Critical Care

Question 1

Cardiac Output

Answer 1

4-8

Question 2

Cardiac Index

Answer 2

2.5-4

Question 3

Systemic Vascular Resistance

Answer 3

1100 +/- 300

Question 4

PCWP

Answer 4

11 +/- 4

Question 5

CVP

Answer 5

7 +/1 2

Question 6

Pulmonary artery Pressure

Answer 6

25/10+/-5

Question 7

Mixed Venous Oxygen Saturation (SvO2)

Answer 7

75 +/- 5

Question 8

MAP

Answer 8

CO x SVR

Question 9

How to measure Preload

Answer 9

Wedge Pressure

Question 10

Preload

Answer 10

related to left ventricular end diastolic pressure

Question 11

Afterload

Answer 11

Resistance against ventricle contracting (SVR)

Question 12

Normal O2 delivery to consumption ratio

Answer 12

4:1

Question 13

Causes of right shift of oxygen-Hgb dissociation curve (O2 unloading)

Answer 13

Increased CO2 (Bohr effect)
increased temp
Increased ATP production
Increased 2,3-DPG production
Decreased pH

Question 14

Hemoptysis after flushing Swan-Ganz catheter

Answer 14

increase PEEP to tamponade pulmonary artery bleed
mainstem intubate non-affected side
Place Fogarty baloon down mainstem on affected side

Question 15

___ can only be measured by using a Swan-Ganz catheter

Answer 15

Pulmonary vascular resistance

Question 16

Two determinants of myocardial O2 consumption

Answer 16

ventricular wall tension

HR

Question 17

Blood w/ lowest venous saturation

Answer 17

coronary sinus blood

Question 18

Blood w/ highest venous saturation

Answer 18

renal veins

Question 19

MCC of adrenal insufficiency

Answer 19

withdrawal of exogenous steroids

Question 20

Acute adrenal insufficiency symptoms

Answer 20

cardiovascular collapse (unresponsive to fluids/pressors)
nausea/vomiting
abdominal pain
decreased glucose
increased potassium

Question 21

DX of adrenal insufficiency

Answer 21

corticotropin stimulation test (ACTH given, cortisol measured)

Question 22

TX of adrenal insufficiency

Answer 22

Dexamethasone (give empirically, do not have to wait for test results)

Question 23

Tx of neurogenic shock

Answer 23

Volume first, phenylephrine after resuscitation

Question 24

Cardiogenic shock tx

Answer 24

(Massive MI, severe CHF)

• dobutamine
• IABP (intra-aortic balloon pump)

Question 25

Beck’s triad

Answer 25

hypotension
JVD
Muffled heart sounds

Question 26

1st sign of cardiac tamponade

Answer 26

impaired diastolic filling of right atrium

Question 27

Only type of shock w/ increased CVP, PCWP

Answer 27

Cardiogenic

Question 28

Only type of shock w/ increased CO

Answer 28

Septic

Question 29

Two types of shock w/ increased SVR

Answer 29

Hemorrhagic

Cardiogenic

Question 30

Early vs late gram negative sepsis

Answer 30

Early: decreased insulin, increased glucose (impaired utilization)

Late: increased insulin, increased glucose (insulin resistance)

Question 31

First sign of sepsis

Answer 31

Hyperglycemia

Question 32

Petechia, hypoxia, confusion

Answer 32

fat emboli

Question 33

Test for fat emboli

Answer 33

sudan red stain

Question 34

Decreased EtCO2, Hypotension

Answer 34

PE

Question 35

Tx for air emboli

Answer 35

place patient head down, roll to left, aspirate air out w/ central line or PA catheter

Question 36

How does intra-aorti balloon pump work

Answer 36

Inflates on T wave (diastole)

Deflates on P wave (systole)

Question 37

Goal of intra-aortic balloon pump

Answer 37

Improves diastolic coronary perfusion

Question 38

Mediators of SIRS

Answer 38

IL1
TNF-a

**endotoxin (lipid A) is most potent stimulus –> TNF-a release

Question 39

Sepsis

Answer 39

SIRS + infection

Question 40

Septic Shock

Answer 40

Sepsis + hypotension

Question 41

SIRS

Answer 41

Temp: >38, <36
HR: >90
RR > 20
WBC > 12