Critical Care/Anesthesia Flashcards
What is the most common cause of acute pulmonary insufficiency in the immediate postoperative period?
Atelectasis and edema
Hemodynamic findings in hypovolemic shock?
Low PCWP, depressed CO, elevated SVR, low venous O2
Normal values for PCWP, CO, CI, SVR, PAP, RVP, and venous O2?
nl PCWP = 6-12 nl CO = 5 nl CI= 2.5-4.5 nl SVR = 1000-1500 PAP: 25/10 RVP: 25/4 nl venous O2 sat = 70
Hemodynamic values in cardiogenic shock?
High PCWP, depressed CO, elevated SVR, and low venous O2
Hemodynamic values in septic shock?
Normal PCWP, high CO, low SVR, slightly high venous O2
Hemodynamic values in neurogenic shock?
low PCWP, low CO, low SVR, low venous O2
What are effects of excessive carb administration via TPN?
- hyperglycemia and DKA
- excessive insulin production leading to rebound hypoglycemia if TPN discontinued
- failure to wean from the vent 2/2 increased CO2 production from breakdown of carbs
Steps in RSI?
1) Preoxygenation
2) opioid–fentanyl
3) sedative–etomidate
4) paralytic–succinylcholine
What are hemodynamic findings in LHF
High PCWP (>18)
What are hemodynamic findings in tamponade?
Equalization of diastolic pressures in the heart
Hemodynamic findings in hypovolemic shock>
High PVR and low diastolic P in the heart
Hemodynamic findings in early septic shock>
Low SVR but nl CI 2/2 compensation with tachycardia
What is vital capacity?
The amount of air that can be exhaled after max inspiration, = inspiratory capacity + expiratory reserve volume
What is inspiratory capacity?
Tidal volume + inspiratory reserve volume
What is total lung capacity?
VC + residual volume
Dopamine targets which receptors?
DA1/DA2 agonist at low doses (increases renal blood flow and therefore UOP), beta agonist at moderate doses (increases cardiac output and contractility), alpha agonist at high doses (peripheral vasoconstriction).
Which anesthetic gas has the least myocardial depression?
Nitrous oxide
What vasopressor to use in neurogenic shock?
Phenylephrine (peripheral vasoconstriction)
What maneuver has been proven to improve ARDS outcomes?
increasing PEEP
Which reflexes may still be present in brain death?
Spinal reflexes such as limb withdrawal
What is the equation for arterial oxygen content? What is the most important factor?
=1.34 x Hgb x SaO2 (O2 sat). Most important is Hgb,
What are sxs and tx for CO2 embolus?
Sxs: sudden drop in end tidal CO2. Tx: DC pneumoperitoneum, place patient in L lateral decub, aspirate from CVL in R atrium, and hyperventilate
3 stages of ARDS?
1) exudative–protein rich edema moves into alveolar spaces. Leukocytes proliferate and cause lung injury.
2) fibroproliferative–fibrosis and collagen formation
3) remodeling
Initial tx for adrenal insuff in patient with chronic steroid use?
IV dexamethasone 4 mg
How is succinylcholine degraded?
Pseudocholinesterase in the plasma
How is pancuronium cleared?
Kidney
How is rocuronium cleared?
Liver
How is cisatracurium cleared?
Hoffman degradation in the blood, therefore can be used in renal and hepatic failure
What are side effects of succinylcholine?
hyperK and malignant hypertension
What is obesity hypoventilation syndrome?
caused by alveolar collapse from chest wall compression, can lead to pulm HTN and RHF. Patients are both hypoxic and hypercapneic.
What is the antidote for benzo overdose and what is the dose?
Flumazenil, 0.2 mg IV. Can give up to 3 mg.
What is the antidote for beta blocker overdose?
Glucagon
What is the sensory pathway for the gag reflex?
Glossopharyngeal nerve (CN IX) via sensation to the upper epiglottis
What is sensory supply of 1) epiglottis 2) larynx above cords 3) larynx below cords
Upper epiglottis: glossopharyngeal nerve (gag reflex)
Lower epiglottis and larynx above cords: internal branch of superior laryngeal nerve (cough reflex, branch of vagus)
Larynx below cords: recurrent laryngeal nerve
