Q

Normal cardiac index and PCWP?

A

CI: 2.5- 4 L

PCWP; 4-12 mmHg

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25
Q

Normal SVR and CVP?

A

SVR: 700-1500 dynes

CPV; 8-12 mmHg

Mixed venous O2; SVO2; 65-75%

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26
Q

MOA of norepinephrine ?

A

Alpha and beta-1 agonist

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27
Q

Arterial oxygen content is determined by?

A

CaO2 = (1.34 x hgb x Sao2) + (000.3 x Pao2)

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28
Q

Tx of malignant hyperthermia?

A

Dantrolene

Can give sodium-bicarbonate for acidosis

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29
Q

How does dantrolene work for malignant hyperthermia?

A

Relaxes muscles and prevents release of Ca from them

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30
Q

Dopamine receptor stimulation based on dosage;

A

DA1/DA2 receptors at low doses

B-receptors at moderate (3-5 ug)

A-receptors at high doses (10 ug)

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31
Q

Hypothermia on the heart produces what EKG findings?

A

J waves

With hypothermia can get vfib and asystole

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32
Q

Urethral injuries are associated with what sxs?

A

Blood at meatus
Inability to void
High riding prostate
Pubic rami fractures
Perineal hematoma

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33
Q

AAST grades of urethral injuries;

A

I; contusion
II; Stretch
III: partial disruptions
IV/V; Complete disruption with/without extensive separation

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34
Q

In zone 3 injuries, exposure can be optimized sometimes by dividing what muscle?

A

Posterior belly of digastric

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35
Q

Passive rewarming techniques?

A

Removing wet clothing
Increasing ambient temperature
Providing warm blankets/sheets

**these prevent heat loss but do not transfer heat energy

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36
Q

Active rewarming techniques?

A

Warm peritoneal/pleural lavage
ECMO/cardiopulmonary bypass

**More effective at heat transfer, use conduction

37
Q

Most common complication after hepatic trauma?

A

Bile leak

38
Q

Causes of an exudative effusion?

A

Pneumonia
Malignancy
Infection
Chylothorax

39
Q

An effusion is exudative if 1 of the following is true;

A

Pleural fluid to serum protein > 0.5

Pleural fluid to serum LDH > 0.6

Pleural fluid LDH > 2/3 of upper limit of normal range

40
Q

Causes of transudative pleural effusions?

A

Cirrhosis
CHF
PE
Nephrotic syndrome
Hypoalbuminemia

41
Q

Exudative effusion if:

A

Effusion protein to serum protein >0.5

Effusion LDH to serum LDH >0.6

LDH concentration in effusion > 200

42
Q

Inicxations for repair of ascending thoracic aneurysm;

A

4.5 cm with chest pain

5 cm with connective tissue disorder or bicuspid aortic valve

Aneurysm > 5.5 cm

> 5mm growth in 1 year

43
Q

MC tumor of the anterior mediastinum;

A

Thymoma

44
Q

MC benign lung tumor?

A

Hamartoma

Well circumscribed tumor with scattered calcifications that alternate with fat

45
Q

Difference between TRALI and TACO?

A

TACO you see volume overload, cardiogenic pulmonary edema

TRALI you don’t see volume overload, echo is normal

TRALI occurs within 6 hrs of transfusion; hypoxemia is seen

TRALI caused by ANTI-HLA I/II or Anti-HNA

46
Q

Bowel prep solution to use in pts with renal insufficiency?

A

High volume polyethylene glycol

Does not alter electrolytes levels

Not recommended for pts with heart failure class III/IV

47
Q

Bispectral index monitor is used for what?

A

Monitor level of consciousness; 0 to 100 (awake)

48
Q

Effects of hypothermia during sx?

A

Increases hospital length of stay
Increases blood loss and transfusion requirements
Increases duration of paralytics during sx too
Increases surgical site infection

49
Q

Nivolumad and ipilimumab?

A

Immunotherapies
Nivolumab; monoclonal antibody that binds to PD-1; promotes T-cell killing effect

Ipilimumab; promotes growth and function of T-cells

SE: can cause adrenal suppression

50
Q

First drug of choice in lower blood sugars in pts with type II DM and normal renal function?

A

Metformin; biguanide class of drug

Does not cause hypoglycemia

51
Q

Which anticoagulant is not cleared by kidney and safe to use in CKD?

A

Argatroban

Cleared by liver

52
Q

NMS vs serotonin syndrome:

A

NMS; lead pipe rigidity

SS: hyperreflexia and clonus

53
Q

Tx for serotonin syndrome?

A

Cyproheptadine; has antiserotonergic properties

Only comes as PO formulary

54
Q

Elective surgery recs when taking anti platelet therapy after stent placement;

A

Avoid sx for at least 6 weeks after bare metal stent placement

Avoid sx for at least 6 months after drug eluting stent placement

55
Q

How do we reverse rocuronium fast?

