Critical care Flashcards
the most post op delirium is after what type of surgery?
cardiothoracic
what does Norepinephrine work?
stimulates alpha-1, alpha-2, and beta-1 adrenergic receptors
increases contractility with peripheral and splanchnic vasoconstriction
how do you calculate sodium deficit?
(desired sodium - patient’s sodium) x total body water
total body water = pt’s wt in kg x gender factor (.6 in males, .5 in females)
how do you calculate total body water?
TBW = wt in kg x gender factor (.6 in male, .5 in female)
what is the treatment for ventricular fibrillation?
administer NON-SYNCHRONIZED cardio version of 200 J
with 1 mg epinephrine every 3-5 minutes
if fails to convert, give amiodarone
what is synchronized shocks given?
unstable rapid afib
what are the two shockable rhythms?
ventricular fibrillation and non-perfusing ventricular tachycardia
when is defibrillation NOT indicated?
asystole or PEA
give 1 mg epinephrine every 3-5 minutes
is atelectasis a type of pulmonary shunt?
yes - the blood flow to alveoli is unaffected but the air exchange is impeded due to alveolar collapse
what is a life threatening type of V/Q mismatch?
massive PE
what techniques are used in pulmonary thromboembolectomy?
suction catheters, grasping clot with forceps, direct inspection with sterile pediatric bronchoscope, manual compression of the lungs
all used to remove clot burden
when is systemic thrombolysis indicated for patients with PE?
persistent hypotension or shock d/t the acute PE
how is a pulmonary thromboembolectomy done?
midline sternotomy, cardiopulmonary bypass, an opening is made in the main pulmonary artery and extended into he left PA
what is the best peri-operative management of a patient with HFpEF?
guideline directed blood pressure control with beta blockers, ACE, or hydralazine
how does dobutamine work?
pure beta adrenergic effects
at lower doses beta 1 is targeted which increases cardiac contractility
at higher doses beta 2 are stimulated which has vasodilatory effect
when doing CPR on a hypothermic patient, when can you stop?
if systole persists despite rewarming to 90 F or 32.2 C
how does an intra aortic balloon work?
deflates in systole
increases forward blood flow by reducing after load through a vacuum effect
inflates during diastole
increasing blood flow to coronary arteries via retrograde flow
altogether decrease myocardial oxygen demand and increase myocardial oxygen supply
what happens if an intra aortic balloon inflates too early?
increases afterload
what can happen with T spine injuries at or above T6?
autonomic dysreflexia = hypertension, bradycardia, diaphoresis
increased sympathetic below T level but increased parasympathetic above T level of injury
with TBI, what is the ideal CPP?
CPP = MAP - ICP
keep CPP 60-70 mmHg and ICP below 20 mmHg
when should therapeutic hypothermia following cardiac arrest by stopped?
hypotension and decrease in hemoglobin of 3 g/dL
how to determine if a patient has primary or secondary hyperaldosteronism?
get plasma renin and aldosterone level and calculate ratio
if both elevated and ratio ~ 10 = secondary
if reduced renin and elevated aldosterone and ratio > 20 = primary
what parameters fall under neurogenic shock?
cardiac output will be low and SVR is markedly reduced
PCWP: decreased (6), CO: decreased (1.5), SVR : low (400), venous O2 sat: 50%
what parameters fall under hypovolemic shock?
PCWP: decreased (6), CO: decreased (1.5), SVR: high (1800), venous O2 sat: 50%
what parameters fall under cardiogenic shock?
PCWP: increased (20), CO: decreased (1.5), SVR: increased (1800), venous O2 sat: 50%
what parameters fall under septic shock?
PCWP: normal (10), CO: increased (8), SVR: low (400), venous O2 sat: increased (80%)
what parameters fall under normal state?
PCWP: 10, CO: 5, SVR: 1000, venous O2 sat 70%
hyperglycemia in critical care patients is due to
insulin resistance
