Critical Care

Question 1

Dobutamine

Answer 1

B1, B2 agonist =» Increased inotropy

First choice for cardiogenic shock WO HYPOTENSION

Question 2

Dopamine

Answer 2

D, B1 agonist =» Increased inotropy

Alternative to levophed

***At high dose, also activates a1 =» Increased SVR

Question 3

Epinephrine

Answer 3

a1, a2, B1, B2 =» Increased SVR and inotropy

First choice in anaphylactive shock; can be added to levophed in distributive shock

Question 4

Norepinephrine

Answer 4

a1, a2, B1 =» Increased SVR and inotropy

Question 5

Phenylephrine

Answer 5

a1 =» Increased SVR

May be used when norepinephrine CI’d (tachyarrhythmias) or w/ failure of first line drugs

Question 6

Vasopressin

Answer 6

V =» Increased SVR

May be added to levophed in septic shock

Question 7

AVASP

Answer 7

Basically like BiPAP ventilator; can control both pressure and volume delivery

Indicated for patients w/ OHS, COPD, and even neurogenic hypercarbic conditions who have failed traditional BiPAP

Question 8

Medicines to start at end of life

Answer 8

Morphine drip; titrate to 10-15 RR/min
Glycopyrollate
Ativan if needed

Question 9

Things a PA catheter can tell you

Answer 9

CVP 
CI
SI 
SVR
Pulmonary Vascular Resistance

Question 10

Patient w/ necrotizing pancreatitis who develops oliguric renal failure

Answer 10

Measure abdominal pressure; they may have developed abdominal compartment syndrome

Question 11

Anticoagulation for NSTEMI

Answer 11

Ok to use THERAPEUTIC DOSING OF LOVENOX

Question 12

Two new medications for hyperkalemia

Answer 12

Patiramir

Zirconium

Well tolerated by patients

Question 13

Blood transfusion in a patient with autoimmune hemolytic anemia

Answer 13

Provide uncrossmatched blood; probably most ALL units will have some component of cross reactivity

Question 14

Management recs for chest tube w/ empyema

Answer 14

DNAse + alteplase q12hrs for 3 days

If imaging shows a trapped lung, bronchopleural fistula, or patient fails to improve w/ intracatheter thrombolytis, proceed to VATS

Question 15

Medication to give when loop diuresis is not quite effective and patient has renal insufficency

Answer 15

Metolazone; should not require renal dosing

Question 16

Inotropes to start w/ cardiogenic shock 2/2 depressed systolic function

Answer 16

Dobutamine + Levophed

Question 17

3 types of mechanical circulatory support in cardiogenic shock

Answer 17

1. Intra-aortic balloon pump (pressure unloading)
   
   • contraindicated w/ aortic valve issues; meant to transition to coronary intervention; increases coronary perfusion during diastole and decreases cardiac afterload
2. LVAD (volume unloading)
3. ECMO (biventricular volume unloading)

Question 18

Duration of QTc to worry about QT prolonging agents

Answer 18

> 500ms

Question 19

CVC SvO2

Answer 19

> 80% = more likely septic shock (high output)

50% = more likely cadiogenic shock (low output)

Poor mans PA catheter O2 reading