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TrueLearn Review > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Change in Delta Pressure to __ mmHg indicates fasciotomy

A

Change in Delta Pressure from 40 to 20mmHg indicates fasciotomy

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2
Q

Calculation for Delta Pressure for compartments

A

DBP - compartment pressure = Delta Pressure

Delta P < 20-30 = fasciotomy

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3
Q

Vasopressors are first line for_____ shock

A

Vasopressors are first line for NEUROGENIC shock

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4
Q

Septic shock tx (3)

A
  1. volume resus
  2. Antibiotics
  3. then pressors
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5
Q

Cardiogenic shock tx

A

ionotropes and chronotropes - main goal is increasing contractility

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6
Q

Manifestations of ACS (Inc Intraabdominal pressure leading to ischemia of bowel) (5)

A
  1. Inc Intracranial Pressure (nml 7-15)
  2. Inc Peak Pressures (up to 40)
  3. Cardiac failure bc of dec preload and inc after load
  4. Rena Failure- Inc SVR (>2500 dynes)
  5. GI ischemia
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7
Q

Why inc hyperpigmentation in Cushings?

A

In Cushings, Inc ACTH - ACTH similar to MSH - increase in melatonin

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8
Q

Nurtition and Extubation; What Macro to change?

A

Dec the Colories, esp from carbos

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9
Q

Respiratory Quotient >1.0

A

Overfeeding

balanced = 0.85

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10
Q

What is the most common adverse effect of vasopressin?

A 
Decreased CO (bc dec HR)
-- should be added after max Norepi
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11
Q

Initial treatment for invasive aspergillosis in Neutropenic patient

A

VORIconazole
C. krusei - Vori
C. glabrata - Micfungin
C. albicans - Fluc

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12
Q

Dopamine effects (Low v Mod v High)

A

Low Dopamine = Dopa-R to increase mesenteric blood flow
Mod Dopa = Beta adrenergic-R and inc contractility
High Dopa = alpha adrenergic, induce vasoconstriction

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13
Q

Emergent Uremic Coagulopathy Tx

A

DDAVP temporary before

Dialysis

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14
Q

_____ = MC inheritable coagulopathy; why?

A

Factor V Leiden - Activated Protein C is unable to inhibit the altered Factor V therefore more thombus is made

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15
Q

AKI and increase in Serum Cr?

A

Increase in plasma Creatinine by < 50% indicative of AKI

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16
Q

Suspected Treacheoinominate fistula s/p Trach 3 weeks ago, how to dx? (steps after)

A

Flexible bronch, then digital occlusion and cuff overinflation then to OR

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17
Q

Lab findings associated with DIC?

A

High fibrin split products

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18
Q

Found down, hypotensive brady and warm. Dx?

A

Neurogenic shock

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19
Q

What causes right shift of O2 binding curve? (4)

A
  1. Increased DPG
  2. Inc Temp
  3. Inc PP CO2
  4. Increased H (acidosis)
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20
Q

As the 02 binding curve, goes RIGHT, Hgb has ____ affinity for O2

A

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)

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21
Q

On the 02 binding curve, Left shift means Hgb has _____ affinty for 02

A

Left shift = HIGHER affinity, therefore holds on more

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22
Q

__ and ___ cause a LEFT shift in oxygen binding curve

A

CO and Meth-Hgb

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23
Q

MTP ratio of products

A

1:1:1

24
Q

If dx is Compartment syndrome, go to OR; if in doubt, what can you do?

A

Measure compartment pressure (if patient is obtunded or in kids)

25
Q

Classification of systolic v diastolic HF

A

HFrEF= EF < 40% is systolic

HFpEF EF>50 = DIAstolic

26
Q

MCC diastolic HF (HFpEF)

A

HTN»DM, CM

27
Q

The use of nitroprusside to reduce after load must be used cautiously as it can induce _____ toxicity

A

The use of nitroprusside to reduce after load must be used cautiously as it can induce CYANIDE toxicity

28
Q

What is a secondary cause of hepatic failure

A

Septic shock bc its a reflection of the overall critical condition

29
Q

POD 3 s/o lobectomy with HR 150s and irregular. Dx and why?

