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Critical Care Flashcards

1
Q

What is compliance?

A

Change in volume divided by change in pressure

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2
Q

What is CPP (cerebral perfusion pressure)? Normal values?

A

MAP - ICP

>70 mm Hg

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3
Q

What is the substrate for lactate?

A

Pyruvate

Anaerobic pathway: pyruvate –> lactate by lactate dehydrogenase

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4
Q

Fate of lactate

A

Converted into glucose in the liver (or kidney) via Cori cycle

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5
Q

What is base deficit?

A

Indirect measurement of acidosis on ABG

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6
Q

What is weakness of base deficit as an end point of resuscitation?

A

Nonspecific.

Resuscitation with normal saline causes hyperchloremic acidosis.

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7
Q

What is currently the best end point of resuscitation?

A

Lactate

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8
Q

Normal I:E ratio?

A

1:2

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9
Q

What is RSBI?

A

RR/TV

>105 means likely to fail extubation

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10
Q

Treatment of auto-PEEP?

A

Decrease RR
Decrease TV
Increase expiratory time

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11
Q

Causes of hypoxia?

A
  1. Decreased inspired oxygen
  2. V/Q mismatch
  3. Shunt
  4. Decrease in barometric pressure (increased altitude)
  5. Diffusion (pulmonary edema or ARDS)
  6. Hypoventilation (airway obstruction)
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12
Q

Three determinants of oxygen delivery?

A
  1. CO
  2. Hgb
  3. O2 saturation of Hgb (SaO2)
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13
Q

Why does giving too much blood decrease oxygen delivery?

A

Increases viscosity of blood

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14
Q

What is the best marker of ventilation?

A

PaCO2 (on ABG)

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15
Q

What 2 barriers constitute the alveolar-capillary barrier?

A
  1. Microvascular endothelium

2. Alveolar epithelium

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16
Q

What is the pathogenesis of the early acute phase of ARDS?

A

Breakdown of the alveolar-capillary barrier and accumulation of transudate fluid (protein filled) in the alveolar air sac

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17
Q

Diagnostic definition of ARDS?

A
  1. Timing - less than 1 week after insult
  2. CXR - bilateral infiltrates
  3. Noncardiogenic edema
  4. P/F ratio < 300
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18
Q

Mild, moderate, severe ARDS p/f?

A 
200-300 = mild
100-200 = moderate
<100 = severe
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19
Q

Acetazolamide MOA (carbonic anhydrase inhibitor)?

A

Diuretic
Removes bicarbonate in the urine
Use in metabolic alkalosis

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20
Q

Milrinone MOA?

A

PDE III inhibitor
decreases breakdown of cAMP => increases intracellular levels of cAMP and calcium
positive inotrope
decreases afterload (SVR)
no net increase in myocardial oxygen consumption

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21
Q

Isoproterenol MOA?

A

Beta 1 and 2 agonist
positive inotrope
increases HR (chronotropy)

22
Q

Esmolol MOA?

A

Beta adrenergic antagonist
short half life = 9 min
easily titrated

23
Q

Narcotic OD tx?

24
Q

Benzo OD tx?

A

Flumazenil

25
Q

Calcium channel blocker OD tx?

26
Q

Malignant hyperthermia tx?

A

Dantrolene

27
Q

Heparin reversal tx?

28
Q

Phenergan-induced dystonia tx?

29
Q

Tylenol OD tx?

A

Acetylcysteine

30
Q

Beta-blocker OD tx?

31
Q

Brown recluse spider bite tx?

32
Q

Hydrofluoric acid burn tx?

A

Calcium gluconate

33
Q

Cyanide toxicity from burn inhalation injury?

A
  1. Sodium nitrate

2. Sodium thiosulfate

34
Q

What should tidal volume and plateau pressures be in patient with ARDS?

A

Tidal volume 4-6 mL/kg

Plateau pressures < 35

35
Q

Who needs ppx for UGIB in the ICU?

A
  1. Patients intubated > 48 hr
  2. Coagulopathic patients
  3. Burn patients
  4. Brain-injured patients
  5. Patients with recent hx of PUD
36
Q

Duration of antibiotics for VAP?

37
Q

Does prone positioning increase oxygenation?

38
Q

Tx for Swan-Ganz pulmonary artery injury?

A
  1. Deflate balloon
  2. Withdraw catheter
  3. Ipsi side down
  4. Increase PEEP
  5. Angioembolization
39
Q

Physiologic effect of increasing dead space ventilation?

A

Hypoxemia and hypercapnia

40
Q

Differential diagnosis for cause of increased trach secretions?

A

Infection

Fluid overload

41
Q

Expected PaO2 with the following SaO2:

  1. 97%
  2. 90%
  3. 75%
  4. 50%
A
  1. 100 mm Hg
  2. 60
  3. 40
  4. 26
42
Q

Antidote for nitroglycerin toxicity?

A

Methylene blue

43
Q

Half life of amiodarone?

44
Q

Types of shock?

A

Inadequate tissue perfusion
Hypovolemic
Cardiogenic (pump failure)
Extracardiac obstructive (tension PTX, cardiac tamponade)
Distributive (septic, neurogenic, and traumatic)

45
Q

Goal UOP?
Adult
Pediatric
Peds < 2 yo

A

Adult: 0.5-1 mg/kg/hr
Pediatric: 1 ml/kg
< 2 yo: 1-2 ml/kg

46
Q

Markers of resuscitation

A

Lactate

Base deficit

47
Q

What is base deficit?

A

Amount of fixed base (or acid) that must be added to an aliquot of blood to restore the pH to 7.4

Normal: 2 to -2
Mild: -3 to -9
Severe: >-10

Has been shown to be superior to pH in assessing the normalization of acidosis after shock resuscitation

48
Q

Hemorrhagic shock: Class I, II, III, IV

  • Blood loss mL
  • Blood loss %
  • HR
  • BP
  • Pulse pressure
  • RR
  • UOP
  • Mental status
A

Class I: <750 mL/<15%/<100/Nml/Nml/Nml/>30/Nml
Class II: 750-1500 mL/15-30%/>100/Nml/Dec/20-30/20-30/mildly anxious
Class III: 1500-2000 mL/30-40%/>120/Dec/Dec/30-40/5-15/Anxious & confused
Class IV: >2000 mL/40%/>140/Dec/Dec/>35/Minimal/confused & lethargic

49
Q

MC cause of cardiogenic shock?

A

Anterior wall MI

  • also common is PE, myocardial or pulmonary contusion
50
Q

Beck’s triad

A

Muffled heart sounds
JVD (elevated CVP)
Hypotension

Pulsus paradoxus

51
Q

CO2 embolus treatment?

A

Pause the pneumoperitoneum
Left lateral decubitus position
Aspirate out the air from a central line in the right atrium

52
Q

How to differentiate ARDS from cardiogenic pulmonary edema?

A

Measure PAWP with Swan Ganz

<18 mm Hg = non-cardiogenic, confirms ARDS diagnosis

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