Critical Care Flashcards
Change in Delta Pressure to __ mmHg indicates fasciotomy
Change in Delta Pressure from 40 to 20mmHg indicates fasciotomy
Calculation for Delta Pressure for compartments
DBP - compartment pressure = Delta Pressure
Delta P < 20-30 = fasciotomy
Vasopressors are first line for_____ shock
Vasopressors are first line for NEUROGENIC shock
Septic shock tx (3)
- volume resus
- Antibiotics
- then pressors
Cardiogenic shock tx
ionotropes and chronotropes - main goal is increasing contractility
Manifestations of ACS (Inc Intraabdominal pressure leading to ischemia of bowel) (5)
- Inc Intracranial Pressure (nml 7-15)
- Inc Peak Pressures (up to 40)
- Cardiac failure bc of dec preload and inc after load
- Rena Failure- Inc SVR (>2500 dynes)
- GI ischemia
Why inc hyperpigmentation in Cushings?
In Cushings, Inc ACTH - ACTH similar to MSH - increase in melatonin
Nurtition and Extubation; What Macro to change?
Dec the Colories, esp from carbos
Respiratory Quotient >1.0
Overfeeding
balanced = 0.85
What is the most common adverse effect of vasopressin?
Decreased CO (bc dec HR) -- should be added after max Norepi
Initial treatment for invasive aspergillosis in Neutropenic patient
VORIconazole
C. krusei - Vori
C. glabrata - Micfungin
C. albicans - Fluc
Dopamine effects (Low v Mod v High)
Low Dopamine = Dopa-R to increase mesenteric blood flow
Mod Dopa = Beta adrenergic-R and inc contractility
High Dopa = alpha adrenergic, induce vasoconstriction
Emergent Uremic Coagulopathy Tx
DDAVP temporary before
Dialysis
_____ = MC inheritable coagulopathy; why?
Factor V Leiden - Activated Protein C is unable to inhibit the altered Factor V therefore more thombus is made
AKI and increase in Serum Cr?
Increase in plasma Creatinine by < 50% indicative of AKI
Suspected Treacheoinominate fistula s/p Trach 3 weeks ago, how to dx? (steps after)
Flexible bronch, then digital occlusion and cuff overinflation then to OR
Lab findings associated with DIC?
High fibrin split products
Found down, hypotensive brady and warm. Dx?
Neurogenic shock
What causes right shift of O2 binding curve? (4)
- Increased DPG
- Inc Temp
- Inc PP CO2
- Increased H (acidosis)
As the 02 binding curve, goes RIGHT, Hgb has ____ affinity for O2
Right shift of 02 binding curve, Hgb has LESS affinity for 02 meaning it will readily release 02 to tissues
(*think of lactic acidosis bc hypoperfusison)
On the 02 binding curve, Left shift means Hgb has _____ affinty for 02
Left shift = HIGHER affinity, therefore holds on more
__ and ___ cause a LEFT shift in oxygen binding curve
CO and Meth-Hgb
MTP ratio of products
1:1:1
If dx is Compartment syndrome, go to OR; if in doubt, what can you do?
Measure compartment pressure (if patient is obtunded or in kids)
Classification of systolic v diastolic HF
HFrEF= EF < 40% is systolic
HFpEF EF>50 = DIAstolic
MCC diastolic HF (HFpEF)
HTN»DM, CM
The use of nitroprusside to reduce after load must be used cautiously as it can induce _____ toxicity
The use of nitroprusside to reduce after load must be used cautiously as it can induce CYANIDE toxicity
What is a secondary cause of hepatic failure
Septic shock bc its a reflection of the overall critical condition
POD 3 s/o lobectomy with HR 150s and irregular. Dx and why?
A fib - usually fluid resus causes atrial distension and then A fib
The use of US for CVC placement decreases? (3)
Rate or arterial puncture
hematoma formation
number of attempts
GCS 7, TBI, most important info?
