critical care

Question 1

What is Levophed?

Answer 1

Norepinephrine

Question 2

SIR criteria (need 2)

Answer 2

WBC > 12 or 20, HR > 90, temp > 38 or 10% bands

Question 3

Neurogenic shock

Answer 3

Disruption of CNS -> unopposed vagal tone, vasodilation. Low BP and bradycardia. Tx fluids, pressors, atropine and/or pacemaker for brady

Question 4

Tx of cardiogenic shock, left-sided HF

Answer 4

Diuretics, nitrates, pressors (dopamine medium dose, dobutamine, amrinone), intra-aortic balloon pump can be used

Question 5

Tx of cardiogenic shock, right-sided HF

Answer 5

Give fluids to maintain preload

Question 6

What is a normal SVR index?

Answer 6

700 to 1600 (1100) dynesseccm^-5

Question 7

What is a normal PCWP?

Answer 7

4-12 (9) mm Hg

Question 8

What is a normal RA pressure?

Answer 8

1-5 (3) mm Hg

Question 9

What is a normal PVR?

Answer 9

20-130 (70) dynesseccm^-5

Question 10

What is normal RV pressure?

Answer 10

25/9 mm Hg

Question 11

What is normal cardiac index?

Answer 11

2.5 to 3.5

Question 12

What is normal PASP?

Answer 12

15-30 / 6-12 (10-18) mm Hg

Question 13

Dobutamine

Answer 13

Strong beta1 (inotrope, chronotrope), mild beta 2 (vasodilate). Used in cardiogenic shock.

Question 14

Isoproterenol

Answer 14

Strong beta1 and beta 2. used in cardiogenic shock with bradycardia

Question 15

Milrinone

Answer 15

Not a pressor but used in ICU often. Phosphodiesterase inhibitor with ionotropic and vasodilator effects. Used in HF, cardiogenic shock.

Question 16

Dopamine

Answer 16

Low dose stim DA receptors and mildly beta 1 (used in renal failure, medium dose stim DA and moderately beta1 and mild alpha 1 (used in cardiogenic shock), high dose stim DA and beta1 and strongly alpha1 (used in cardiogenic or septic shock)

Question 17

NE

Answer 17

Strongly stim alpha1 and beta1. Used in septic shock.

Question 18

Epi

Answer 18

Strongly stimulates beta1, alpha1, and moderate beta2. Used in anaphylaxis, sepsis, cardiopulmonary arrest.

Question 19

Phenylephrine

Answer 19

Alpha1 only, used in septic shock, neurogenic shock, anesthesia-induced hypotension

Question 20

Types of MV: pressure support

Answer 20

There is an initial “boost” of pressure, triggered by the patient’s own breath, which helps overcome the resistance created by the endotracheal tube. This mode can be used on its own or in concert with IMV mode. Important mode for weaning.

Question 21

Types of MV: assist-control (AC)

Answer 21

Set tidal volume is given a set number of times per minute. If the patient initiates a breath, the ventilator responds by giving the preset tidal volume.

Question 22

Types of MV: intermittent mandatory ventilation (IMV)

Answer 22

When pt initiates a breath, the ventilator gives boost of pressure support, but tidal volume is det by patient’s effort. If pt does not initiate breath, there is back up to automatically give set # of breaths per minute (like AC).

Question 23

Types of MV: CPAP

Answer 23

Continuous positive airway pressure, regardless of breathing cycle. Patient must breath on own

Question 24

Types of MV: PEEP

Answer 24

positive end-expiratory airway pressure. Usu set at 5-20 mm Hg

Question 25

Tidal volume should be set at what?

Answer 25

7 cc/kg

Question 26

Why is alkalemia a possible cause for failure to wean off ventilation?

Answer 26

H+ stimulates respiration