Critical care

Question 1

the most post op delirium is after what type of surgery?

Answer 1

cardiothoracic

Question 2

what does Norepinephrine work?

Answer 2

stimulates alpha-1, alpha-2, and beta-1 adrenergic receptors

increases contractility with peripheral and splanchnic vasoconstriction

Question 3

how do you calculate sodium deficit?

Answer 3

(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)

Question 4

how do you calculate total body water?

Answer 4

TBW = wt in kg x gender factor (.6 in male, .5 in female)

Question 5

what is the treatment for ventricular fibrillation?

Answer 5

administer NON-SYNCHRONIZED cardio version of 200 J

with 1 mg epinephrine every 3-5 minutes

if fails to convert, give amiodarone

Question 6

what is synchronized shocks given?

Answer 6

unstable rapid afib

Question 7

what are the two shockable rhythms?

Answer 7

ventricular fibrillation and non-perfusing ventricular tachycardia

Question 8

when is defibrillation NOT indicated?

Answer 8

asystole or PEA

give 1 mg epinephrine every 3-5 minutes

Question 9

is atelectasis a type of pulmonary shunt?

Answer 9

yes - the blood flow to alveoli is unaffected but the air exchange is impeded due to alveolar collapse

Question 10

what is a life threatening type of V/Q mismatch?

Answer 10

massive PE

Question 11

what techniques are used in pulmonary thromboembolectomy?

Answer 11

suction catheters, grasping clot with forceps, direct inspection with sterile pediatric bronchoscope, manual compression of the lungs

all used to remove clot burden

Question 12

when is systemic thrombolysis indicated for patients with PE?

Answer 12

persistent hypotension or shock d/t the acute PE

Question 13

how is a pulmonary thromboembolectomy done?

Answer 13

midline sternotomy, cardiopulmonary bypass, an opening is made in the main pulmonary artery and extended into he left PA

Question 14

what is the best peri-operative management of a patient with HFpEF?

Answer 14

guideline directed blood pressure control with beta blockers, ACE, or hydralazine

Question 15

how does dobutamine work?

Answer 15

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

Question 16

when doing CPR on a hypothermic patient, when can you stop?

Answer 16

if systole persists despite rewarming to 90 F or 32.2 C

Question 17

how does an intra aortic balloon work?

Answer 17

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

Question 18

what happens if an intra aortic balloon inflates too early?

Answer 18

increases afterload

Question 19

what can happen with T spine injuries at or above T6?

Answer 19

autonomic dysreflexia = hypertension, bradycardia, diaphoresis

increased sympathetic below T level but increased parasympathetic above T level of injury

Question 20

with TBI, what is the ideal CPP?

Answer 20

CPP = MAP - ICP

keep CPP 60-70 mmHg and ICP below 20 mmHg

Question 21

when should therapeutic hypothermia following cardiac arrest by stopped?

Answer 21

hypotension and decrease in hemoglobin of 3 g/dL

Question 22

how to determine if a patient has primary or secondary hyperaldosteronism?

Answer 22

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

Question 23

what parameters fall under neurogenic shock?

Answer 23

cardiac output will be low and SVR is markedly reduced
PCWP: decreased (6), CO: decreased (1.5), SVR : low (400), venous O2 sat: 50%

Question 24

what parameters fall under hypovolemic shock?

Answer 24

PCWP: decreased (6), CO: decreased (1.5), SVR: high (1800), venous O2 sat: 50%

Question 25

what parameters fall under cardiogenic shock?

Answer 25

PCWP: increased (20), CO: decreased (1.5), SVR: increased (1800), venous O2 sat: 50%

Question 26

what parameters fall under septic shock?

Answer 26

PCWP: normal (10), CO: increased (8), SVR: low (400), venous O2 sat: increased (80%)

Question 27

what parameters fall under normal state?

Answer 27

PCWP: 10, CO: 5, SVR: 1000, venous O2 sat 70%

Question 28

hyperglycemia in critical care patients is due to

Answer 28

insulin resistance