Critical Care Flashcards
Berlin Criteria
For the diagnosis of ARDS “Berlin criteria” of 2012 by the European Society of Intensive Care Medicine, endorsed by the American Thoracic Society and the Society of Critical Care Medicine. They are a modification of the previously used criteria:[5][6] - Acute onset - Bilateral infiltrates on chest radiograph sparing costophrenic angles - Pulmonary artery wedge pressure
normal central venous pressure tracing consists of
three positive waves (a, c, v) two negative troughs (x, y).
A-wave on CVP tracing
what is it?
when are the exaggerated ?
when are they absent?
Presystolic a wave:
produced by venous distention consequent to right atrial contraction.
Large a waves
right atrium is contacting against increased resistance:
- tricuspid stenosis
- pulmonary stenosis
- pulmonary hypertension
The a wave is absent in patients with atrial fibrillation and junctional rhythm.
what is the c-wave in CVP wave form
c wave: produced by bulging of the tricuspid valve into the right atrium during ventricular systole.
how does the x wave look in constrictive pericarditis
With constrictive pericarditis, there is accentuation of the x descent,
Y-decent on the CVP wave
The y descent follows tricuspid valve opening with rapid inflow of blood into the right ventricle.
treatment of pulmonary contusions with Blast Injury
Treatment principles for blast lung injury parallel those for lung contusion due to other causes with the exception:
- the use of mechanical positive-pressure ventilation in patients with blast lung injury should be avoided.
- Early aggressive positive-pressure ventilation in the initial emergency management can quickly convert a salvageable patient to an unsalvageable patient.
- bronchoscope examination is not necessary in the management of lung contusion.
- avoid fluid overload with crystalloid and colloid (including hetastarch) solutions,
- prophylactic antibiotics are not indicated
- Corticosteroids are not of proven value and, therefore, should not be used.
Medications given preoperatively shown to decrease the likelyhood of postoperative atrial fibrillation
Observational and randomized trials have demonstrated a reduction in the incidence of this complication in CABG patients when they are pre-treated with:
- statins
- beta blockers,
- amiodarone
(ACC/AHA guidelines Level of Evidence: B).
sotalol
non-selective competitive beta-adrenergic receptor blocker that also exhibits Class III antiarrhythmic properties. pre-operative administration does not help post op atrial fibrillation
Does pre CABG statin help postoperative a-fib
Yes ACC/AHA guidelines Level of Evidence: B
Does pre CABG Dignoxin help post a-fib
No
Does pre CABG beta-blocker help post operative a-fib
yes ACC/AHA guidelines Level of Evidence: B
Does pre op sotalol help post op afib
No
Does pre CABG amiodarone help post op afib
Yes ACC/AHA guidelines Level of Evidence: B
Does pre-Cabg non-DHPR Ca Blocker help prevent post afib
No
Bundle of kent
Accessory pathway between the atria and ventricle seen in WPW
Treatment of WPW
Immediate tx of an episode can be synchronized cardioversion if hemodynamically unstable
Procainamide or amiodarone can stabalize heart rate,
Nodal blocking agents should be avoided
Definitive tx - ablation of the acessory pathway
Early tx of post infarct VSD
- Early surgical intervention, before the development of end-organ dysfunction.
- _Preoperative managemen_t should focus on reducing systemic vascular resistance.
- Lower blood pressure may limit infarct expansion, minimize the left-to-right shunt and maximize forward systemic cardiac output.
- The intra-aortic balloon pump will help by reducing afterload and augmenting coronary perfusion pressure.
- Isolated coronary grafting and “conventional” supportive medical management should _not_ be considered as care options.
Risk factors for post operative transfusion
- advanced age
- female gender
- co-morbidities
- small body size
- low preoperative hematocrit
- preoperative antiplatelet
- preop antithrombotic medications
- redo and complex procedures,
- emergency operations
Trigger for cryoprecipitate
1 pool cryo for fibrinogen > 400
Non-hemolytic febrile reaction
- Etiology:
- Clinical presentation:
Non-hemolytic febrile reaction
-
Etiology:
- Caused by recipient antibodies against donor HLA and leukocyte specific antigen on leukocytes and platelets
- Cytokine release -à mild pyrexia about 1 hour after the transfusion
- Clinical presentation:
- High grade fever, rigors , nausea, and vomiting
- Severity of the symptoms is proprition to the number of leukocytes in the transfused blood.
diagnosis for type 5 MI
Type 5 - MI following CABG according to the universal definition of coronary artery diease
- The serum cardiac troponin I test is favored, and the definition of perioperative MI following on-pump CABG is 5 times the 99th percentile of that range during the first 72 hours after CABG.
- This enzyme level reflects significant myocardial cell damage, but the number is not reliable if the patient had an MI in evolution before the operation.
- Additionally, therefore, either new Q waves or new LBBB on ECG, or evidence on imaging of myocardial loss or wall motion defect are supportive of the enzyme elevation criterion.
Southwest Oncology Group Trial 9416 (Intergroup Trial 0160).
neoadjuvant therpay for superior sulcus tumors
5 year survival for superior sulcus lung tumors
44-54%
The National Lung Screening Trial (NLST)
population indicated for screening based on this surgery
smokers (> 30 pack-year history)
ages 55-74 years
who quit less than 15 years ago.
Frequency of anatomotic leak after Esophagectomy ?
occurs in 9-14% of cases
