Critical Care

Question 1

The rapid shallow breathing index is the ratio of the ____________

Answer 1

respiratory rate to tidal volume

Question 2

The negative inspiratory force should be at least greater than ________ for extubation

Answer 2

–20 cm H2O

Question 3

negative inspiratory force is?

Answer 3

a measurement of respiratory muscle strength and ventilator reserve.

one of several clinical indicators that are often used to assess a patient’s ability to be successfully “weaned” and liberated from mechanical ventilation.

Question 4

The minute ventilation, which is the product of __________

Answer 4

= tidal volume x respiratory rate

should be less than 10 L/min.

normal while resting is about 5–8 L/min
↓ decreases when at rest, and ↑ with exercise.

Question 5

When a hemolytic reaction caused by an incompatible blood transfusion is suspected, do this?

Answer 5

• Stop x-fusion
• insert foley (watch output)
• diuresis w/ mannitol*
• alkalinizing ua with sodium bicarbonate IV*

*AKI from hgb in the renal tubules= major consequence of hemolysis–>
↓ alkaline environment, ↑ acid environment

Question 6

Adult respiratory distress syndrome criteria

Answer 6

B/L pulmonary infiltrates
PaO2 /FiO2 less than 200
pulmonary wedge pressures less than 18 mm Hg

Question 7

Three major physiologic alterations of ARDS

Answer 7

(1) hypoxemia unresponsive to inspired O2
(2) ↓ pulmonary compliance
(3) decreased functional residual capacity

Question 8

How to increase tissue O2 uptake

Answer 8

Acidosis
2,3-DPG
↑ PaCO2
↑ temperature

*shift the curve to the right.

Question 9

At all doses of dopamine, the__________ can be expected to rise

Answer 9

diastolic blood pressure

Question 10

Activation of dopamine receptors causes __________

low doese dopamine

Answer 10

vasodilation of the renal and mesenteric a

mild vasoconstriction of the peripheral bed

–> thereby redirects blood flow to kidneys and bowel.

Question 11

High dose dopamine will?

Answer 11

activate α-receptor
–> peripheral vasoconstriction

blood shifts from extremities to organs, ↓ kidney function, and hypertension.

Question 12

transfusion-related acute lung injury manifests as

Answer 12

respiratory distress
hypoxemia
bilateral pulmonary infiltrates
*not due to volume overload.

Question 13

The major risk factor for TRALI is ?

Answer 13

transfusion of any plasma-containing blood products from multiparous female donors.

Question 14

Allergic complications of transfusions and treatments

Answer 14

allergic reactions
rash and fever
mild reactions are treated with an antihistamine

Question 15

Hemolysis complications of transfusions and treatments

Answer 15

hemolytic reactions
ddx w/ positive Coombs test
rx: d/c transfusion
identify the responsible antigen to prevent future reactions.

Question 16

TACO complications of transfusions and treatments

Answer 16

• Transfusion-associated circulatory overload (TACO)
• Occurs in patients with heart failure getting large volume transfusions
• Rx: administration of diuretics

Question 17

___________ is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock.

Answer 17

Dobutamine

Question 18

cardiac output=

Answer 18

cardiac output= stroke volume x heart rate

Question 19

Cardiac Cath RA

Answer 19

between 1 -8 mmHg

Question 20

Cardiac Cath RV

Answer 20

diastolic pressure is 1 - 8 mmHg

peak systolic pressure is 15 - 30 mmHg.

Question 21

Cardiac Cath Pulmonary artery

Answer 21

systolic is 15 - 30 mmHg

diastolic is 4 - 12 mmHg.

Question 22

Cardiac Cath LV

Answer 22

Diastolic 4-12 mmHg

Question 23

Cardiac Cath LA

Answer 23

4-12 mmHg

Question 24

PEEP improves oxygenation by ___________

Answer 24

↑ functional residual capacity by keeping the alveoli open at the end of expiration.

Question 25

Beck triad

Answer 25

Tamponade

systemic hypotension, JVD, and distant heart sounds

Question 26

pulsus paradoxus, which is manifested by

Answer 26

↓ systolic blood pressure by > 10 mm Hg at the end of the inspiratory phase

Question 27

pseudocholinesterase deficiency

Answer 27

prolongs the effects of succinylcholine, a depolarizing neuromuscular blocking agent

Question 28

___________ binds free hemoglobin

Answer 28

haptoglobin

Question 29

____________ reflects the difference between the oxygen delivered to the tissues and the oxygen taken up by the tissues.

Answer 29

Mixed venous oxygen saturation

Svo2 stands for mixed venous saturation of oxygen

marker of O2 delivered to the peripheral tissues (if ↓SvO2 in multiorgan failure–> add a inotrope to help increase CO ie. in severe sepsis)

Question 30

hypoventilation acid base status

Answer 30

resp acid PCO2 > 40 mmHg

no oxygen, body will shift to acidic state

Question 31

Hyperventilation acid base

Answer 31

resp alk PCO2 < 40 mmHg

Question 32

Metabolic alkalosis causes

Answer 32

vomiting up HCl (acid loss)
diuretic use- thiazide and loop diuretics
antacid use (anti-acid get it)
mineralocorticoid (e.g. aldosterone) excess

Question 33

Metabolic acidosis- Normal anion gap

Answer 33

diarrhea- loss of bicarbonate in stool

Renal Tublar Acidosis

Question 34

The _________ level provides a rough estimate of protein nutritional adequacy

Answer 34

serum albumin

Question 35

The respiratory quotient (RQ) is?

Answer 35

ratio of the rate of carbon dioxide production over the rate of oxygen uptake.

An RQ of 0.75 to 0.85 is ideal (little more more oxygen vs CO2)