Critical Care Flashcards by Jared Getzlaff

Cardioplegia solution

High concentration potassium

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Location of the SA node

Junction of RA and SVC

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Most common cause of acquired aortic stenosis

Calcific degeneration

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Mild hypothermia

90-94 shivering and mild mental changes, tachycardic

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Moderate hypothermia

(84-89) agitated combative, afib hypoT

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Severe hypothermia

(70-84) flaccid comatose, vfib, death

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Profound hypothermia

(<70) loss of vitals/cardiac activity

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Unstable patient in afib; tx

Synchronized cardioversion

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Tx systolic heart failure with fluid overload

Dobutamine and diuretics

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Cardiac arrest hypothermic; next step

ABC’s then immediate rewarming

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PCWP 6; CO 1.5; SVR 400; venous O2 50%

Neurogenic shock

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Pre-op workup for patient able to perform 4 METs

None

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Lethal triad

Hypothermia, coagulopathy, metabolic acidosis

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CPP define and target for TBI

CPP=MAP - ICP; 60-70mmHg

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Percent septic shock idiopathic

30%

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Septic shock resuscitated and started on NE with MAP of 50; next step

Vasopressin 0.03units/min

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Sodium deficit

(Desired sodium - patients sodium) x TBW(60% males and 50% females)

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High CVP, PCWP and SVR with low CI; type of shock

Cardiogenic

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Renal response to hypovolemia

Vasoconstriction of efferent arteriole, secretion of ADH, RAAS stimulation

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Definitive treatment hyperkalemia

Dialysis

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Highest risk surgeries for post-op delirium

Cardiothoracic followed by ortho

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Most common risk factor for post-op afib

fluid overload

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PCWP 6, CI 1.5, SVR 1800, venous O2 50%; type of shock

Hypovolemic or hemorrhagic

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POD2 hypoxia with normal vitals, exam, CXR; dx and tx

Atelectasis, IS

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Gradual change in amplitude with twisting of QRS around isoelectric line; dx and tx

Torsades; IV magnesium 2g push followed by 2-3mmol/L infusion

Gastric outlet obstruction acid-base/electrolyte disorder and renal excretion

hypochloremic hypokalemic metabolic alkalosis, aciduria with potassium excretion

Precipitates dysrhythmias even at low-normal potassium levels

Digoxin (binds to Na/K ATPase at K+ binding site

Precipitates dysrhythmias even at low-normal potassium levels

Digoxin (binds to Na/K ATPase at K+ binding site

Post-op SOB, ipsilateral dullness to percussion, decreased breath sounds, contralateral tracheal deviation; dx

Pleural effusion/empyema

Orientation of great neck vessels for IJ placement

IJ lateral to Common Carotid

Early finding of compartment syndrome

Pain with passive stretch

Compartment pressure indicating fasciotomy

Delta 20-30mmHg

Hard sign to stop therapeutic hypothermia

Hemorrhage

Marker for Hepatorenal syndrome and tx

Decreased GFR, transplant

Spine trauma, hypertension, bradycardia and diaphoresis; dx, level of injury

Autonomic dysreflexia, T6 or above

Unstable, suspected pulm art injury s/p Swan-Ganz placement; next step

mediam sternotomy

Hypertension, hypokalemia, hypernatremia, metabolic alkalosis); dx and next step

Hyperaldosteronism, serum renin/aldosterone

Primary v secondary hyperaldosteronism (renin/aldo)

Primary - reduced renin, elevated Aldo and ratio Secondary - elevated renin/aldo and Aldo/renin ~10

Hyperglycemia in critical illness due to what

Insulin resistance

Hx of COPD s/p lobectomy in afib; tx

Rate control with CCB

Atelectasis effect on FRC and VC

Decreased

NE receptors and effects

alpha-1, peripheral vasoconstriction alpha-2, splanchnic vasoconstriction beta-1, increased HR and contractility

Concerned for CO poisoning; next step

Send carboxyhemoglobin and start 100% O2

Vfib; next step

Administer non-synchronized cardio version of 200J, followed by another 200J with 1mg epinephrine every 3-5min