A

A fib - usually fluid resus causes atrial distension and then A fib

30
Q

The use of US for CVC placement decreases? (3)

A

Rate or arterial puncture
hematoma formation
number of attempts

31
Q

GCS 7, TBI, most important info?

A

PMH; specifically if taking any blood thinners

32
Q

Before considering brain death exam, patient must have? (4)

A
  1. irrevesible and proximate cause of coma
  2. normotension
  3. no sedation or paralytics
  4. no acid base or electrolyte disturbances
33
Q

Criteria for brain death exam?

A
  1. Normothermia for > 6 hours
  2. Loss of all reflexes
  3. Failed apnea test =
  4. If apnea aborted (when pt deasts tp < 85% during 8 mins off vent) then need CT A or MR-A brain flow study
34
Q

3 Phases of ARDS

A
  1. Exudative = protein rich fluid moves to alveolar fluid
    Leukocytes proliferate and cause intrinisic lung injury
  2. Fibroproliferative - collagen formation stiff lung
  3. Resolution when the lung clears the edema
35
Q

Anorexia/Refeeding

A

HypoPhosphotemia and HypoKalemia in AN.
TPN =carbs which increases Insulin which moves K and Phos into the cell.
Electrolyte imbalance

36
Q

Sepsis from ___ is associated with lowest mortality rate in ICU

A

UTI

37
Q

s/p intubation with hypotension, hyperresonace and absent breath sounds. Dx? Pathophy?

A

Tension PTX (bc hemothorax is dullness to percussion). Tension PTX causes dec venous return

38
Q

CPP equation and value?

what about TBI?

A

CPP = MAP-ICP
MAP 60+ and ICP (10)
So CPP should be above 60

In TBI, CPP 60-70 and ICP <20

39
Q

Afib and HDS tx?

A

B blockade

40
Q

Hypovolumic shock can be caused by ??

A

hemorrhage, dec intravascular volume from diarrhea, adrenal insuff, DI and dehydration

41
Q

Obestity hypoventilation characterized by _

A

hypoxemia and hypercapnia; chest wall compression leading to alveolar collapse; dec ventilation

42
Q

Transcutaneous pacing indications

A 
Sx bradycardia
Av blcok (TII second or TIII)
43
Q

Avoiding Iatrogenic catherter placement in Men

A
  1. standard Foley
    1. Fr Coude catheter
  3. Urology consult
44
Q

Low v med v high risk surgerys

A 
Low = <1% risk MI breast and endoscopy
Med = 1- 5% risk = ENT, Thoracic, abdominal, ortho, CEA
High= >5% emergent, cardiac and vasc
45
Q

Periop cardiac risk increased in patients unable to perform _ METs

A

4 METs - climbing a flight of stairs, walking up a hill, walking at 4mph, or mod intensity chores

46
Q

Mechanism: hypokalemnia in GOO

A

Vomiting –> Dehydration –> kidneys inc the Na reabsorption (more than K) – leads to hypokalemia

47
Q

Berlin criteria of ARDS

A
  1. Resp dysfxn within 1 week
  2. CXR with b/l opacities
  3. P/F 201-330 =mild
    P/F 100-200 = moderate
    P/F < 100 severe
48
Q

Pancreatitis + possible aspiration. HOw to feed?

A

Naso Jejunal feeding tube

49
Q

2 biggest RFs for bleeding from gastric stress ulcers are ? And PPx?

A

coagulopathy and mech vent > 48 hours.
Other RFs: h/o GI bleed, renal failure, TBI, burns, sepsis
Start PPI > H2 blocker

50
Q

HAP that is not present on admission occurs _ 48 hours or more after time of admission

A

48 hours

51
Q

HTN + hypokalemia +weakness. DDX and w/u?

A

Hyperaldosteronism (primary or secondary)
Renin/Aldo ratio > 20 = primary
R/A ~10 secondary

52
Q

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?

A

AMS + lactic acidosis usually cyanide toxicity by notroprusside.
IV nitroprusside used in cases of hypertensive crises.
Tx hydroxocobalamin and sodium thiosulfae

53
Q

what is a RF for multi drug resistant HAP?

A

renal replacement therapy

54
Q

UGI s/p transfusion and 15. inutes later patient complains of chills

A

acute transfusion reaction

release of cytokines from donor WBCs

55
Q

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?

A

Doapamine

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