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Internal Medicine > Critical Care > Flashcards

Critical Care Flashcards

1
Q

[diagnosis]

72/M with COPD, CHF and back pain. On oxycodone and morphine treatment

unarousable, discovered multiple intake of morphine

BP 130/80, HR of 90/min, O2 sats 90% pinpoint pupils

A

Dx: Acute hyperbaric respiratory failure secondary to opiate overdoe

Initial test: ABG

Appropriate management: reverse effects of opiates, require intubations

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2
Q

[Type of Respiratory Failure]

PaO2 <55-60 mmHg

alveolar flooding, intrapulmonary shunt

A

Type I (flood)

Pulmonary edema, pneumonia, alveolar hemorrhage, ARDS

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3
Q

[Type of Respiratory Failure]

pCO2 >45-50mmHg

Diminished CNS drive to breathe, reduced neuromuscular strength, increased load to respiration

A

Type II (cant eliminate CO2)

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4
Q

[Type of Respiratory Failure]

perioperative respiratory failure, atelectasis

A

Type III Athreelectasis

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5
Q

[Type of Respiratory Failure]

hypoperfusion of respiratory muscles in shock

A

Type IV SHOCK!

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6
Q

[Cause of hypoxemia]

Increased A-a gradient that is correctable with O2 can be caused by?

A

This is V/Q mismatch

  1. Airway disease
  2. Interstitial lung disease
  3. Alveolar disease
  4. Pulmonary vascular disease
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7
Q

[Cause of hypoxemia]

Increased A-a gradient that is not correctable with O2 can be caused by?

A

This is a form of R-L shunt

  1. Intracardiac shunt
  2. Vascular shunt within lungs
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8
Q

[Cause of hypoxemia]

Normal A-a gradient that has increased PaCO2

A

This is hypoventilation

  1. Decreased respiratory drive
  2. Neuromuscular disease
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9
Q

[Cause of hypoxemia]

Normal A-a gradient that has a normal PaCO2

A

Low FiO2 (high altitude)

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10
Q

What is the parameter for ventilation?

A

PaCO2

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11
Q

How will you correct hypercarbia?

A

increase the minute ventilation or increase RR

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12
Q

How will you correct hypoxemia?

A

increase FiO2 or increase PEEP

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13
Q

[diagnose]

46M currently admitted developed progressive dyspnea and hypoxia 84%

High pitch crackles, CXR diffuse bilateral infiltrates

ABG: pH 7.3 pCO2 50, HCO3 19, PO2 60 at 10lpm

A

Dx: ARDS

Next step: Intubate

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14
Q

What is the diagnostic criteria for ARDS?

A

Berlin Criteria

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15
Q

In Berlin Criteria,

what is the CXR finding suggestive of ARDS?

A

Bilateral alveolar or interstitial infiltrates not fully explained by effusion, consolidation or atelectasis

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16
Q

In Berlin Criteria, what is the cut-off value for left atrial hypertension?

A

PCWP <18 mmHg

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17
Q

What are the PF ratio of severity in Berlin Criteria?

A

PF is:

Severe: <100
Moderate: 100-200
Mild: 200-300

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18
Q

What are the components of Berlin Criteria?

A
  1. Acute onset
  2. Ratio of PaO2/FiO2
  3. Diffuse bilateral infiltrates in CXR
    atrial hypertension
  4. Swan-Ganz pressure <18 mmHg
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19
Q

What is the best management MV management for ARDS?

A
  1. Low tidal volume 6mL/kg of predictive body weight
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20
Q

What is the MV management for ARDS?

A
  1. TV 6mL/kg

2. PEEP 12-15mmHg

21
Q

Early muscular blockade using this drug is recommended in the first 48 hours?

A

Cisatracurium besylate

22
Q

What keeps the alveoli open in ARDS?

A

PEEP

23
Q

[diagnose]

57/M with CHF presents at the Er with progressive dyspnea.

