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Trauma > critical care > Flashcards

critical care Flashcards

1
Q

what tidal volume should be used in cases of ARDS

A

4-6ml/kg of ideal body weight

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2
Q

indications for operative fixation of severely displaced rib fractures

A
  1. those undergoing thoracotomy for intrathoracic injuries
  2. progressive pulmonary deterioration despite aggressive nonoperative management
  3. those unable to be weaned from vent after resolution of pulm contusions
  4. significant chest wall deformity and nonunion fractures
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3
Q

parkland formula

A

4ml/kg per % TBSA; give first half over 8 hours; give second half over 16 hours

example 80kg male with 80% tbsa: 80kgx4x80%=25600
25600/2= 12800: give this over 8 hours, then an additional 12800 over 16 hours

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4
Q

what chest tube output for hemothorax suggests need for thoracotomy?

A

1L of blood output after immediate CT placement or 200-300 cc/hr over 4 hours

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5
Q

what is an adequate UOP for a burn patient?

A

adults: 0.5mg/kg/hr
pediatrics: 1.0mg/kg/hr

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6
Q

what type of fracture is often associated with hollow viscus, mesenteric and solid organ injuries?

A

chance fracture

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7
Q

most effective means of rewarming patients with severe hypothermia?

A

cardiopulmonary bypass and ecmo

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8
Q

CO2 pneumoperitoneum can cause increased pCO2 which can result in ______ after extubation.

A

hypoventilation-related respiratory failure

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9
Q

true or false: septic shock responds well to vasopressors

A

false

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10
Q

type of shock resulting in hypotension from failure of vascular smooth muscle to constrict, partly from upregulation of iNOS and NOS2 in the vessel wall

A

septic shock

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11
Q

what patient population should never get a transvenous pacemaker?

A

pts with mechanical valves

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12
Q

oculovestibular reflex:

A

test for brain death; instill cold saline in right ear elicits nystagmus with fast beat to left (this is normal and negative for brain death)

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13
Q

electrolyte indication for delaying insulin therapy in DKA:

A

hypokalemia less than 3.3

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14
Q

physiologic effects of abdominal compartment syndrome (intraabdominal hypertension/IAH):

A

decreased CO; decreased venous return; increased intrathoracic pressure due to diaphragm being displaced cephalad; increased airway pressures; inadequate renal perfusion

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15
Q

respiratory quotient equation:

A

VCO2/VO2

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16
Q

respiratory quotient of fat

A

0.7

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17
Q

respiratory quotient of glucose

A

1.0

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18
Q

respiratory quotient of protein

A

0.8

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19
Q

respiratory quotient suggestive of over feeding

A

> 1.0

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20
Q

CONTROL trial findings for recombinant factor VIIa(rFVIIa)

A

no mortality benefit in ongoing bleeding; did decrease RBC and FFP transfusion needs

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21
Q

what does dabigatran prolong

A

aPTT; but not in a dose dependent fashion; direct thrombin inhibitor

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22
Q

risk factors for postop delirium:

A

ASA 4 or higher; intraop transfusion of >1L; BMI <18; age >70; cognitive impairment with MMS exam score <25

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23
Q

CRASH trial TXA results:

A

safe in patients with TBI; treatment within 3 hours of death with TXA reduces head-injury related death

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24
Q

heart rhythms that necessitate defibrillation in ACLS:

A

Vfib, VTach

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25
Q

most common cause of acute liver failure in US

A

acetaminophen toxicity

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26
Q

how do you assess for intraabdominal hypertension?

A

bladder pressure at the end of expiration

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27
Q

EKG changes of hypomagnesemia:

A

wide QRS, transition from peaked T waves to dampened T waves; prolonged PR interval; polymorphic ventricular tachycardia

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28
Q

what drug can be given for cardiogenic shock after cabg?

