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SURG > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Normal Cardiac Output

A

4-8 L/min

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2
Q

Normal Cardiac Index

A

2.5 to 4 L/min

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3
Q

Explain difference between cardiac output and cardiac index

A

Cardiac index is assessment of cardiac output based on pts size
CI = CO/BSA

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4
Q

Normal systemic vascular resistance

A

1,100 +/- 300

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5
Q

Normal pulmonary capillary wedge pressure (PCWP)

A

11 +/- 4

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6
Q

Normal central venous pressure

A

7 +/- 2

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7
Q

Normal pulmonary artery pressure

A

25/10 +/- 5

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8
Q

Normal mixed venous oxygen saturation (SvO2)

A

75 +/- 5

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9
Q

Formula for MAP

A

MAP = CO x SVR

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10
Q

What factors determine cardiac performance?

A

Preload
Afterload
Contractility
Heart Rate

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11
Q

What pressure is used to measure preload?

A

wedge pressure

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12
Q

What is after load?

A

Resistance against ventricle contracting (SVR)

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13
Q

Stroke volume

A

determined by LVEDV, contractility, after load

SV = LVEDV-LVESV

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14
Q

Ejection Fraction

A

EF = SV/LVEDV

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15
Q

Atrial kick accounts for what percent of LVEDV?

A

20%

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16
Q

Anrep effect

A

automatic increase in contractility secondary to increased afterload

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17
Q

Bowditch effect

A

automatic increase in contractility secondary to increased heart rate

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18
Q

MC cause of adrenal insufficiency

A

withdrawal of exogenous steroids

19
Q

Acute signs of adrenal insufficiency

A

cardiovascular collapse unresponsive to fluids and pressers, N/V, abdominal pain, fever, lethargy, decreased glucose, increased potassium

20
Q

Dx of acute adrenal insufficiency

A

Corticotropin stimulation test (give ACTH, measure cortisol)

21
Q

Tx of acute adrenal insufficiency

A

Dexamethasone (give empirically if adrenal insufficiency is suspected, does not interfere with tests)

22
Q

Steroid Potency

A

1x- cortisone, hydrocortisone
5x- prednisone, prednisolone, methylprednisolone
30x- dexamethasone

23
Q

Neurogenic Shock causes

A

vasogenic shock- loss of sympathetic tone (decreased SVR)

high spine/head injuries, anaphylaxis

24
Q

Neurogenic shock S&S

A

decreased HR, decreased BP, pink and warm skin

25
Q

Tx for neurogenic shock

A

volume first, then phenylephrine

26
Q

Initial alteration in hemorrhagic shock

A

increase in diastolic pressure

27
Q

Tx for cariogenic shock

A

Dobutamine, IABP

28
Q

Becks triad

A

indicative of cardiac tamponade

JVD, muffled heart sounds, hypotension

29
Q

1st sign of cardiac tamponade

A

impaired diastolic filling of right atrium on Echo

30
Q

Tx of cardiac tamponade

A

fluid resuscitation, pericardial window or pericardiocentesis

31
Q

Early sepsis triad

A

hyperventilation, confusion, hypotension

32
Q

What lab is often seen just before patient becomes clinically septic?

A

hyperglycemia

33
Q

Tx for sepsis

A

volume resuscitation
abx
if septic shock, levophed and vasopressin

34
Q

How does IABP work?

A

Inflates on T wave (diastole) and deflates on P wave (systole) which decreases after load and improves diastolic BP which improves diastolic coronary perfusion

35
Q

Absolute contraindications to IABP

A

aortic dissection, severe aortoiliac disease, aortic regurgitation

36
Q

relative contraindications to IABP

A

vascular grafts, aortic aneurysms

37
Q

Pulmonary compliance

A

change in volume/change in pressure

38
Q

SIRS causes

A

shock, infection (MC- pneumonia), burns, multi-trauma, pancreatitis, ARDs

39
Q

what is the most potent stimulus for SIRS

A

endotoxin (LPS-lipid A)

40
Q

Mechanism of SIRS

A

Inflammatory response is activated systemically (TNF-a, IL-1) and can lead to shock and multi organ dysfunction
capillary leakage, microvascular thrombi, shock, end-organ dysfunction

41
Q

SIRS criteria

A

Temperature >38 C or < 36 C
HR > 90
RR > 20, PaCo2 < 32
WBC > 12K or < 4 K

42
Q

What precludes brain death diagnosis?

A

Temp < 32 C
BP < 90 mm Hg
Drugs (phenobarbital, pentobarbital, ETOH)
Metabolic derangement (hyperglycemia, uremia)
desaturation with apnea test

43
Q

Can you still have deep tendon reflexes with brain death?

A

Yes

SURG (6 decks)

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