PE: 68/50 140 bpm, elevated JVP, bilateral crackles, cold clammy extremities

A

Dx: Cardiogenic shock
Urgent Step: fluid resuscitation

First line vasopressor: NE
Inotrope DOC: Dobutamine

24
Q

What is the cutoff lactate value for lactate?

A

> 1.5 mmol/L

25
Q

What are the components of shock state?

A
  1. Systemic arterial hypotension
  2. Tissue hypoperfusion
  3. Hyperlactatetemia
26
Q

[type of shock]

2DE: Normal cardiac chambers, preserve contractility

A

Distributive shock

Normal or High CO

27
Q

[type of shock]

2DE: Small cardiac chambers and normal or high contractility

A

Hypovolemic shock

Low CO
LOW CVP

28
Q

[type of shock]

2DE: large ventricle, poor contractility

A

Cardiogenic

Low CO
High CVP

29
Q

In circulatory shock,

what is the second line vasopressor?

A

Epinephrine

First line: NE

DO NOT USE DOPAMINE

30
Q

In circulatory shock,

What is the fluid resuscitation of choice?

A

Crystalloid solution

Infuse 300 to 500 mL in 20-30 minutes

31
Q

How will you manage acute CHF?

A
  1. Diurese - furosemide
  2. Morphine
  3. Nitrates
  4. Oxygen
  5. Position, sit upright
32
Q

[How will you manage this case?]

Shock, hypoperfusion, CHF

acute pulmonary edema

A
  1. Lasix (Furosemide) 0.5 to 1mg/kg
  2. Morphine IV 2 mg
  3. Oxygen
  4. Nitroglycerin, NE or Dopa
  5. Dobutamine 2 to 20 ug/kg
33
Q

What is the ACEi for acute pulmonary edema

A

Captopril

34
Q

[How will you manage this case?]

Low CO shock, systolic BP greater than 100?

A

Give Nitroglycerin 10 to 2 ug/min IV

35
Q

[How will you manage this case?]

Low CO shock, Systolic BP 70 to 100 mmHg, No signs of shock?

A

Dobutamine 2 to 20 ug/kg per minute IV

36
Q

[How will you manage this case?]

Low CO shock, Systolic less than 100mmHg, with signs of shock?

A

NE 0.5 to 30ug/min IV or

Dopamine 5 to 15 ug/kg/min

37
Q

Cite the SIRS criteria?

A

SIRS

Temp >38, or <36
RR >20
HR >90
WBC >12
Leukopenia <4000 or 10% bands
38
Q

Arterial hypotension is defined as

A

SBP <90
MAP <60
Changes in SBP from baseline >40

39
Q

What is the criteria for septic shock?

A
  1. Infection
  2. Vasopressor needed to maintain MAP >/65
  3. Serum lactate >2 despite resuscitation
40
Q

Sepsis is diagnosed when…

A
  1. Suspected infection PLUS

2. More than 2 in SOFA points

41
Q

What are the most common gram positive bacteria that cause CAP?

A
  1. S. aureus

2. S. pneumoniae

42
Q

What are the most common gram negative bacteria that cause CAP?

A
  1. E. coli
  2. Klebsiella
  3. P. aeruginosa
43
Q

[According to Surviving Sepsis]

the recommended fluid resuscitation is ___

A

30cc/kg in the first 3 hours, crystalloids

44
Q

[According to Surviving Sepsis]

the recommended vasopressor is?

A

NE then Epi

Then add vasopressin to taper NE

AVOID DOPA

45
Q

[According to Surviving Sepsis]

the recommended antibiotics?

A

vancomycin + tapimycin (avoid double coverage)

46
Q

[According to Surviving Sepsis]

the only transfuse when the Hgb is ___ in the absence of acute bleeding and MI

A

Hgb <7

47
Q

[According to Surviving Sepsis]

what is the recommended TV

A

6mL/kg

48
Q

[According to Surviving Sepsis]

what is the recommended plateau pressure

A

30cm H20

49
Q

[According to Surviving Sepsis]

what is the target MAP

A

MAP 65 mmHg

Internal Medicine (10 decks)

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