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BTK Review 2024 > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What is the formula for oxygen delivery?

A

CO x {(Hgb x SaO2 x 1.34) + (PaO2 x 0.003)}

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2
Q

What is the formula for oxygen consumption?

A

CO x (PaO2 - PvO2)

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3
Q

What is the formula for the oxygen extraction ratio?

A

O2 consumption/O2 dlivery

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4
Q

CVP is a surrogate for what other measurement?

A

RV end diastolic volume

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5
Q

Pulmonary wedge pressure is a surrogate for what other measurement?

A

LV end diastolic volume

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6
Q

What pressures can we measure to estimate RV and LV end diastolic volume?

A
  • RV = CVP
  • LV = PWP
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7
Q

How are cardiac output and cardiac index calculated?

A
  • output = SV x HR
  • index = CO/BSA
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8
Q

How do SVR, CVP, and CO change for hypovolemic shock?

A
  • SVR: increase
  • CVP: decrease
  • CO: decrease
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9
Q

How do SVR, CVP, and CO change for cardiogenic shock?

A
  • SVR: increase
  • CVP: increase
  • CO: decrease
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10
Q

How do SVR, CVP, and CO change for septic shock?

A
  • SVR: decrease
  • CVP: decrease
  • CO: increase
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11
Q

How do SVR, CVP, and CO change for neurogenic shock?

A
  • SVR: decrease
  • CVP: decrease
  • CO: decrease
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12
Q

How dose dopamine act as a vasopressor?

A
  • low dose: dopamine receptors in kidneys
  • med dose: B1 activity
  • high dose: a activity
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13
Q

How does dobutamine act as a vasopressor?

A

B1 activity

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14
Q

How does milrinone work as a vasopressor?

A

is a PDE-III inhibitor which increases cAMP to reduce after load and increase CO

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15
Q

How is the SOFA score best used?

A

to compare patients and allocate resources; higher score means a higher likelihood of mortality

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16
Q

What are the criteria for septic shock?

A

lactate >2 and vasopressor requirement despite adequate fluid resuscitation

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17
Q

How is procalcitonin best used?

A

to provide guidance about when to stop antibiotics

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18
Q

Mannan antigen is a test used for what?

A

to look for invasive candidiasis

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19
Q

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

A

an assay used to test for fungal infection

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20
Q

What are the sepsis treatment guidelines?

A
  • send cultures before antibiotics
  • start antibiotics within 1 hour
  • bolus at 30cc/kg within 3 hours
  • start pressure within 6 hours if needed
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21
Q

What is the empiric treatment for adrenal insufficiency?

A

200mg/day of hydrocortisone

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22
Q

What labs support the diagnosis of adrenal insufficiency?

A
  • hyponatremia
  • hyperkalemia
  • hypoglycemia
  • azotemia
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23
Q

What is the difference between peak and plateau airway pressures on the vent?

A
  • peak reflect large airway pressures
  • plateau reflect alveolar pressures
24
Q

Describe the various modes of ventilator support.

A
25
Q

What is the best predictor of successful extubation? What is best predictor of failure?

A
  • best predictor of success: RSBI < 100
  • best predictor of failure: NIF < 20
26
Q

Describe the Berlin definition of ARDS.

A
  • symptoms within 1 week of insult
  • characteristic bilateral opacities on CXR
  • no other explanation for findings
  • P/F ratio < 300
27
Q

What interventions have been shown to have a mortality benefit in those with ARDS?

A

prone positioning, neuromuscular blockade

28
Q

What are treatment strategies for those with ARDS?

A
  • low TV ventilation (4-6cc/kg)
  • target plateau pressure < 30
  • permissive hypercapnia (ok to allow for pH > 7.2)
  • prone positioning, neuromuscular blockade
  • sedation
  • vasodilators (inhaled NO)
29
Q

How will an ABG change in someone with a PE?

A

respiratory alkalosis

30
Q

What is the most common EKG finding associated with PE? What is the classic/pathognomonic change?

A
  • most common: sinus tach
  • classic: S1Q3T3
31
Q

Describe the believed pathophysiology contributing to hepatorenal syndrome.