A

dobutamine (inotrope) with goal CI >2

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29
Q

pharmacologic properties of dobutamine:

A

catecholamine that acts on beta adrenergic receptors; enhances myocardial contractility with modest (mild) change in HR

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30
Q

contraindications to PEG placement

A

massive ascites; severe malnutrition; life expectancy <30 days

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31
Q

hemodynamic changes of septic shock:

A

decreased CVP, decreased PCWP, increased CI, decreased SVR

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32
Q

types of distributive shock:

A

neurogenic, anaphylactic, septic; all with decreased SVR

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33
Q

contraindications to succinylcholine:

A

any patient who is hyperkalemic or at risk for hyperkalemia; prolonged immobilization, upper or lower motor neuron disorders, burn patients

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34
Q

HD changes of acute spinal cord injury:

A

bradycardia, hypotension, decreased CO, decreased PVR, cardiac dysrhythmias

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35
Q

characteristics of type 1 hepatorenal syndrome:

A

doubling of Creatinine within 2 weeks and creatinine of at least 2.5; urine sodium is low; no improvement with albumin; frequently follows precipitating event; if untreated mortality in 2 weeks; not associated with ascites

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36
Q

characteristics of type 2 hepatorenal syndrome:

A

less rapid deterioration than type 1; associated with diuretic resistant ascites; 4-6 month mortality if untreated

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37
Q

initial treatment of hypotension from neurogenic shock

A

fluids; maintain MAP 85-90

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38
Q

should steroids be used for septic shock?

A

only if fluids and vasopressors are unable to restore hemodynamic stability

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39
Q

rhythms for synchronized cardioversion:

A

SVT, afib, aflutter, atrial tachycardia, monomorphic VT with pulses

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40
Q

cardiogenic shock HD changes:

A

increased CVP, increased PCWP, decreased SVO2, decreased CO, increased SVR

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41
Q

what respiratory condition has improved mortality with administrations of early neuromuscular blockade (cisatracurium) for 48 hrs

A

ARDS

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42
Q

sympathetic fibers of the heart exit the spinal cord at what level

A

T1-T4; injuries at or above this cause decreased myocardial contractility and HR

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43
Q

refeeding syndrome electrolyte abnormalities:

A

hypokalemia, hypophosphatemia, hypomagnesemia, hyponatremia, and thiamine deficiency

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44
Q

pts with afib for over 48 hours or unknown amount of time should be treated with what?

A

rate control, then anticoagulation

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45
Q

pressor of choice for pts with anaphylactic shock and refractory hypotension despite immediate and adjunctive treatment with crystalloid

A

epinephrine

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46
Q

what drug has been shown to reduce postop pain and opioid consumption?

A

dexmedetomidine (IV)

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47
Q

diagnostic test to confirm anaphylaxis

A

total serum tryptase 1 hr after sx onset

48
Q

in what time frame after prehospital CPR can a resuscitative thoracotomy still be performed

A

within 10 minutes for blunt; within 15 minutes for penetrating

49
Q

first hemodynamic change seen with hemorrhage:

A

narrowed pulse pressure

50
Q

total amount of air that can be expelled after maximal inhalation:

A

vital capacity

inspiratory reserve volume + tidal volume + expiratory reserve volume

51
Q

first physical exam finding of hemovolemic shock:

A

cutaneous hypoperfusion

52
Q

heparin mechanism of action:

A

activates antithrombin III which antagonizes thrombin and factor Xa

53
Q

amount of air moved in a normal breath

A

tidal volume

54
Q

amount of air left after maximal exhalation

A

residual volume

55
Q

amount of air that can additionally be expired from lungs by maximal effort after normal expriation

A

expiratory reserve volume

56
Q

treatment of hepatorenal syndrome:

A

liver transplant is only treatment

57
Q

second line vasopressor to norepinephrine in increasing blood pressure

A

vasopressin (also used for bleeding esophageal varices)

58
Q

refeeding syndrome causes severe electrolyte and fluid shifts leading to cardiac, pulmonary, muscular, GI, neuro and heme complications because of what surge?

A

insulin surge in response to carbs causing extracellular K, Mg, and PH to move intracellularly

59
Q

most fatalities from refeeding syndrome are from what type of complications?

