Critical Care Flashcards
The rapid shallow breathing index is the ratio of the ____________
respiratory rate to tidal volume
The negative inspiratory force should be at least greater than ________ for extubation
–20 cm H2O
negative inspiratory force is?
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.
The minute ventilation, which is the product of __________
= 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.
When a hemolytic reaction caused by an incompatible blood transfusion is suspected, do this?
- 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
Adult respiratory distress syndrome criteria
B/L pulmonary infiltrates
PaO2 /FiO2 less than 200
pulmonary wedge pressures less than 18 mm Hg
Three major physiologic alterations of ARDS
(1) hypoxemia unresponsive to inspired O2
(2) ↓ pulmonary compliance
(3) decreased functional residual capacity
How to increase tissue O2 uptake
Acidosis
2,3-DPG
↑ PaCO2
↑ temperature
*shift the curve to the right.
At all doses of dopamine, the__________ can be expected to rise
diastolic blood pressure
Activation of dopamine receptors causes __________
low doese dopamine
vasodilation of the renal and mesenteric a
mild vasoconstriction of the peripheral bed
–> thereby redirects blood flow to kidneys and bowel.
High dose dopamine will?
activate α-receptor
–> peripheral vasoconstriction
blood shifts from extremities to organs, ↓ kidney function, and hypertension.
transfusion-related acute lung injury manifests as
respiratory distress
hypoxemia
bilateral pulmonary infiltrates
*not due to volume overload.
The major risk factor for TRALI is ?
transfusion of any plasma-containing blood products from multiparous female donors.
Allergic complications of transfusions and treatments
allergic reactions
rash and fever
mild reactions are treated with an antihistamine
Hemolysis complications of transfusions and treatments
hemolytic reactions
ddx w/ positive Coombs test
rx: d/c transfusion
identify the responsible antigen to prevent future reactions.
TACO complications of transfusions and treatments
- Transfusion-associated circulatory overload (TACO)
- Occurs in patients with heart failure getting large volume transfusions
- Rx: administration of diuretics
___________ is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock.
Dobutamine
cardiac output=
cardiac output= stroke volume x heart rate
Cardiac Cath RA
between 1 -8 mmHg
Cardiac Cath RV
diastolic pressure is 1 - 8 mmHg
peak systolic pressure is 15 - 30 mmHg.
Cardiac Cath Pulmonary artery
systolic is 15 - 30 mmHg
diastolic is 4 - 12 mmHg.
Cardiac Cath LV
Diastolic 4-12 mmHg
Cardiac Cath LA
4-12 mmHg
PEEP improves oxygenation by ___________
↑ functional residual capacity by keeping the alveoli open at the end of expiration.
Beck triad
Tamponade
systemic hypotension, JVD, and distant heart sounds
pulsus paradoxus, which is manifested by
↓ systolic blood pressure by > 10 mm Hg at the end of the inspiratory phase
pseudocholinesterase deficiency
prolongs the effects of succinylcholine, a depolarizing neuromuscular blocking agent
___________ binds free hemoglobin
haptoglobin
____________ reflects the difference between the oxygen delivered to the tissues and the oxygen taken up by the tissues.
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)
hypoventilation acid base status
resp acid PCO2 > 40 mmHg
no oxygen, body will shift to acidic state
Hyperventilation acid base
resp alk PCO2 < 40 mmHg
Metabolic alkalosis causes
vomiting up HCl (acid loss)
diuretic use- thiazide and loop diuretics
antacid use (anti-acid get it)
mineralocorticoid (e.g. aldosterone) excess
Metabolic acidosis- Normal anion gap
diarrhea- loss of bicarbonate in stool
Renal Tublar Acidosis
The _________ level provides a rough estimate of protein nutritional adequacy
serum albumin
The respiratory quotient (RQ) is?
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)
