Critical Care COPY Flashcards by Alice C

Calculate free water deficit

[(plasma Na/140)-1] x (weight in kg x 0.6)

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SIADH labs

HypoNa + urine Na >20

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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

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Effect of Glycine solution for TURP

Transient blindness

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Effect of distilled water for TURP

Hemolysis, fluid overload, dilution hypoNa and high chance of TURP syndrome

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Effect of saline and other balanced salt solutions for TURP

Significant current dispersion

Normally used sorbitol/mannitol combination for TURP

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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

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Type of shock:
PCWP >18
CI <2.2

Cardiogenic

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Cause of oliguria:
FeNa 1%
BUN: Cr >20
Urine:Serum Cr >40
Urine Osm >500
Random Urine Na <20

Pre-renal
- hypovolemia

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Cause of oliguria:
FeNa 2%
BUN: Cr <20
Urine:Serum Cr <20
Urine Osm <400
Random Urine Na >20

Intrinsic or post-renal

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Formula to calculate FeNa

[(pCr x uNa) / (pNa x uCr)] x100

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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

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Cause of hypoPhos with TPN

Glucose loading w/ TPN –> intracellular shift of Phos

Other causes of hypophos:
Refeeding
DKA
Hyperventilation
Diuretics - aucetazolaimide (proximal tubule)

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Toxin that travels via neuronal retrograde transport and enters inhibitory interneurons in the spina cord

Tetanus
- prevents release of GABA

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Inhibitors of HPV

Hypocarbia
Vasodilators
Infection
Metabolic alkalosis
Volatiles >1MAC

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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

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Causes of inc PIP + inc Pplateau

Compliance issue
- Abd insufflation
- Ascites
- Intrinsic lung disease
- Obesity
- Pulmonary edema
- PTX
- Trendelenburg

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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