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Critical Care Flashcards

1
Q

Calculate free water deficit

A

[(plasma Na/140)-1] x (weight in kg x 0.6)

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2
Q

SIADH labs

A

HypoNa + urine Na >20

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3
Q

Fire at tire factory poisoning and treatment

A

Cyanide = hydroxycobalamin

Sodium thiosulfate and nitrate not used because causes methHb and slow onset

High O2 on VBG (not using O2)
Prolonged SNP infusions can cause

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4
Q

Effect of Glycine solution for TURP

A

Transient blindness

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5
Q

Effect of distilled water for TURP

A

Hemolysis, fluid overload, dilution hypoNa and high chance of TURP syndrome

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6
Q

Effect of saline and other balanced salt solutions for TURP

A

Significant current dispersion

Normally used sorbitol/mannitol combination for TURP

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7
Q

Calculate Sodium deficit

A

(140 - serum Na) x Total body water (kg x 0.6)

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8
Q

Factors increasing likelihood of post-op ventilation following thymectomy for MG

A
  1. Duration of disease >6 years
  2. Hx of chronic respiratory disease (asthma, COPD)
  3. Pyridostigmine dose >750mg/day
  4. Vital capacity <2.9L or 40ml/kg
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9
Q

Type of shock:
PCWP >18
CI <2.2

A

Cardiogenic

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10
Q 
Cause of oliguria:
FeNa 1%
BUN: Cr >20
Urine:Serum Cr >40
Urine Osm >500
Random Urine Na <20
A

Pre-renal

- hypovolemia

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11
Q 
Cause of oliguria:
FeNa 2%
BUN: Cr <20
Urine:Serum Cr <20
Urine Osm <400
Random Urine Na >20
A

Intrinsic or post-renal

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12
Q

Formula to calculate FeNa

A

[(pCr x uNa) / (pNa x uCr)] x100

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13
Q

Causes of inc MvO2

A

Inc SaO2: supplemental O2

Dec VO2: Carbon monoxide, cyanide, hypothermia, sepsis

Inc CO: dobutamine, sepsis, thyroid storm, AV fistula, cirrhosis

Inc Hb: Transfusion

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14
Q

Cause of hypoPhos with TPN

A

Glucose loading w/ TPN –> intracellular shift of Phos

Other causes of hypophos:
Refeeding
DKA
Hyperventilation
Diuretics - aucetazolaimide (proximal tubule)
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15
Q

Toxin that travels via neuronal retrograde transport and enters inhibitory interneurons in the spina cord

A

Tetanus

- prevents release of GABA

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16
Q

Inhibitors of HPV

A 
Hypocarbia
Vasodilators
Infection
Metabolic alkalosis
Volatiles >1MAC
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17
Q

Indications for hyperbaric O2

A 
Air embolism
Carbon monoxide, brown recluse other poisoning
chronic infections
Acute ischemia from crush, CRAO
Burns
Lung lavage

Ability to deliver 1 MAC of N2O –> decompression sickness when suddenly stopped,
Higher Desflurane delivered = dial down

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18
Q

Causes of inc PIP + inc Pplateau

A

Compliance issue

  • Abd insufflation
  • Ascites
  • Intrinsic lung disease
  • Obesity
  • Pulmonary edema
  • PTX
  • Trendelenburg
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19
Q

Causes of inc PIP + unchanged Pplateu

A

Airway resistance problem

  • Airway compression
  • Bronchospasm
  • Foreign body
  • Kinked ETT
  • Mucous plug
20
Q

Predicts INC mortality following pneumonectomy

A
  1. VO2 Max <15ml/kg/min
  2. Inability to ascend 2 flights of stairs
  3. ppoFEV1 <30%
  4. Combined ppoFEV1 <35 + DLCO <35
21
Q