A

heart failure and arrhythmias (cardiac)

60
Q

what type of organisms cause most empyemas:

A

anaerobic

61
Q

what medication is used in brain death patients to protect organs from diabetes insipidus?

A

vasopressin

62
Q

type 1 hypersensitivity reaction:

A

binding of antigens to IgE causes mast cell and basophil degradation; e.g. anaphylaxis

63
Q

type 2 hypersensitivity reaction:

A

immunoglobulins attach to surface antigens with subsequent complement fixation; autoantibodies develop to cell surface receptors; delayed after exposure to antigens; eg. Graves disease

64
Q

type 3 hypersensitivity reaction:

A

circulating antigen-antibody immune complexes with subsequent complement fixation leads to deposition in vessels, joints, and kidneys; eg. serum sickness

65
Q

type 4 hypersensitivity reaction:

A

cell-mediated immunity leading to local injury when antigen present; e.g. contact dermatitis

66
Q

in patients without a brain injury with massive bleeding and an elevated INR, what is goal BP until major bleeding has been stopped?

A

SBP 80-90

67
Q

true or false: PCC is superior to FFP in rapid reversal of vit K antagonists

A

true

68
Q

TXA should be given within ___ of injury in bleeding trauma patients

A

3 hours

69
Q

dobutamine effects:

A

beta 1 adrenergic receptors at low dose which increases contractility; beta 2 adrenergic receptors at high dose which has vasodilatory effect

70
Q

what is delta pressure in compartment syndrome:

A

diastolic pressure minus compartment pressure; used to dx compartment syndrome needing fasciotomy between 20-30

71
Q

vasopressin mechanism:

A

vasoconstriction via V1 receptor; no cardiac effect

72
Q

leading cause of death due to hospital acquired infection:

A

pneumonia

73
Q

substance used in trauma to inhibit fibrinolysis and reduce surgical blood loss; decreases mortality if given within 1 hour of presentation:

A

transexamic acid

74
Q

true or false: TXA increases risk of PE or VTE

A

false

75
Q

prothrombin complex concentrate contains what factors:

A

factor II, VII, IX, X, protein C, protein S; indicated for urgent reversal of vitamin K antagonists like warfarin; does not increase venous thromboembolism

76
Q

pts with severe frostbite who present within 24 hrs of cold injury may be a candidate for what medical therapies:

A

tissue plasmingen activator (tPA) thrombolysis, prostacyclin, or both

77
Q

what should be given to reverse rivaroxaban quickly (factor xa inhibitor)?

A

PCC

78
Q

physiologic changes of pregnancy:

A

increased tidal volume; decreased PaCO2; increased blood volume; decrease LE sphincter competency; increased coagulation; decreased GB emptying

79
Q

test used to detect occult placental hemorrhage in pregnant trauma pt

A

kleihauer betke test

80
Q

crystalloid resuscitation in pediatric trauma:

A

20cc/kg

81
Q

blood resuscitation in pediatric trauma:

A

10cc/kg

82
Q

hemodynamic response of elderly in trauma differ in that they have ___ cardiac function, ___ after load, ___ sensitivity to catecholamines, and ___ robust sympathetic response

A

decreased cardiac function, increased afterload from atherosclerosis, decreased sensitivity to catecholamines, and less robust sympathetic response

83
Q

True or false. A short course of 7-8 days of abx is as effective as 14-15 days of abx for VAP.

A

true

84
Q

Cause and symptoms of proprofol infusion syndrome:

A

caused by impaired mitochondrial function leading to metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, arrhythmia, cardiac failure, and hypertriglyceridemia

85
Q

True or false. Hypernatremia does not need to be corrected for a brain death exam.

A

False

86
Q

What constitutes a positive apnea test for brain death?

A

PaCO2>60mm Hg or 20mmHg above baseline

87
Q

Three treatment factors associated with improved mortality for ARDS:

A

low tidal volume ventilation (6-8cc/kg)
early neuromuscular blockade
prone positioning

88
Q

True or false. Early enteral nutrition in patients with severe pancreatitis decreases incidence of pancreatic infections and mortality.

