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Critical Care > Critical Care Modules part I > Flashcards

Critical Care Modules part I Flashcards

1
Q

what are the 5 H’s in H’s/T;s

A

hypovolemia, hypoxia, hypothermia, hypo/hyper K, hydrogen (acidosis)

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2
Q

what are the 5 T’s in H’s/T’s

A

tamponade, tension pneumothorax, toxins, thrombosis pulmonary, thormbosis coronary

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3
Q

what is the FiO2 for 2lpm nasal canula

A

= 21% + 3* ( _ lpm) = 27%

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4
Q

ESKAPE pathogens (increasing resistance)

A

enterococcus, staph aureus, klebsiella and ESBL e coli, acinetobacter, pseudomonas, enterobacter

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5
Q

time dependent abx

A

beta lactams, carbapenems, linezolid, erythromycin

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6
Q

conc-dependent abx

A

aminoglycosides, metronidazole

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7
Q

AE of daptomycin

A

myopathy

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8
Q

televancin and quinopristin-dalfopristin use

A

last resort for MRSA and VRE

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9
Q

AE FQs

A

qtc prolongation, drug itneraction w warfarin, avoid w/ divalent cations

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10
Q

abx good in legionnaries

A

macrolides

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11
Q

poly myxin good for and toxicity

A

MDR organisms. but neuro and nephro toxic

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12
Q

what connects RA and LA

A

buchmanns bundle

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13
Q

tx for sinus brady

A

atropine or pacing if unstable

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14
Q

a flutter rotates this direction

A

counter clockwise

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15
Q

bpm a flutter

A

250-300

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16
Q

wandering atrial pacemaker vs multifocal atrial tach

A

same but MAT > 100. 3 different p morphologies

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17
Q

criteria for v tach

A

absence of RS in v1-v6, onset of R to nadir of S is greater than 100 ms, AV dissociation

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18
Q

tx v tach

A

amiodarone if decreased LV function; DC cardioversion oif preserved LV function, defibrillation if pulseless vtach, procainamide, sotalol

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19
Q

tx torsades

A

magnesium

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20
Q

tx and dose for SVT

A

6 mg IV adenosine

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21
Q

plateau pressure =

A

peak airway pressure - resistance of circuit/airway

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22
Q

break down the rule of 9s for burns

A

whole arm = 9% each; whole leg = 18% each; front torso = 18%, back torso = 18%, head = 9%, genitals = 1%

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23
Q

resus burns with this fluid

A

LR

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24
Q

parkland formula

A

4 ml * body weight kg * %BSA (note: w/ 2* or 3* burns only). Give half in first 8 hours. half in next 16

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25
Q

burn center referral criteria (doesn’t mean urgent)

A

1) >10% BSA or 3rd degree burn. 2) Involve sensitive areas (e.g. hands, face, genitalia). 3)Electrical or chemical. 4) inhalation injury

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26
Q

coumadin affects these factors (and so does liver failure)

A

II, VII, IX, X, C, S

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27
Q

factors made outside liver

A

VIII by endothelial cells

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28
Q

difference in coag labs between liver dysfunction and sepsis DIC

A

in liver failure, VIII and vWF are increased

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29
Q

why is plt production impaired in liver failure

A

liver makes TPO. also cirrhotic livers sequester

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30
Q

why is arterial ammonia better to measure

A

its before tissues can consume some

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31
Q

AE metronidazole

A

neurotoxicity

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32
Q

AE lactulose

A

diarrhea and hypernatremia

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33
Q

ratio of spironolactone:lasix to maintain normokalemia

A

100:40

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34
Q

SAAG for transudate (portal HTN)

A

high, i.e. >1.1

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35
Q

tx hepatorenal syndrome

A

albumin and specific vasoconstrictors (nore, midodrine, octreotide) help in the short term. liver transplant is only cure

36
Q

factors for MELD

A

bili, INR, Cr

37
Q

factors for Child and which is worst class

A

bili, PT, ALBUMIN, encephalopathy, ascities

38
Q

dx of hypoosmolar hypovolemic hypo Na

A

if FENa > 1% diuretics, aldosterone def, RTA. if <1%, actual dehydration or third spacing

39
Q

dx of euvolemic hypoosmolar hypo Na

A

dilute urine (<100 mOsm), UNa <30 = polydipsia. concentrated = SIADH

40
Q

correction of hyponatremia

A

1-2 mEq/L/hr but not more than 12 in 24 hrs

41
Q

free water deficit in hyper Na

A

0.6 * total body weight * [MeasuredNa/140 - 1]

42
Q

correction rate of hypernatremia

A

if symptomatic, correct 1-2 mEq/L/hr. Give 1st half of NS in first 12-24 hrs. Give rest in next 24 hrs.

