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Critical Care > Critical Care Modules part II > Flashcards

Critical Care Modules part II Flashcards

1
Q

acetylcysteine efficacy in preventing AKI

A

may help but unclear. it increases Cr clearance by unknown mechanism

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2
Q

tx atrial tach

A

sotalol, amiodarone, or flecainide. DC cardiovert if unstable

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3
Q

tx pSVT

A

if stable - vagal, beta block, CCB

unstable - 6 mg adenosine. cardiovert if unsuccessful

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4
Q

tx vtach

A

stable - IV procainamide, amio, sotalol
unstable - sync cardiovert
pulseless - defib

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5
Q

tx WPW

A

stable - procainamide +/- amio

unstable - DC cardiovert

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6
Q

drugs to avoid in WPW

A

anything that inhibits AV node: adenosine, beta blockers, CCB, digoxin

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7
Q

tx polymorphic v tach

A

immediate defbi. add amio or lidocaine. consier beta blocker

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8
Q

tx torsades

A

stable - mag

unstable defib or transvenous pacing

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9
Q

tx irregular SVT w/ BBB (only one of its kind)

A

DC cardioversion

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10
Q

drugs to avoid in irregular SVT w/ BBB (only one of its kind)

A

CCB, beta blockers, adenosine, digoxin –> sudden death

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11
Q

tx sinus brady

A

if sx - atropine, dopamine or epi

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12
Q

tx sinus brady 2/2 drug toxicity

A

for CCB or beta blocker tox - calcium and glucagon

for dig tox or hyper k - digoxin antibody fragments

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13
Q

tx ventricular escape rhythm

A

use pacing. usually unstable

AVOID lidocaine –> asystole

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14
Q

what has higher water content, muscle or fat

A

muscle

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15
Q

infants have proportaionally (?more/less?) body water

A

more

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16
Q

volume loss for classes of hemorrhage shock

A

I < 750
II 750-1500
III 1500-3000
IV > 3000

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17
Q

where does buffering in LR come in

A

liver converts lactate to bicarb. thats why in liver transplant patients we avoid LR.. hard to tell real lactate elevation from impaired clearanc

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18
Q

transexamic acid MOA

A

blocks fibrinolysis to promote clotting

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19
Q

dosing of transexamic acid

A

given as loading dose w/in 8 hrs, and as driop over 8 hrs

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20
Q

clinical effect of transexamic acid

A

decreases mortality but doesn’t change transfusion requirement

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21
Q

how many liters can you transfuse in 1 hr for 16 G? 18 G?

A

13 L/hr w/ 16G

6 L/hr w/ 18G

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22
Q

glucose goals

A

<180 for most patients. <150 for cardiac.

keep >100 in neuro pts. >70 in most others

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23
Q

tx hypoglycemia

A

stop insulin
10-20 g D50w
repeat glucose check and dextrose q15 min until >70

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24
Q

Kussmaul respiration

A

deep slow hyperventilation of DKA

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25
Q

focal neuro deficits are seen in (?DKA/HHNC?)

A

hyperosmolar hyperglycemic nonketotic coma

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26
Q

weaning off SIMV

A

decrease number of machine given breaths

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27
Q

weaning off AC

A

increase time on trach collar, then let them rest with AC

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28
Q

weaning off PS

A

decrease pressure over time

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29
Q

what lyte disorder is an under dx cause of inability to wean off vent

A

hypo phos - causes weakness

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30
Q

indications for ICP monitoring

A 
Salvageable pt w/ severe TBI (GCS 3-8) AND...
abnormal CT scan
OR
normal CT scan but w/ 2 or 3 of these
- age > 40
- motor posturing
- SBP < 90
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31
Q

sedatives to use to prevent elevated ICP

A

benzos, prophofol, opiates. in refractory cases, paralytics, barbiturates.

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32
Q

medical tx elevated ICP

A

sedation, hypertonic saline or mannitol, optimize MAP, therapeutic hypothermia.

for refractory cases, barbirturate coma, paralytic, hyperventilation

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33
Q

scales for SAH prognosis

A

Hunt and Hess scale.

World Federation of Neurologic surgeons scale.

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34
Q

triple H therapy for SAH

A

hypervolemia, hypertension, hemodilution - prevents delayed cerebral ischemia

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35
Q

midaz AE

A

accumulates in kidney dysfunction –> prolonged sedation

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36
Q

propofol-related infusion syndrome

A

acidosis, arrhythmia, ARF, shock

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37
Q

pentobarbital AE

A

hypotension, myocardial depression, immunocompromise

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38
Q

only acute stroke tx that improves mortality

A

decompressive craniectomy after malignant large vessel territory infraction w/ cerebral edema

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39
Q

immunonutrition

A

use in burn or trauma patients. glutamine, arginine, antioxidants, omega-3 fatty acids

40
Q

lyte distrubance in refeeding syndrome

A

low phos, mag, k

41
Q

early TPN shows benefit only in these cases

A

1) malnourished patients who will have major upper GI surgery in 5-7 days
2) ICU patients malnourished on admission

42
Q

indications for stress ulcer GI ppx

A

resp failure, TBI, coag disorder, burn/major trauma, hypotension, hx GIB, transplant

43
Q

AE PPI

A

N/V/D, rebound acid hypersecretion, osteoporosis, c diff

44
Q

AE H2 blockers

A

HA, constipation, diarrhea

45
Q

AE sucralfphate

A

low k, low phs, aluminum tox

46
Q

RASS score range

A

-5 to +4

47
Q

RASS -5

A

unarousable

48
Q

RASS -4

A

any movement to physical stim

49
Q

RASS -3

A

any movement to voice

50
Q

RASS -2

A

wakes for less than 10 secs

51
Q

RASS +2

A

Frequent nonpurposeful movement or patient–ventilator dyssynchrony

52
Q

RASS +3

A

Pulls on or removes tube(s) or catheter(s) or has aggressive behavior toward staff

53
Q

RASS +4

A

overly combative/violent

54
Q

pain med to avoid in kidney injury

A

morphone. metabolites are toxic and accumulate

55
Q

pain med that causes qt prolongation

A

methadone

56
Q

dosing equivalents for fent, dilaudid, morphine

A

100 ug fentanyl = 1.5 mg dilaudid = 10 mg morphine

57
Q

AE propofol

A

propofol infusion syndrome - asystole/brady, rhabdo, severe metabolic acidosis.

note that prop has no analgesia

58
Q

AE for atypicla antipsych

A

qt prolongation and hypotension. no strong evidence they even work well for delirium but we use anyway

59
Q

AE etomidate

A

adrenal insufficiency

60
Q

SIRS criteria

A

temp >38/<36
HR >90
RR >20 or PCO2<32
WBC <4/>12 or >10% bands

61
Q

SvO2 in septic patients

A

under-resuscitated have low SvO2. resuscitated patients have high SvO2 (textbook answer at least)

62
Q

lactate and mortality in septic shock

A

if >4 and does not correct w/in 6 hrs of resuscitation, increases mortality

63
Q

initial fluid challenge sepsis

A

30 mL/kg

64
Q

goal directed therapy

A
  1. fix CVP 8-12 w/ fluids
  2. fix MAP >65 w/ pressors if needed
  3. fix ScVO2 >65% with RBCs if needed
65
Q

how is procalcitonin used in empiric therapy

A

low procal can be use to stop abx if no infection identified. should be high w/ bacterial infection

66
Q

pressors in septic schock

A

1st line nore. 2nd vasopressin in addition (lowers nore requirements).
epi can be added or replace nore.
AVOID dopamine (more AEs, icnreases mortality)

67
Q

when to use steroids in shock

A

vasopressin resistant shock

68
Q

surviving sepsis bundle w/in 3 hrs

A

blood cx, abx, measure lactate, 30cc/kg bolus

69
Q

surviving sepsis bundle w/in 6 hrs

A

pressors if MAP <65
if in septic shock or lactate >4 despite resus, measure CVP and ScVO2
remeasure lactate if first was elevated

70
Q

ASIA scale A

A

complete neuro loss in spinal cord injury

71
Q

ASIA scale E

A

normal

72
Q

ASIA scale B

A

sensory intact, but no motor

73
Q

ASIA scale C

A

sensory intact, motor barely preserved

74
Q

ASIA scale D

A

sensory intact, motor preserved more than C

75
Q

type of SCI caused by extension injury es/ in pre-existing stenosis

A

central cord syndrome

76
Q

s/s central cord syndrome

A

greater impairement of upper extremities. distal more than proximal. urinary retntion. sparing of sacral sensation

77
Q

SCI caused by flexion injury w/ vasc compromise

A

anterior cord syndrome. also caused by ASA occlusion

78
Q

s/s anterior cord syndrome

A

loss of pain and temp and motor. maintained vibrationa nd position

79
Q

in brown-sequard loss of proprioception is (ipsi/contra?)

A

ipsilateral loss below lesion

80
Q

in brown sequard loss of pain/temp is (ipsi/contra)

A

contra below lesion

may be ipsi @ level

81
Q

conus medullaris vs. cauda equina

A

equina is LMN. CMS more likely bilateral

82
Q

pathogenesis of autonomic dysrefelxia

A

SCI above T5 prevents descending inhibition from brainstem centers, so adrenal glands presumably release catecholamines

83
Q

s/s autonomic dysreflexia

A

HTN and profuse sweating in resposne to distended viscus

84
Q

SCI where can cause paradoxical movement on inspiration

A

between C4 and T6. paralyzes intercostal contraction

85
Q

SCI where can cause bronchospasm and why

A

between C4 and T6, loss of sympathetic innervation

86
Q

DVT algorithm, low pretest

A

proximal compression u/s is enough to rule out. d-dimer can also help r/o if really low suspicion

87
Q

DVT algorithm, high pretest

A

whole leg u/s can rule out immediately. proximal can r/o if repeated in 1 week

88
Q

PE algorithm, low pretest

A

can wait to start a/c if you want

get spiral CT or V/Q. negative CT, or low or nl V/Q is enough to r/o. if inadequate, do DVT u/s

89
Q

PE algorithm, high pretest

A

start anticoagulation

get spiral CT or V/Q. if negative, still get DVT u/s. if those negative, can even consider conventional angio

90
Q

DVT algorithm, mod pretest

A

same as high pretest algorithm: whole leg u/s can rule out immediately. proximal can r/o if repeated in 1 week

91
Q

PE algorithm, intermediate pretest

A

hybrid of low and high

definitely start anticoagulation (like high) but can rule out with negative CT

92
Q

DVT ppx nonsurgical

A

LMWH or heparin preferred. if high bleeding risk, then mechanical can be a substitute

93
Q

DVT surgical

A

mod risk is LMWH or heparin or mechanical
high risk both chemical and mechanical
if cancer, definitely LMWH
if high bleeding risk, only mechanical

94
Q

ECG PE

A

S1 q3 t3

95
Q

contraindications LMWH

A

renal failure or expected need for thrombolysis

Critical Care (2 decks)

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