PMH; specifically if taking any blood thinners
Before considering brain death exam, patient must have? (4)
- irrevesible and proximate cause of coma
- normotension
- no sedation or paralytics
- no acid base or electrolyte disturbances
Criteria for brain death exam?
- Normothermia for > 6 hours
- Loss of all reflexes
- Failed apnea test =
- If apnea aborted (when pt deasts tp < 85% during 8 mins off vent) then need CT A or MR-A brain flow study
3 Phases of ARDS
- Exudative = protein rich fluid moves to alveolar fluid
Leukocytes proliferate and cause intrinisic lung injury - Fibroproliferative - collagen formation stiff lung
- Resolution when the lung clears the edema
Anorexia/Refeeding
HypoPhosphotemia and HypoKalemia in AN.
TPN =carbs which increases Insulin which moves K and Phos into the cell.
Electrolyte imbalance
Sepsis from ___ is associated with lowest mortality rate in ICU
UTI
s/p intubation with hypotension, hyperresonace and absent breath sounds. Dx? Pathophy?
Tension PTX (bc hemothorax is dullness to percussion). Tension PTX causes dec venous return
CPP equation and value?
what about TBI?
CPP = MAP-ICP
MAP 60+ and ICP (10)
So CPP should be above 60
In TBI, CPP 60-70 and ICP <20
Afib and HDS tx?
B blockade
Hypovolumic shock can be caused by ??
hemorrhage, dec intravascular volume from diarrhea, adrenal insuff, DI and dehydration
Obestity hypoventilation characterized by _
hypoxemia and hypercapnia; chest wall compression leading to alveolar collapse; dec ventilation
Transcutaneous pacing indications
Sx bradycardia Av blcok (TII second or TIII)
Avoiding Iatrogenic catherter placement in Men
- standard Foley
- Fr Coude catheter
- Urology consult
Low v med v high risk surgerys
Low = <1% risk MI breast and endoscopy Med = 1- 5% risk = ENT, Thoracic, abdominal, ortho, CEA High= >5% emergent, cardiac and vasc
Periop cardiac risk increased in patients unable to perform _ METs
4 METs - climbing a flight of stairs, walking up a hill, walking at 4mph, or mod intensity chores
Mechanism: hypokalemnia in GOO
Vomiting –> Dehydration –> kidneys inc the Na reabsorption (more than K) – leads to hypokalemia
Berlin criteria of ARDS
- Resp dysfxn within 1 week
- CXR with b/l opacities
- P/F 201-330 =mild
P/F 100-200 = moderate
P/F < 100 severe
Pancreatitis + possible aspiration. HOw to feed?
Naso Jejunal feeding tube
2 biggest RFs for bleeding from gastric stress ulcers are ? And PPx?
coagulopathy and mech vent > 48 hours.
Other RFs: h/o GI bleed, renal failure, TBI, burns, sepsis
Start PPI > H2 blocker
HAP that is not present on admission occurs _ 48 hours or more after time of admission
48 hours
HTN + hypokalemia +weakness. DDX and w/u?
Hyperaldosteronism (primary or secondary)
Renin/Aldo ratio > 20 = primary
R/A ~10 secondary
32 M with pheo undergoin Left adrenalectomy. During the case, pt was HTN and after case went to ICU. Pt unresponsive with lactic acidosis 3.2. what tx would be helpful?
AMS + lactic acidosis usually cyanide toxicity by notroprusside.
IV nitroprusside used in cases of hypertensive crises.
Tx hydroxocobalamin and sodium thiosulfae
what is a RF for multi drug resistant HAP?
renal replacement therapy
UGI s/p transfusion and 15. inutes later patient complains of chills
acute transfusion reaction
release of cytokines from donor WBCs
ICU with necrotizing panc is hypotensive with UOP 10cc/hr. Maxed with NE.
Another vasopressor started and hour later \UOP increased. what was the agent?
Doapamine