if asymptomatic, max 0.5 mEq/L/hr, max 10/day

43
Q

sx low K

A

weakness, arrhythmia, glucose intolerance

44
Q

dx renal potassium wasting

A

K-to-Cr ratio >13 mEq/g or 24 hr total > 30 mEq

45
Q

hypo K with acidosis

A

RTA 1 (distal) or RTA 2 (proximal)

46
Q

hypo K with alkalosis

A

primary mineralocorticoid excess, Barters, Gitelman

47
Q

EKG hyper K

A

peaked T&raquo_space; prolonged PR&raquo_space; wide QRS&raquo_space; short QT

48
Q

tx hyper K

A

calcium to protect heart. redistribute w/ insulin + glucose, bicarb, albuterol. remove w/ lasix, sodium polystyrene sulfonate (kayexalate), dialysis

49
Q

s/s hyper Ca

A

fatigue, confusion, brady, arrhythmia

50
Q

tx hyper Ca

A

NS, lasix/loops, RRT, IV bisphosphonates, glucocorticoids, calcitonin

51
Q

s/s hyper mag

A

loss of DTR –> respiratory and cardiac depression

52
Q

tx hyper mag

A

stop mag. give loop diuretics and calcium

53
Q

causes low mag

A

alcohol, renal, GI, manutrition, pancreatitis, burns, trauma

54
Q

s/s low mag (conjunction w/ low k)

A

torsades and seizures

55
Q

cleanest central line

A

subclavian

56
Q

optimal duration for VAP tx

A

8 days, except if nonfermenting GNRs like pseudomonas (15 days)

57
Q

indications for tx asymp bacteruria

A

pregnant, undergoign urologic surgery, or women who had shor term cath but persistent bacteria >48 hrs after removal

58
Q

UTI tx duration

A

3 days of <65 Y without upper tract signs.

otherwise: 5-7 if prompt resolution of sx. 10-14 for delayed resolution

59
Q

cranberry product benefits in UTI

A

women w/ recurrent uti

60
Q

methanomine salts and utis

A

help after gyn srugery w/ indwelling caths < 1 week

61
Q

number of people that one can save w/ donated organs

A

9.

2 lungs, 2 kidneys, 2 halves of liver, 1 heart, 1 small bowel, 1 pancreas

62
Q

day 1 ICU care bundle

A

identify medicla decision maker. give leaflet of info

63
Q

day 3 icu care bundle

A

social work and spiritual work

64
Q

day 5 icu care bundle

A

family meeting

65
Q

idea body weight

A

X kg + 2.3 * (inches over 60)

x = 50 in males, 45 females

66
Q

dosing body weight

A

IBW + 0.4 (TBW-IBW)

67
Q

when to use dosing body weight

A

if TBW is 130% or more of IBW

68
Q

dosing of vanc

A

15-20 mg/kg TBW

69
Q

loading dose of vanc if suspect meningitis

70
Q

t/12 of vanc

71
Q

when to measure vanc levels

A

after 4-5 half lives (steady state). then check weekly when longer durations

72
Q

interval dosing for aminoglycosides

A

based on population parameters. usually 8-12 hrs

73
Q

pharmacokinetic considerations of amnioglycosides

A

positive charge, poorly absorbed by GI. so use IM or IV. however, avoid IM in septic shock due to decreased perfusion

74
Q

t1/2 aminoglycoside

75
Q

aminoglycosides have poor penetration in these tissues

A

brain, lung, prostate, fat

76
Q

what body weight do you use to dose aminoglycosides

A

IBW because doesn’t distribute into fat

77
Q

the polarity of this abx helps concentrate it into extracellular compartments

A

aminoglycosides

78
Q

this abx has a post-antibiotic effect

A

aminoglycosides

79
Q

when to measure levels of aminoglycosides

A

twice after first dose. one at 2 hrs, one at 10.

obtain random levels if rapidly changing renal function, intermittent dosing, or unsure how much was given

80
Q

when can you use HartfordNomogram for abx

A

aminoglycosides if extended infusion and patient has normal/stable cr clearance

81
Q

which causes reflex brady: phenylephrine or vasopressin

A

phenylephrine

82
Q

inotropic vasodilators

A

milrinone and dobutamine

83
Q

hct of a unit of blood

84
Q

why does older blood carry less oxygen

A

decreased 2,3 dpg causes left shift

85
Q

etiology nonhemolytic febrile transfusion rxn

A

recipient has antibodies to donor WBCs. can prevent by leukodepletion

86
Q

MC prdct causing TRALI

87
Q

etiology TRALI

A

anti-HLA in DONOR activates recipient neutrophils

Critical Care (2 decks)

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