Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BTK Book Review > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What are three mechanisms of ventilator induced lung injury?

A
  • volume
  • pressure
  • oxygen toxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between peak and plateau airway pressure?

A
  • peak reflects pressure in the larger airways
  • plateau is obtained during an inspiratory pause, allowing pressures to equilibrate, and therefore reflects alveolar pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is signaled by a large difference between peak and plateau airway pressures?

A

a large airway obstruction (e.g. foreign body, bronchospasm, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is signaled by equally high peak and plateau airway pressures?

A

alveolar lung disease such as ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is continuous mandatory ventilation/assist control?

A

a mode of ventilation where RR and volume are set and every breath is fully supported

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the primary disadvantage of pressure support ventilation?

A

it can result in hypoventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is synchronous intermittent mandatory ventilation?

A
  • a mode of ventilation for which RR and volume are set
  • spontaneous breaths above the set rate are not fully supported
  • mandatory breaths are synchronized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are important factors and criteria to consider for extubation?

A
  • tolerate a daily pressure support trial
  • follows commands when off sedation
  • FiO2 < 50, PEEP < 10
  • RSBI < 100 (best predictor)
  • NIF > 20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the best predictor of successful extubation?

A

an RSBI < 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is RSBI calculated?

A

as RR/TV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the utility of NIF in considering extubation?

A

< 20 is a good predictor of failure but > 20 doesn’t have much predictive value for success

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the criteria for diagnosing ARDS?

A
  • occurs within one week of insult
  • has characteristic CXR findings
  • rule out cardiogenic causes
  • P/F < 300
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is considered low tidal volume ventilation?

A

4-6cc/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the major strategies for ventilation in ARDS patients?

A
  • low TV ventilation (4-6cc/kg)
  • permissive hypercapnia to pH 7.20
  • airway pressure release ventilation
  • prone positioning
  • paralysis
  • NO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is APRV ventilation?

A
  • airway pressure release ventilation

- set a P-high, P-low, T-high, and T-low for a long inhalation period and short exhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the new definitions for sepsis and septic shock?

A
  • sepsis = SOFA of 2 or more on presentation or an increase of 2 or more after
  • septic shock = pressor requirement and lactate of 2 or more despite resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the utility of procalcitonin?

A
  • high sensitivity for sepsis but low specificity

- when it normalizes, it is an indicator to stop antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the utility of 1,3 beta-d-glucan?

A

if elevated, it is indicative of fungal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is manna antigen a test for?

A

invasive Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is sepsis managed?

A
  • send blood cultures
  • within 3hrs: start antibiotics and bolus at 30cc/kg of crystalloid if lactate > 4
  • within 6hrs: start pressors if needed to maintain MAP and repeat a lactate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are considered first and second line pressors for sepsis?

A
  • levo is first

- vaso is second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does dopamine work as a pressor?

A
  • low dose: dopamine receptors in kidney
  • medium dose: B1 receptor activation
  • high dose: alpha receptor activation
23
Q

How does levo act as a pressor?

A

a1, some B1

24
Q

How does epi act as a pressor?

A

a1, B1, B2

25
Q

How does vasopressin work as a pressor?

A

activation of V1 receptors

26
Q

How does dobutamine work as a pressor?

A

B1 activation (increases cardiac output but can have vasodilatory effects)

27
Q

What is the mechanism of action of milrinone?

A
  • PDE inhibitor and increases cAMP

- has inotropic and vasodilatory effects

28
Q

What acid-base disturbance do patients with PE most often have?

A

respiratory alkalosis due to tachypnea secondary to hypoxia

29
Q

What are the indications for thrombolytics with PE?

A

hemodynamic instability or right heart strain on echo

30
Q

What is a a trendelenburg procedure?

A

pulmonary embolectomy

31
Q

Pulmonary wedge pressure is really a measure of what?

A

end diastolic LV volume

32
Q

How is cardiac index calculated?

A

as cardiac output/BSA

33
Q

What happens to systemic vascular resistance in patients with hemorrhagic shock?

A

it increases

34
Q

What happens to CVP and PWP in patients with cardiogenic shock?

A

they both increase

35
Q

How is oxygen delivery calculated?

A

cardiac output x [Hb x SaO2 x 1.34 + (PaO2 x 0.003)]

36
Q

How is oxygen consumption calculated?

A

cardiac output x (PaO2 - PvO2)

37
Q

How is the oxygenation extraction ratio calculated?

A

= O2 consumption / O2 delivery
= {CO x [Hb x SaO2 x 1.34 + (PaO2 x 0.003)]} / [CO x (PaO2-PvO2)
= [Hb x SaO2 x 1.34 + (PaO2 x 0.003)] / (PaO2 - PvO2)

38
Q

Which anticoagulant can be removed via dialysis?

A

dabigatran

39
Q

How is dabigatran reversed?

A

dialysis or praxbind

40
Q

How is warfarin reversed?

A

vit K, FFP, or PCC

41
Q

PCC can be used to reverse which anti-coagulants?

A
  • full effect for warfarin

- partial effect for Eliquis and Xarelto

42
Q

What is the respiratory quotient?

A
  • a ratio of CO2 production/O2 consumption
  • it is a helpful measure of nutrition because it identifies carbohydrate overfeeding in intubated patients, which results in higher CO2 production and difficulty weaning
43
Q

How is the respiratory quotient interpreted?

A
  • 0.7 indicates fat metabolism
  • 0.8 indicates protein metabolism
  • 1.0 indicates carbohydrate metabolism
  • > 1 indicates overfeeding
44
Q

How is nitrogen balance calculated? How is it interpreted?

A

= protein intake/6.25 - (urine nitrogen + 4)

- positive means the patient is in an anabolic state, negative means they’re in a state of catabolism

45
Q

How many calories in a gram of…

  • carbohydrate
  • dextrose
  • lipids
  • protein
A
  • carbohydrate: 4
  • dextrose: 3.5
  • lipids: 9
  • protein: 4
46
Q

Carbohydrates should make up __% of non-protein calories.

A

75%

47
Q

Lipids should make up __% of non-protein calories.

A

25%

48
Q

What is a person’s daily protein requirement?

A

1-2 g/kg/day

49
Q

When should TPN be considered?

A

5-7 days without enteral nutrition

50
Q

What is the differential for hemoptysis after Swan Ganz balloon inflation?

A

ruptured pulmonary artery

51
Q

What is the treatment for tornadoes de pointes?

A

IV mag

52
Q

What mediates acute rejection?

A

T-cells

53
Q

How do cyclosporine and tacro work?

A

they are calcineurin inhibitors that block IL2

BTK Book Review (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions