Critical Care COPY Flashcards
Calculate free water deficit
[(plasma Na/140)-1] x (weight in kg x 0.6)
SIADH labs
HypoNa + urine Na >20
Fire at tire factory poisoning and treatment
Cyanide = hydroxycobalamin
Sodium thiosulfate and nitrate not used because causes methHb and slow onset
High O2 on VBG (not using O2)
Prolonged SNP infusions can cause
Effect of Glycine solution for TURP
Transient blindness
Effect of distilled water for TURP
Hemolysis, fluid overload, dilution hypoNa and high chance of TURP syndrome
Effect of saline and other balanced salt solutions for TURP
Significant current dispersion
Normally used sorbitol/mannitol combination for TURP
Factors increasing likelihood of post-op ventilation following thymectomy for MG
- Duration of disease >6 years
- Hx of chronic respiratory disease (asthma, COPD)
- Pyridostigmine dose >750mg/day
- Vital capacity <2.9L or 40ml/kg
Type of shock:
PCWP >18
CI <2.2
Cardiogenic
Cause of oliguria:
FeNa 1%
BUN: Cr >20
Urine:Serum Cr >40
Urine Osm >500
Random Urine Na <20
Pre-renal
- hypovolemia
Cause of oliguria:
FeNa 2%
BUN: Cr <20
Urine:Serum Cr <20
Urine Osm <400
Random Urine Na >20
Intrinsic or post-renal
Formula to calculate FeNa
[(pCr x uNa) / (pNa x uCr)] x100
Causes of inc MvO2
Inc SaO2: supplemental O2
Dec VO2: Carbon monoxide, cyanide, hypothermia, sepsis
Inc CO: dobutamine, sepsis, thyroid storm, AV fistula, cirrhosis
Inc Hb: Transfusion
Cause of hypoPhos with TPN
Glucose loading w/ TPN –> intracellular shift of Phos
Other causes of hypophos:
Refeeding
DKA
Hyperventilation
Diuretics - aucetazolaimide (proximal tubule)
Toxin that travels via neuronal retrograde transport and enters inhibitory interneurons in the spina cord
Tetanus
- prevents release of GABA
Inhibitors of HPV
Hypocarbia
Vasodilators
Infection
Metabolic alkalosis
Volatiles >1MAC
Indications for hyperbaric O2
Air embolism
Carbon monoxide, brown recluse other poisoning
chronic infections
Acute ischemia from crush, CRAO
Burns
Lung lavage
Ability to deliver 1 MAC of N2O –> decompression sickness when suddenly stopped,
Higher Desflurane delivered = dial down
Causes of inc PIP + inc Pplateau
Compliance issue
- Abd insufflation
- Ascites
- Intrinsic lung disease
- Obesity
- Pulmonary edema
- PTX
- Trendelenburg
Causes of inc PIP + unchanged Pplateu
Airway resistance problem
- Airway compression
- Bronchospasm
- Foreign body
- Kinked ETT
- Mucous plug
Predicts INC mortality following pneumonectomy
- VO2 Max <15ml/kg/min
- Inability to ascend 2 flights of stairs
- ppoFEV1 <30%
- Combined ppoFEV1 <35 + DLCO <35
Cause of hypoxemia with normal A-a gradient
Hypoventilation
Labs in Conn Syndrome
HypoK metabolic alkalosis
- primary hyperaldosteronism
- Fatigue, HA, HTN from hypervolemia
- Tx = spironolactone and K
change in pH for every degree decrease
pH 7.25 @ 37 when drawn from 27 degree patient
1 degree decrease = pH increase 0.017
pH –> 7.42 (10 x 0.017)
Changes at high altitude
Hyperventilation - dec PaCO2 (PaCO2 30, PaO2 55)
Kidneys compensate in a few days to normalize pH but still have dec PaCO2
H moves from CSF to plasma (inc CSF pH)
Left shift oxygen-Hb curve (hypocarbia) —> right shift from hypoxia and inc 2,3 DPG
Chronic hypoxia inc PVR
Inc Hb –> inc viscosity and risk of clotting
Brief inc in CO
Signs of cyanide toxicity
Cyanosis only very late, typically no cyanosis present
Inc PaO2 d/t inability to utilize O2
SvO2 inc
Anion gap metabolic acidosis
Labs for ATN:
Urine Na
Urine Osm
Spec Grav
FeNa
Urine Na >40 (can’t reabsorb)
Urine Osm <350
SG very low ~1.0035
FeNa >1%
Tx Sarin gas poisoning
Atropine and Pralidoxime
Organophsphates inhibit Ach-esterase = excess Ach –> bradycardia, mitosis, salivation, respects distress
Wavelengths for pulse ox
DeoxyHb - 660
OxyHb - 940
Bezold-Jarisch Reflex
apea, bradycardia, hypotension
following inferior and posterior MIs as a result of dec preload or stretch of the ventricles mediated by vagal
Commonly seen with spinal anesthesia
MELD score
Cr (greatest effect)
Yea/No Dialysis
Na
INR
Bilirubin
Childs-Pugh score
Bilirubin
INR
Albumin
Ascities
Hepatic encephalopathy
Features of TRALI
Pulmonary edema - high protein content
Transient leukopenia
Normal cardiac filling pressures
Multiparous donors
Inc temp
Calculate A-a gradient
PAO2 = (FiO2 x 713) - (PaCO2/.8)
If <20 = hypoxemia is due to hypoventilation or dec fio2
Post-thyroidectomy complication time course:
1. immediate
2. within 6 hours
3. 24 hours
immediate = b/l recurrent laryngeal injury
within 6 hours = hematoma
24 hours = hypocalcemia
Volume of total dead space
2ml/kg
Labs in Cushing syndrome
HypoK metabolic alkalosis + hyperglycemia
Labs with vomiting/pyloric stenosis
7.51
PCO2 47
HCO3- 31
Na 130
K 2.9
Cl 93
Most predictive of pulmonary complications following wedge resection
FEV1 <60% of predicted
DLCO<60% of predicted
PPO FEV1 <800ml
PPO FEV1% >40%
VO2 Max <15ml/kg/min
Mechanism of high altitude pulmonary edema
excessive uneven HPV
2-4 days after ascent
Tx = rapid descent, O2, hyperbaric
ICU feeding strategies
Enteral w/o antioxidants
Protein-based full feeds
Pulmonary changes with obesity
Inc Tv
Dec everything else
Electrolyte dec in ESRD
Calcium
Initial compensation for acute respiratory acidosis
Plasma protein buffer (including Hgb)
Factor for calculating qSOFA
0-3
-AMS
-RR >22
-SBP <100
How does hyperbaric oxygen work?
Increases amount of dissolved oxygen
