Critical Care Flashcards
BiPAP Numbers
IPAP/EPAP
10/5
Winter’s Formula
PCO2 = 1.5 x HCO3 + 8 +/- 2
Causes of HAGMA
Methanol, Uremia, DKA/drugs, phosphate/paraldehyde, ischemia/iron/isoniazid, lactate, ethylene glycol, starvation/salicylates
Causes of NAGMA
Diarrhea, ureteral division, RTA, hyperalimentation, Addision/Acetazolamide/ammonium, MISC
Mineralcorticoids and acid base issues
stimulate H+ excretion
metabolic alkalosis
Metabolic Alkalosis –> Low urinary chloride
Vomiting
NG Suction
Over-diuresis
Post-hypercapnia
Metabolic Alkalosis + HTN
Cushing Disease
Conn Syndrome
Renal Artery Stenosis
Renal Failure + Alkali
Metabolic Alkalosis with normal chloride and no HTN
hypomag, hypok
Laxative Abuse
Licorcie
Barter’s, Gietlmann’s
Delta Ratio
ag-12 / bicarb -24
Delta Ratio of 1-2
AGMA
Delta Ratio > 2
AGMA + metabolic alkalosis
Delta Ratio < 1
AGMA + NAGMA
Respiratory Acidosis Causes- Three Categories to Think About
- chest cavity
- central respiratory drive
- lung/airways
PE causes respiratory ….
alkalosis
Hypovolemic Shock
- Decreased Preload
- Decreased CO
- Increased SVR
Cardiogenic Shock
- Increased Preload
- Decreased CO
- Increased SVR
Distributive Shock
(excessive vasodilation)
Decreased Preload
Increased CO
Decreased SVR
Causes of Distributive Shock
Anaphylaxis
Neurogenic
Sepsis
Obstructive Shock
decreased Preload, CO
increased SVR
Causes of Obstructive Shock
PE severe RHF Tension PTX Cardiac Tamponade Restrictive CM
Cold Shock
increased SVR, decreased CO
clamped down (decreased pulses, long cap refill)
give Epi
Warm Shock
decreased SVR, increased Co
brisk cap refill, bounding pulses
give NE
alpha 1,2
blood vessels, vasoconstriction
B1
myocardium, inotropy and chronotropy
B2
blood vessels, vasodilation
D1
renal vasodilation
V1
vasculature, vasoconstrict
NE
alpha 1, beta 1
vasoconstrict, increase CO, contractility
Phenylephrine
alpha 1
Epinephrine
low dose B1
high dose alpha 1
Dopamine
low dose D1
Medium B1
High dose alpha 1
Vasopressin
V1
Dobutamine
B1 (some B2)
cardiogenic shock w/ HTN
Milrinone
PDE III Inhibitor
increased Co, , contractility
Inspiratory stridor- location
above vocal cords
ARDS definition
onset w/in 1 week of insult
bilateral opacities
not related to pulmonary edema or cardiac cause
Po2/Fio2 <300 on at least 5cm PEEP
TV in ARDS
~6ml/kg
prevent volutrauma
Full Expansion on CXR
9-10 posterior ribs
6-7 anterior ribs
Diagphrams on Lateral CXR
right over left
Size of pulmonary nodule (definition)
less than 3 cm
Nodular Pattern on CXR
- small discrete rounded opacities
- interstitial lung disease
Air Space Disease on Imaging, ddx includes 5 categories
water/pulm edema pus blood cells (lymphoma) lipoproteins (pulmonary alveolar proteinosis)
Structures of Anterior Mediastinum
teratoma
thymoma
retrosternal thyroid
lymphoma
IPAP
inspiration pressure
ventilation
EPAP
expiration
oxygenation
AC Mode
- set volume and backup rate
- pressure is variable and related to compliance
Compliance =
change in volume / change in pressure
Pressure Control Mode
Select pressure
- TV, rate are variable, volume dependent on compliance
PEEP and venous return
PEEP increases intrathoracic pressure which increases R atrium pressure
blood flows to heart due to gradient between which is decreased when you have increased R atrium pressure
–> decrease in Cardiac Output
Peak Pressure
when there is airflow/airflow resistance
What causes high peak pressures
bronchospasms, secretions, ETT occlusion/plugging, mucuous plugging
Plateau Pressure
pressure when airflow stops/lung compliance
Cardiac Output =
HR x SV
Mixed Venous Oxygen Saturation
75-85
“oxygen left over”
oxygen bound to Hgb returning to heart
Paraprotein Gap
Total protein - albumin
>4 significant