A

portal hypertension leads to splanchnic vasodilation which decreases effective arterial blood volume and subsequently renal perfusion

32
Q

How is hepatorenal syndrome managed?

A
  • octreotide induces splanchnic vasoconstriction
  • midodrine: induces systemic vasoconstriction
  • albumin: increased oncotic pressure and intra-vascular volume
33
Q

Which patients on a steroid regimen are NOT at risk for peri-operative adrenal insufficiency?

A

those on a steroid regimen for < 3 weeks or at < 5mg/day

34
Q

How is peri-operative adrenal insufficiency treated?

A
  • IV hydrocortisone 25-50mg on day of surgery and then transition to normal PTA dose for minor surgeries
  • IV hydrocortizone 50-75mg q8 for 1-2 days and then transition to normal PTA dose for major surgeries
35
Q

How should oral anti-hyperglycemic medications be managed perioperatively?

A
  • hold SGLT2 inhibitors for 3-4 days pre-operatively
  • hold all other PO anti-hyperglycemic medications on day of surgery
36
Q

How is respiratory quotient calculated and used?

A
  • it is a measure of CO2 production/O2 consumption
  • increases with carbohydrate overfeeding which can cause difficulty weaning from the ventilator
  • 0.7 = fat metabolism
  • 0.8 = protein metabolism
  • 1.0 = carbohydrate metabolism
37
Q

How is nitrogen balance calculated and used?

A

= protein intake/6.25 - (urine urea nitrogen + 4)
- negative balance indicates catabolism
- positive balance indicates anabolism

38
Q

How man calories are in…
- carbohydrates
- dextrose
- lipids
- protein

A
  • carbohydrates: 4kcal/g
  • dextrose: 3.4kcal/g
  • lipids: 9kcal/g
  • protein: 4kcal/g
39
Q

Which fatty acids are less inflammatory and immunogenic?

A

omega-3 fatty acids

40
Q

What are the essential fatty acids?

A

lineolic acid
alpha-lineolic acid

41
Q

Folate deficiency contributes to what lab changes?

A

a macrocytic anemia

42
Q

What are the components and role for immunonutrition?

A
  • includes omega-3 fatty acids, glutamine, arginine
  • associated with lower infectious complication rates
43
Q

What defines intra-abdominal hypertension? What about abdominal compartment syndrome?

A
  • hypertension is sustained pressure of 12 or higher
  • compartment syndrome is sustained pressure of greater than 20 with new onset multi-organ failure
44
Q

What are the signs of abdominal compartment syndrome?

A
  • abdominal distension
  • oliguria
  • increased SVR
  • increased airway pressures
45
Q

What would cause an apnea test to be indicative of brain death?

A

PaCO2 > 60 or increase in PaCO2 more than 20 above baseline

46
Q

What is the diagnosis and treatment in a patient that develops hemoptysis after Swan Ganz balloon inflation?

A
  • diagnosis is ruptured pulmonary artery
  • treatment is embolization
47
Q

What is the treatment for torsades de pointes?

A

IV magnesium

48
Q

What are the indications for renal replacement therapy?

A
  • acidosis
  • electrolyte abnormalities
  • intoxicants
  • overload (volume)
  • uremia
49
Q

Which anesthetic induction medication should be avoided in patients at risk for adrenal insufficiency?

A

etomidate (inhibits steroid synthesis)

50
Q

What is a side effect of etomidate?

A

it inhibits steroid synthesis and puts patients at risk for adrenal insufficiency

51
Q

What is virchow’s triad?

A
  • venous stasis, hypercoagulable state, endothelial injury
  • factors contributing to thrombosis
52
Q

What is the most common post-operative complication in patients over age 65?

A

delirium

53
Q

What are the indications for thrombolysis in patients with pulmonary embolism?

A

hemodynamic instability or with evidence of right heart strain

54
Q

What lab values are consistent with hepatorenal syndrome?

A
  • oliguria
  • increased Cr and BUN
  • urine Na < 10
  • urine RBC < 50
  • urine protein < 500mg/day
55
Q

What happens to K, Mg, and Phos in patients with refeeding syndrome?

A

they all decrease

56
Q
A

BTK Review 2024 (19 decks)

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