Critical Care/Post Op Care Flashcards
How do you calculate sodium deficit?
(normal serum sodium - observed serum sodium) x 0.6 x (total body weight)
In intrinsic renal failures, what is
- urine osmolality
- urine sodium
- FeNA
- BUN/SCR
- Urine/PCR
urine osmolarity: >500 in Prerenal
urine sodium: >40 –> 2% –> >20 in Prerenal
Urine/PCR ( >40 in Prerenal
A change of 10mm Hg CO2 (over 40) results in a change of pH by _____ (from 7.4). Is this an increase or decrease?
A change (both directions) of 0.08 (from 7.4) per 10mm Co2
T/F: Spironolactone results in a loss of potassium.
False! It is potassium-sparing
Villous adenoma of the colon can result in watery diarrhea and (hypo/hyper)kalemia.
HYPOkalemia
Which is associated with hypokalemia: acidosis or alkalosis?
Alkalosis
Copper deficiency is characterized by
microcytic, hypochromic anemia
Skin lesions similar to enterohepatic acrodermatitis can be seen in which nutritional deficiency? What do these lesions look like?
Zinc deficiency!
= scaly, hyperpigmented lesions over the acral surgaces of elbows and knees
Out of the following bodily fluids – saliva, gastric, pancreatic, ileal, colonic – which is most acidic? Which is most basic? Which is most like plasma?
acidic = gastric
basic = pancreatic
most like plasma = ileal
How many mEq of sodium in normal saline?
In LR?
NS: 154 Na, 154 Cl, 40 Hco3
LR: 130 Na, 4K, 109 Cl, 28 HCO3
What is the succussion splash and what is it used to detect?
Place one hand behind the other on the left abdomen and rib cage and rock the patient between two hands. In PYLORIC OBSTRUCTION, will be able to feel fluid hitting the fingers (splash)
What are the most common causes of pyloric obstruction in adults?
Duodenal ulcer and gastric carcinoma
T/F: In patients with hypochloremic alkalosis (as in those with pyloric stenosis) whose metabolic abnormalities are refractory to normal saline, 0.1N and 0.2 hydrochloric acid is a safe and effective therapy.
True
Once spontaneous bleeding occurs in hemophilia, factor VIII should be transfused until the fraction reaches ___%
30%
What is the treatment of hypermagnesemia?
Calcium gluconate or calcium chloride to reverse ECG changes temporarily
Which INCREASES ionized calcium: alkalosis or acidosis?
acidosis
What is the equation for corrected calcium?
serum calcium + 0.8(4-albumin)
How do you calculate serum osmolality? What is normal?
2 (Na + K) + BUN/2.8 + glucose/18
280-300
What is the mnemonic for signs and symptoms of hypercalcemia?
Stones (renal stones), Bones (bone pain), Groans (nausea/vomiting, abdominal pain), Thrones (polyuria), and Psychiatric overtones (depression, cognitive dysfunction, coma, anxiety)
What is mithramycin used for?
hypercalcemia (but control is temporary; do not use firstline)
Which RTA results in loss of bicarbonate? What in loss of acid secretion?
proximal = loss of bicarb distal = loss of acid secretion
T/F: If ristocetin is added to the blood of someone with vWD, their platelets will aggregate.
FALSE! This is partly how vWD can be diagnosed.
What is the most common hemostatic disorder inherited by autosomal dominant methods?
von Willebrands Disease
ADP, serotonin, and thromboxane A2 are important mediators of platelet aggregation, In the presence of _______________, they cause release of platelet content and their granules, resulting in formation of a platelet plug.
calcium, magnesium, Platelet Factor 4
Warfarin-induced skin necrosis happens how long after initiation of therapy?
3-10 days
Patients receiving which drugs require higher amounts of Coumadin for therapeutic levels?
barbiturates, OCPs, corticosteroids
Why is fibrinolysis seen after surgery on the prostate?
It is rich in urokinase
How do you treat fibrinolysis?
Check to see if primary (due to streptokinase, prostate procedures –> urokinase) by checking PT, PTT, and bleeding time/platelet count. These would be elevated in DIC, but not primary fibrinolysis.
If NOT elevated, can give aminocaproic acid.
A hemolytic transfusion reaction during anesthesia will be characterized by?
bleeding and hypotension
Patients with polycythemia vera should receive ___________ for 6 weeks prior to having an elective cholecystectomy.
chlorambucil
In TPN, the ratio of non protein foods to nitrogen should be given in which ratio?
100kcal non-nitrogen/ g nitrogen
To increase calories via the peripheral route, what should be prescribed?
Fat emulsions (like soybean oil); high dextrose solutions will lead to phlebitis due to hypertonicity of the fluid
A patient can be weaned from the ventilator if their vital capacity is >___mL/kg
10-15
Successful weaning from ventilation is portended by minute ventilation < ___
10 L/min
Successful weaning from ventilation is portended by a tidal volume >___
5 mL/kg
Why does sudden cessation of TPN lead to tachycardia and other sympathetic symptoms?
Pancreatic cells upregulate release of insulin while on TPN, so cessation leads to hypoglycemia. Catecholamines are released due to the hypoglycemia.
Why can lots of glucose administration (TPN) during surgery lead to increased urine output?
It can cause a hyperosmolar nonketotic coma…all of the osmoles pull water into the vasculature, increasing urine output. Treatment is insulin drip with potassium replacement (insulin will drive potassium intracellularly)
Why does excess glucose make it more difficult to wean the ventilator?
Excess glucose = increased production of CO2 = increased ventilatory requirements. Treatment is increase of fat calories (which has a respiratory quotient of 0.7, vs 1.0 like glucose)
Old age causes a (left/right) shift in the oxygen dissociation curve.
Left
Hormones (cortisol, thyroid, aldosterone) cause a (left/right) shift in the oxgyen dissociation curve.
right
____________ is indicated after mismatched blood perfusion to help alkalinize the urine..
IV sodium bicarb
____________ are necessary to correct dilutional thrombocytopenia following blood transfusion
Platelet transfusions
3:1 rbc:plt vs 1:1 severe trauma
Potential complications of a PA catheter insertion:
1) transient arrythmias
2) RBBB
3) cardiac perforation
4) PTX
The abnormal hemostasis common in renal failure is characterized by which lab abnormality?
Prolonged bleeding time, due to failure of platelets to interact appropriately with vWF. It’s corrected with transfusion of cryoprecipitate or by using desmopressin
How do you calculate DAILY fluid requirement? Hourly fluid requirement?
DAILY: 100 mL/kg for the first 10, 50 mL/kg for the next 10, then 20 mL/kg for every other 10 after that
HOURLY: 4 mL/kg for the first 10, 2 mL/kg for the next 10, then 1 for each after that
How does heparin and LMWH help to anticoagulate?
Bind to and accelerate the activity of antithrombin III
Which nutritional deficiencies can lead to hyperglycemia?
Chromium: insulin cofactor
Manganese: cofactor for enzyme of energy and protein metabolism, as well as fat synthesis (deficiency also leads to hypocholesterolemia)
Which clotting factors are especially deficient in plasma?
Factor V, Factor VIII
Which coagulation factors are vitamin K-dependent?
factor II, V, IX, X
T/F: DIC prolongs PT and PTT, but does not cause hypofigrogenemia.
False, it causes all 3 (along with an increased concentration of fibrin split products)
What synthetic colloid can cause hyperamylsemia?
Hetastarch
What is the only EKG rhythm that can obscure ST elevations?
LBBB
What is the main treatment for candidal sepsis?
amphotericin B
What are precipitating factors for sickle cell crisis?
hypoxemia, acidosis