Cause of hypoxemia with normal A-a gradient

A

Hypoventilation

22
Q

Labs in Conn Syndrome

A

HypoK metabolic alkalosis

  • primary hyperaldosteronism
  • Fatigue, HA, HTN from hypervolemia
  • Tx = spironolactone and K
23
Q

change in pH for every degree decrease

pH 7.25 @ 37 when drawn from 27 degree patient

A

1 degree decrease = pH increase 0.017

pH –> 7.42 (10 x 0.017)

24
Q

Changes at high altitude

A

Hyperventilation - dec PaCO2 (PaCO2 30, PaO2 55)

Kidneys compensate in a few days to normalize pH but still have dec PaCO2

H moves from CSF to plasma (inc CSF pH)

Left shift oxygen-Hb curve (hypocarbia) —> right shift from hypoxia and inc 2,3 DPG

Chronic hypoxia inc PVR

Inc Hb –> inc viscosity and risk of clotting
Brief inc in CO

25
Q

Signs of cyanide toxicity

A

Cyanosis only very late, typically no cyanosis present

Inc PaO2 d/t inability to utilize O2

SvO2 inc

Anion gap metabolic acidosis

26
Q 
Labs for ATN:
Urine Na
Urine Osm
Spec Grav
FeNa
A

Urine Na >40 (can’t reabsorb)
Urine Osm <350
SG very low ~1.0035
FeNa >1%

27
Q

Tx Sarin gas poisoning

A

Atropine and Pralidoxime

Organophsphates inhibit Ach-esterase = excess Ach –> bradycardia, mitosis, salivation, respects distress

28
Q

Wavelengths for pulse ox

A

DeoxyHb - 660

OxyHb - 940

29
Q

Bezold-Jarisch Reflex

A

apea, bradycardia, hypotension

following inferior and posterior MIs as a result of dec preload or stretch of the ventricles mediated by vagal

Commonly seen with spinal anesthesia

30
Q

MELD score

A 
Cr (greatest effect)
Yea/No Dialysis
Na
INR
Bilirubin
31
Q

Childs-Pugh score

A 
Bilirubin
INR
Albumin
Ascities
Hepatic encephalopathy
32
Q

Features of TRALI

A 
Pulmonary edema - high protein content
Transient leukopenia
Normal cardiac filling pressures
Multiparous donors
Inc temp
33
Q

Calculate A-a gradient

A

PAO2 = (FiO2 x 713) - (PaCO2 x 1.25)

If <20 = hypoxemia is due to hypoventilation or dec fio2

34
Q

Post-thyroidectomy complication time course:

  1. immediate
  2. within 6 hours
  3. 24 hours
A

immediate = b/l recurrent laryngeal injury
within 6 hours = hematoma
24 hours = hypocalcemia

35
Q

Volume of total dead space

A

2ml/kg

36
Q

Labs in Cushing syndrome

A

HypoK metabolic alkalosis + hyperglycemia

37
Q

Labs with vomiting/pyloric stenosis

A 
7.51
PCO2 47
HCO3- 31
Na 130
K 2.9
Cl 93
38
Q

Most predictive of pulmonary complications following wedge resection

A 
FEV1 <60% of predicted
DLCO<60% of predicted
PPO FEV1 <800ml
PPO FEV1% >40%
VO2 Max <15ml/kg/min
39
Q

Mechanism of high altitude pulmonary edema

A

excessive uneven HPV
2-4 days after ascent
Tx = rapid descent, O2, hyperbaric

40
Q

ICU feeding strategies

A

Enteral w/o antioxidants

Protein-based full feeds

41
Q

Pulmonary changes with obesity

A

Inc Tv

Dec everything else

42
Q

Electrolyte dec in ESRD

A

Calcium

43
Q

Initial compensation for acute respiratory acidosis

A

Plasma protein buffer (including Hgb)

44
Q

Factor for calculating qSOFA

A

0-3

  • AMS
  • RR >22
  • SBP <100
45
Q

How does hyperbaric oxygen work?

A

Increases amount of dissolved oxygen

Advanced Exam (10 decks)

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