A

Sugammadex

Forms a complex with rocuronium and removes it from the neuromuscular junction

56
Q

SIADH criteria;

A

Serum osm <275

Urine osm >100

Urine Na >30

Evuolemia

Normal thyroid and pituitary, kidney function

57
Q

Rapid correction of hyponatremia can cause?

A

Osmotic demyelination syndrome

58
Q

How does TXA work?

A

Reversible competitive inhibitor that binds to plasminogen

Prevents plasmin from breaking down fibrin into fibrin split products;

This stabilizes clot and decreases blood loss

59
Q

NMDA receptor antagonist;

A

Ketamine

60
Q

How does lidocaine work?

A

Inhibits voltage gated Na channels —-> impaired nerve conduction

61
Q

What makes up functional residual capacity?

A

Residual volume + Expiratory reserve volume

Volume of air at the end of normal expiration*

62
Q

What does antithrombin do?

A

Antithrombin is an anti-coagulant which inhibits thrombin (Factor X) and other coagulants

Heparin binds to antithrombin and potentiates its activity on thrombin 1000x

63
Q

Preferred class of abx against ESBL-bacteria?

A

Carbapenems

64
Q

Rapid correction of hyponatremia leads to?

A

Central pontine myelinosis

65
Q

Loss of deep tendon reflexes assc with?

A

Hypermagnesemia

66
Q

Circumoral numbness assc with?

A

Hypocalcemia

67
Q

What causes the hypokalemia seen in hypokalemic, hypochloremic, metabolic alkalosis conditions?

A

The kidneys dump K in an effort to absorb H to balance the metabolic alkalosis

68
Q

What do we see with tumor lysis syndrome?

A

Decrease in serum Ca

Increased serum uric acid, K, P, Cr, plasma urea

69
Q

Hyper or hypo k leads to aldosterone production?

A

Hyper k

70
Q

Made by C cells of thyroid:

A

Calcitonin

Lowers ca levels by inhibiting osteoclasts

71
Q

How is hypermagnesemia treated?

A

Stabilize membrane with Ca

Aggressive diuresis

72
Q

Sxs of hypermagnesemia?

A

Hypotension
Decreased deep tendon reflexes
Bradycardia

73
Q

Tx of CCB toxicity?

A
74
Q

Tx of calcium channel blocker toxicity?

A

Ca-Cl or Ca-gluconate
Atropine if Brady
Pressers if needed
Insulin

75
Q

MC causes of non-anion gap metabolic acidosis?

A

Renal tubular acidosis
Diarrhea
Pancreatic/SB drainage (fistula)

76
Q

Signs of hypocalcemia:

A

Trousseau
CHVOSTEK
Circumoral numbness

77
Q

Signs of HYPERcalcemia;

A

Abdominal groans
Kidney stones
Psych overtones

Polyuria

78
Q

SE of amiodarone?

A

Pulm fibrosis
Hypo/hyperthyroidism

79
Q

What med known to cause SIADH?

A

Amiodarone

80
Q

What do we see with SIADH?

A

Hyponatremia
Hypo-osmolality
Urine osm >100 mosm

81
Q

Anaphylaxis during a blood transfusion is characterized by;

A

Hypotension
Wheezing
Flushing
Angioedema

82
Q

Cause of anaphylaxis during a blood transfusion?

A

IgA deficiency

Pts form anti-iga antibodies that reacts with IgA on transfused blood products

83
Q

Acute hemolytic transfusion rxn?

A

2/2 ABO incompatibility

Leads to intravascular lysis of RBCs fevers, chills, flank pain, oozing from IV sites

84
Q

In elderly pts with emergency surgery, what has been shown to be best predictor of post-op outcomes?

A

Frailty index

85
Q

Two major spirometry values used to predict thoracic surgery candidacy include:

A

DLCO2 and FEV1

DLCO2 should be > 60%

FEV1 should be >60%

86
Q

Toxicity and osmolality’

A

Osmolality; concentration of all particles in a solution; plasma osm is 275-295

Tonicity; effect the fluid has on cells causing them to swell, shrink, or stay the same

87
Q

After radioactive iodine therapy, how long should one wait before becoming pregnant?

A

6-12 months

88
Q

Dabigatran and renal insufficiency?

A

Dabigatran is renally cleared

Check Cr clearance before discontinuing before a surgery

IF Cr Cl <50, discontinue dabigatran 3-5 days before surgery, otherwise can be discontinued 2 days prior to surgery

89
Q

Radioactive iodine and opthalmopathy in Graves dx?

A

RAI can make opthalmopathy worse

Sometimes with mild opthalmopathy, steroids are given before initiation of RAI treatment for Graves dx

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