Intra-abdominal hypertension; tx

Decompress with NG, Foley and Rectal tubes

Effects of compartment syndrome (card/pulm/renal)

Decreased preload/CO, increased peak airway pressures, renal dysfunction

Inferior wall infarct; next step

Saline bolus to increase preload and hypotension

Post-op resp failure, hypoxia, tachycardia, tachypnea, respiratory alkalosis; dx

Lung-protective ventilation in ARDS

4-6mL/kg TV and plateau pressure <30cmH20 Also prone >12hrs and P:F<100 has survival benefit

Rate of sodium correction for children with acute severe hypernatremia

no more than 0.5 mEq/L/hour or 10-12 mEq/L/day

Hydronephrosis from ureteral obstruction refractory to conservative management; tx

Perc nephrostomy

Causes of anion-gap metabolic acidosis

Methanol Uremia Diabetic ketoacidosis Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates

Hyponatremia <120; tx and rate

Hypertonic saline (3%), 0.5 mEq/h

Normal anion gap acidosis causes

Loss of bicarb (diarrhea, ileostomy, EC fistula, type II/proximal RTA) Decreased renal acid excretion (type I/distal RTA)

Early sign of hypocalcemia

circumoral or fingertip paresthesias

Lung cancer, bx with absent nucleoli, hyponatremia; dx

SIADH secondary to small-cell lung cancer

Lung cancer, hypercalcemia; dx

Squamous cell carcinoma of the lung (PTH-related peptide)

Components of LR

Na 130 K 4 Cl 109 Ca 2.7 Lactate 28

Components of LR

Na 130 K 4 Cl 109 Ca 2.7 Lactate 28

High ileostomy output; acid-base disorder

Normal anion gap metabolic acidosis

Complication from severe hyponatremia <115

Seizures

Risk of rapid correction of hyponatremia

Central pontine myelinolysis or osmotic demyelination syndrome

Risk of rapid correction of hyponatremia

Central pontine myelinolysis or osmotic demyelination syndrome

FENa

FENa =[(Urine Na/Serum Na) / (Urine Creatinine/Serum Creatinine)] x 100)

FENa < 1; dx and tx

Prerenal AKI, IV fluid resuscitation

FENa > 2; dx and tx

Intrinsic AKI, adress underlying renal pathology

FENa > 4; dx and tx

Postrenal AKI, relieve obstruction

Vit D effects on Calcium

Vit D increases absorption of Ca in small intestine

Free-water deficit

FWD = weight x 0.5women or 0.6men x [(Na-140)/140]

Euvolemic, hyponatremia, asymptomatic; tx

Free water restriction

pH 7.25, PaO2 88, PaCO2 60, HCO3- 26; acid base disorder

Respiratory acidosis

Hyponatremia in the setting of DKA; dx

Pseudohyponatremia

Maintenance fluid newborn and why

1/4NS with D5, decreased GFR with poor ability to concentrate urine

Gastric fluid loss

1-2L

Biliary and Pancreatic fluid loss

500 and 1500mL

Small bowel fluid loss

1500mL

Adrenal response to hyperkalemia

Aldosterone production by zone glomerulosa

Best measurement of intravascular volume

UOP

Hypomagnesemia effects on Ca, PTH, Cacitriol

Hypocalcemia, hypoparathyroidism, decreased calcitriol synthesis

Gastric outlet obstruction; acid base disorder

Hypochloremic, hypokalemic, metabolic alkalosis with paradoxical aciduria

First-line tx for hyperkalemia with ECG changes

Calcium gluconate

Post-op fever and respiratory alkalosis; dx

Pneumonia

Femoral canal lateral to medial

NAVEL: Femoral nerve, artery, vein, lymphatics

CVP 4, PCWP 10, SVR 2100, CI 1.5

Hypovolemic shock

Hx of RA s/p extensive surgery with hyponatremia, hyperkalemia; dx and tx

Adrenal insufficiency, IV hydrocortisone

SOFA components

P:F, GCS, MAP, Vaopressors, Cr and UOP, Bili, Plt

SBT readiness criteria

Lack of profound hypoxemia or pH derangement, hemodynamic stability, ability to initiate breathe