Critical Care

Question 0

What is sepsis?

Answer 0

SIRS and known source of infection.

Question 1

What are the SIRS criteria?

Answer 1

Meet 2 of:

1) T > 38 or < 36
2) P > 90
3) RR > 20
4) PaCO2 < 32 mmHg
5) WBC > 12,000 or < 4,000
6) > 10% bands

Question 2

What is severe sepsis?

Answer 2

Sepsis with end-organ dysfunction (e.g. ARF, altered mental status, ARDS) with hypotension that responds to fluids.

Question 3

What is septic shock?

Answer 3

Sepsis with hypotension that is refractory to fluid resuscitation.

Question 4

What is the hemodynamics profile of hypovolemic shock?

Answer 4

Decreased PCWP
Decreased CO
Increased SVR

Question 5

What is the hemodynamics profile of cardiogenic shock?

Answer 5

Increased PCWP
Decreased CO
Increased SVR

Question 6

What is the hemodynamics profile of distributive shock?

Answer 6

Decreased or normal PCWP
Increased CO
Decreased SVR

Question 7

What are the risks of a Swan-Ganz catheter?

Answer 7

Infection
Arrhythmias (2/2 irritation of endocardium)

Question 8

Action of dobutamine?

Answer 8

Strong stimulation of B1.
Mild stimulation of B2.
Used in cardiogenic shock.

Question 9

Action of isoproterenol?

Answer 9

Strong stimulation of B1.
Mild stimulation of B2.
Used in cardiogenic shock w/ bradycardia.

Question 10

Action of milrinone?

Answer 10

PDE inhibitor –> increased AMP –> ionotropic effects on heart, vasodilation.
Used in HF and cardiogenic shock.

Question 11

Action of low-dose dopamine (1-3 ug/kg/min)?

Answer 11

Stimulation of dopamine (dilates renal vasculature).
Mild B1 stimulation.
Used in renal insufficiency.

Question 12

Action of med-dose dopamine (5-10 ug/kg/min)?

Answer 12

Stimulation of dopamine.
Moderate stimulation of B1.
Mild stimulation of A1 (vasoconstriction).
Used in cardiogenic shock.

Question 13

Action of high-dose dopamine (10-20 ug/kg/min)?

Answer 13

Strong stimulation of dopamine, B1, A1.

Used in cardiogenic or septic shock.

Question 14

Action of norepinephrine?

Answer 14

Strong stimulation of A1.
Moderate stimulation of B1.
Used in septic shock.

Question 15

Action of epinephrine?

Answer 15

Strong stimulation of B1, A1.
Moderate stimulation of B2.
Used in anaphylaxis, septic shock, cardiopulmonary arrest.

Question 16

Action of phenylephrine?

Answer 16

Strong stimulation of A1.

Used in septic, neurogenic shock, anesthesia-induced hypotension.

Question 17

Action of sodium nitroprusside?

Answer 17

Venodilation and arterial dilation.

Used in low CO w/ high BP.

Question 18

What is PS mechanical ventilation?

Answer 18

PS = pressure support.

Pt-initiated breath triggers boost of pressure.

Question 19

What is AC mechanical ventilation?

Answer 19

AC = assist-controlled.
Preset VT is given at preset freq/min.
Pt-initiated breath receives preset VT.

Question 20

What is IMV?

Answer 20

IMV = intermittent mandatory ventilation.

PS mode, w/ AC mode as backup.

Question 21

What is CPAP?

Answer 21

CPAP = continuous positive airway pressure.
No variation with breathing cycle.
Pt breathes on own.

Question 22

What is PEEP?

Answer 22

PEEP = positive end-expiratory pressure.
Provided to keep alveoli open.
Pt breathes on own.