A

True

89
Q

True or false. For patients with TBI, use of unfractionated heparin for VTE ppx results in lower odds of VTE and lower mortality compared to LMWH

A

False. LMWH is the preferred management

90
Q

Common drugs that suppress adrenal function?

A

ketoconazole and etomidate

91
Q

Why are high doses of IV lorazepam dangerous?

A

the diluent includes propylene glycol which can cause lactic acidosis, myocardial depression, and shock

92
Q

Flexible bronchoscopy causes ____ PaO2 levels and _____ PaCO2 levels in intubated patients.

A

decreased PaO2

increased PaCO2

93
Q

In the critical care setting, the target temperature of a patient after cardiac arrest is _____ for 24 hours

A

33-36C

94
Q

Two strongest independent risk factors of stress ulcer formation:

A

respiratory failure requiring mechanical ventilation (strongest factor)
coagulopathy

95
Q

What alpha 2 agonists can be used as adjuncts to lorazepam in treatment of critically ill patients with alcohol withdrawal for hypertension and tachycardia?

A

clonidine and dexmedetomidine

96
Q

Long acting oral agent for alcohol withdrawal:

A

chlordiazepoxide

97
Q

Inotrope that is available in premixed bags. Greater effect on cardiac output than NE

A

dopamine

98
Q

Pressor that can be given peripherally. Pure adrenergic vasoconstrictor. Can cause reflex bradycardia in spinal cord injury

A

phenylephrine

99
Q

Pressor that acts on all 5 adrenergic receptors causing vasoconstriction, vasodilation, inotropy chronotropy, bronchodilation, glycogenolysis, and lipolysis.

A

epinephrine

100
Q

Pressor that constricts arterioles via V1a receptor. Second line agent to catecholamine agents in septic shock.

A

vasopressin

101
Q

Recommendation for initial crystalloid infusion in sepsis:

A

30cc/kg within 1st 3 hours

102
Q

True or false. Hetastarch should be used in sepsis due to decreased risk of AKI & death

A

False. increased risk of death and AKI

103
Q

treatment of monomorphic ventricular tachycardia

A

immediate cardioversion

104
Q

treatment of monomorphic ventricular ectopy

A

amiodarone

105
Q

tx of narrow complex ventricular tachycardia

A

calcium channel blockade of AV node

106
Q

tx of bradycardia

A

atropine

107
Q

Definition of sepsis:

A

qSOFA score of at least 2 in the setting of suspected infection

108
Q

components of qSOFA:

A

RR>/= 22, altered mental status, SBP = 100

109
Q

definition of septic shock:

A

persistent hypotension requiring pressors to maintain MAP>65 and lactate >2 despite adequate resuscitation

110
Q

Associated factors for patients over the age of 75 with posteroperative delirium:

A

ASA III-IV
impaired mobility
use of opioids

111
Q

Nutritional needs for critically ill patients:

A

25-30 kCal/kg

112
Q

TBI and intracranial hemorrhage patient chemoprophylaxis:

A

LMWH within 24-48 hrs

113
Q

criteria for use of TXA in trauma:

A
  1. adult patient in hemorrhagic shock within known predictors of fibrinolysis
  2. give only if less than 3 hours from injury
  3. dose 1 g IV over 10 minutes followed by 1 g IV over 8 hours
114
Q

HDS patients with positive pericardial fast should be managed with:

A

subxiphoid pericardiotomy

115
Q

Increasing PEEP will cause what cardiovascular effects?

A

reduction in cardiac output secondary to decreased venous return and left ventricular stroke volume; elevates intrathoracic pressure and restricts right ventricular heart filling

116
Q

Goal cerebral perfusion pressure and intracranial pressure for TBI patients:

A

60-70mm Hg for CPP and <20 for ICP

117
Q

how is CPP calculated?

A

MAP-ICP

Trauma (7 decks)

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