CRITICAL CARE Flashcards
4 types of shock
hypovolemic
Vasogenic
Neurogenic
Cardiogenic
Normal left atrial pressure
8-10 mmHg
what can cause a false reading of left atrial pressure
mitral valve insufficiency
effect of PEEP
decrease preload
Increase arterial oxygen content right increase in functional residual capacity via recruitment of alveoli
Factors that affect oxygen delivery
Cardiac output
Hemoglobin concentration
Oxygen saturation
Where is taken from to determine venous oxygen saturation
pulmonary artery ( D. OXYGENATED BLOOD GOING TO LUNG)
SURROGATE MARKER VENA CAVA
Markers of pulmonary embolism
Tachycardic tachypnea hypotensive INCREASED pulmonary artery pressure Increased central venous pressure DECREASE PaO2 and pCO2 ventilation perfusion mismatch Right heart failure Ralph Fourth heart sound
Treatment per patient with cardiogenic shock and low cardiac output with increased SVR
DOBUTAMINE to support inotropic effect
Characteristics of ARDS
#1Pulmonary artery wedge pressure less than 18 mmHg #2 no clinical evidence of right heart failure subsequent to left heart failure #3 diffuse bilateral pulmonary infiltrates #4 PaO2 to FiO2 ratio less than 200
First and second most common nosocomial infections with ventilator patient’s
#1 #2 ventilator associated pneumonia
Common organisms for ventilator associated pneumonia
#1 polymicrobial #2 gram-negative rods
Diagnostic criteria for ventilator associated pneumonia
#1 fever #2 pertinent sputum in conjunction with radiographic evidence #3 blood cultures LOOKED this up and Cameron
best indicator adequate resuscitation in hypovolemic shock
urine output
parameters consistent with septic shock
this is high output cardiac failure #1 SVR decrease #2 systemic blood pressure decrease #3 Central venous pressure decreased #4 wedge pressure unaffected #5 SpO2 increase (tissue not extracting oxygen well)
free water deficit calculated quick and dirty
for every 3 of sodium above 140 equals 1 L of water
EKG changes seen with HYPOKALEMIA
#1 U waves #2 FLATTENED T waves #3 ST segment changes #4 arrhythmia
next step in treatment for hypercalcemic crisis after fluids, calcitonin in breast cancer patient with calcium of 20
bisphosphonate onset immediately
(pamidronate - inhibit osteoclastic)
Use for patients with bony metastasis
Mithramycin takes 24 hours to work
What is maximum correction rate for hyponatremic
1 mEq per hour until sodium reaches 130 or neurologic symptoms improve
Normal serum phosphorus
2.5-5.0
Effects of hypophosphatemia
Cardiac dysfunction Muscle weakness Decreased cardiac output Respiratory failure Encephalopathy Hemolysis
signs the of hypercalcemia
Lethargy
Stupor
coma
Cerebral salt wasting
Diagnosis of exclusion
Renal sodium and chloride wasting
Seen in the face of dehydration
Diabetes insipidus
ADH
dilute urine with hypernatremia
urine output 200 300 per hour
high-output renal failure
Increase potassium
Increased BUN
Increased creatinine
SIADH
ADH
Retention of free water
LOW urine output
can be seen with euvolemic or hyponatremic status and elevated urine sodium urine osmolarity
Water intoxication
rapid decrease in serum sodium and cause death-cerebral swelling
What causes RIGHT shift of oxygen dysociation curve
Right is right
CADET, face Right!” for CO2, Acid, 2,3-DPG, Exercise and Temperature
Treatment for acute DT tachycardia hypertension postop with
diazepam
Diagnosis of thyroid in the ICU criteria
nearly nondetectable TSH
elevated T3
Elevated T4
Elevated glucose
Gross common cause of death from hepatic failure secondary to acetaminophen overdose
cerebral edema
