Crit Care 2: Page 66-75 Flashcards

1
Q

Two things to do to minimize ICU weakness

A

early mobilization and management if hyperglycemia

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2
Q

Two measurements indicating decreased oxygenation

A

Decreased O2 saturation

Wide A-a

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3
Q

Inspiratory stridor suggests obstruction where?,

A

at or above the vocal cords

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4
Q

expiratory stridor and wheezing suggest?

A

an intrathoracic process

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5
Q

Main causes of shunts

A

alveolar collapse (atelectasis) and alveolar filling with blood, cells, protein, or water

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6
Q

____ is the most common complication after smoke inhalation

A

Pneumonia, especially from Staphylococcus and Pseudomonas species.

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7
Q

cholinesterase inhibitor exposure treatment

A

high-dose atropine is administered until bronchorrhea and bronchospasm are controlled.

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8
Q

What general finding on histology in ARDS

A

diffuse alveolar damage

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9
Q

Clinical features of Ammonia toxicity

A

Cough, upper airway burns, pulmonary edema, asphyxiation in poorly vented areas

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10
Q

Clinical features of Chlorine toxicity

A

Upper airway irritation and burns, bronchospasm, pulmonary edema

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11
Q

Clinical features of phosgene toxicity

A

Systemic toxicity, including elevated methemoglobin level, cyanosis, and metabolic acidosis; pulmonary edema

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12
Q

Clinical features of musard gas toxicity

A

Upper airways burns and obstruction can occur

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13
Q

Clinical features of organophosphates inhibitor toxicity

A

Systemic toxicity causing acetylcholine toxicity (rhinorrhea, bronchorrhea, diarrhea, bronchospasm, bradycardia, flaccid paralysis, apnea)

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14
Q

Six direct pulmonary injuries that are common causes of ARDS

A

Aspiration of gastric contents

Fat embolism

Near drowning

Pneumonia (including viral causes such as COVID-19)

Smoke or chemical inhalation

Thoracic trauma/thoracic contusion

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15
Q

Six indirect pulmonary injuries that are common causes of ARDS

A

Disseminated intravascular coagulation

Nonthoracic trauma

Pancreatitis

Pulmonary reperfusion injury (after lung transplantation)

Sepsis/septic shock

Transfusion of blood products

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16
Q

The compliant lung is susceptible to____

A

(volutrauma)

17
Q

Recomended tidal volumes plateau pressures

A

guidelines recommend a tidal volume of 4 to 8 mL/kg of predicted body weight and a plateau pressure less than 30 cm H2O.

18
Q

What ventilator variable prevents atelectotruama

A

PEEP

19
Q

PO2/FIO2 ratio less than ___ should be proned 12-16 hrs a day

A

150 and on 60% FiO2

20
Q

Although mortality did not differ between groups, patients who were treated with _____ fluid management showed improved oxygenation and decreased time on the ventilator and in the ICU.

A

Conservative

21
Q

In cardiogenic pulmonary edema________, hastens the resolution of hypoxemia, improves symptoms, lowers intubation rates, and decreases mortality compared with oxygen therapy alone.

A

noninvasive positive pressure ventilation (continuous positive airway pressure or bilevel positive airway pressure)

22
Q

_______ is a common postoperative complication

A

Atelectasis

23
Q

Because outcomes after intubation and mechanical ventilation are very poor for patients with acute exacerbations of idiopathic pulmonary fibrosis, goals of care and palliative care strategies should be discussed early and other therapies, such as extracorporeal membrane oxygenation, should only be offered as a bridge for patients eligible for ______

A

lung transplantation.

24
Q

In the patient with PE and RV dysfunction. Increased intrathoracic pressures from mechanical ventilation can 1. _____ venous return and RV preload. 2_____ alveolar pressures can compress capillaries and 3.____ RV afterload.

A
  1. Decrease
  2. Increased
  3. Increase
25
Q

Why do all patients who are suspected of acute hypercapnic respiratory failure need arterial blood gas analysis even if hypoxemia resolves with oxygen administration

A

Fixing oxygenation can worsen hypercapnia via: V/Q mismatch, decreased respiratory drive, and the Haldane effect

26
Q

Which obstructive airway disease has an elevated baseline PCO2

A

CODP

27
Q

In which which obstructive airway disease does an elevated PCO2 indicate probable respiratory demise

A

Asthma

28
Q

Arterial blood gases should be monitored within ___ hours of initiation of NPPV

A

2

29
Q

How to treat obesity hypoventilation syndrome

A

Noninvasive ventilation with bilevel positive airway pressure or volume-targeted pressure support

30
Q

Pulmonary Function Values Suggestive of Neuromuscular Weakness
FVC:
Maximal inspiratory pressure:
Maximal expiratory pressure:

A

FVC: >20% decrement in FVC while supine compared with upright position

Maximal inspiratory pressure: Less than −60 cm H2O or 50% of predicted

Maximal expiratory pressure: Less than +60 cm H2O or 50% of predicted

31
Q

Two most common causes of acute neurologic respiratory failure in the ICU

A

Guillain-Barré syndrome and myasthenic crisis

32
Q

How to reduce autopeep

A

prolong the expiratory time (with lower respiration rate) and administer bronchodilators.

33
Q

Three reasons why excessive oxygenation in CODP is bad

A

increasing V/Q mismatch, decreasing respiratory drive, and the Haldane effect

34
Q

Is there evidence to support NPPV in asthma exacerbations

A

not really