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Advanced Anesthesia > Critical Care/Respiratory > Flashcards

Critical Care/Respiratory Flashcards

1
Q

Absolute contraindications for percutaneous tracheostomy placement?

A
  • operator inexperience
  • infants
  • insertion site infection
  • severe/uncontrolled coagulopathy
  • unstable cervical spine injury
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2
Q

Hallmark finding in patients with catheter-induced pulmonary artery rupture?

A

Hemoptysis

Critical first step in management is adequate oxygenation/ventilation with lung isolation of unaffected lung.

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3
Q

Ratio of total dead space (physiologic) to tidal volume?

A

1/3

Dead space = 2 mL/kg

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4
Q

Relationship of speed of inhalational induction to FRC?

A

inversely proportional (think of FRC as lung volume diluting volatile anesthetic)

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5
Q

Relationship of speed of inhalational induction to blood:gas coefficient?

A

inversely proportional

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6
Q

Relationship of speed of inhalational induction to cardiac output?

A

inversely proportional; affects SOLUBLE volatiles MORE

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7
Q

Relationship of speed of inhalational induction to FA/FI?

A

proportional

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8
Q

Relationship of speed of inhalational induction to minute ventilation?

A

proportional

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9
Q

Calculating V/Q ratio?

A

Ventilation = (tidal volume - dead space) * RR

Q = CO = HR x SV

V/Q

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10
Q

Most common anesthetic complication of an anterior mediastinal mass?

A

compression of the tracheobronchial tree

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11
Q

Difference between high frequency oscillatory ventilation and high frequency jet ventilation?

A

HFOV: active inspiration and expiration; mostly used in neonates; very small volumes at 600-1200 per minute

HFJV: active inspiration but passive expiration; tidal volumes smaller than dead space and >100 per minute

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12
Q

How does obesity and pregnancy effect closing capacity?

A

no effect

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13
Q

Mnemonic for decreased FRC?

A

PANGOS:
pregnancy
ascites
neonates
GA
obesity
supine position

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14
Q

How does critical illness myopathy present? How to differentiate from critical illness polyneuropathy?

A

Flaccid quadriparesis and failure to wean from mechanical ventilation in the setting of IV glucocoricoids and ICU.

Deep tendon reflexes and sensation remain NORMAL in CIM vs depressed DTRs in CIP

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15
Q

How does ascites affect lung dynamics?

A

Mimics restrictive lung disease: all lung volumes are decreased including vital capacity, tidal volumes, FRC, and forced vital capacity. FEV1/FVC is generally UNCHANGED because both values decrease proportionally.

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16
Q

Most important electrolyte to monitor as a donor management goal?

A

Sodium: goal is < 155

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17
Q

Diagnosis of PHTN requires 3 elements?

A
  1. resting PAP > 25
  2. PCWP < 15
  3. PVR > 3 Woods units
18
Q

Flow

A
19
Q
A

Asthma

20
Q
A

COPD

21
Q
A

Restrictive lung dz

22
Q
A

DYNAMIC variable intrathoracic obstruction: positive pressures during expiratory phase pushes obstruction inward while negative pressure pulls obstruction outward with pleura

ex: tracheobroncheal pathology like tracheomalacia, distal tracheal tumors, bronchial tumors, mediastinal mass

23
Q
A

DYNAMIC variable extrathoracic obstruction: inspiratory neg pressure drops airway pressure and causes collapse

Ex: VC paralysis, VC constriction, laryngeal tumor, AW burns, glottis strictures, epiglottitis, proximal tracheal tumor

24
Q
A

FIXED intrathoracic OR extrathoracic obstru

ex: tracheal stenosis, goiter, foreign body, large AW tumor

25
Q

Increased PIP by itself usually indicates?

A

Airway issue: compression, bronchospasm, foreign body, kinked ETT, mucus plug, secretions

26
Q

Increased PIP plus increased plateau pressure indicates?

A

extra thoracic or pulmonary problem not related to actual airway:

abdominal insufflation

ascites

intrinsic lung dz

obesity

pulmonary edema

tension PTX

trendelenberg position

27
Q

The hallmark of restrictive lung disease?

A

A decrease in total lung capacity less than 80%

FEV1/FVC ratio unchanged

28
Q
A

Incompetent inspiratory valve

29
Q
A

Exhausted CO2 absorber

30
Q
A

partial endotracheal tube obstruction

31
Q

Phase 2 testing that predicts POOR perioperative outcome post pneumonectomy?

A
  • Inability to ascend at least 2 flights of stairs
  • FEV1 < 30% of normal predicted value
  • Combined predicted postop FEV1 < 35% and DLCO < 35% of normal predicted value
  • Right heart catheter data: mean PAP > 35, mean PCO2 > 45, PO2 < 60,
  • and the following right heart catheter data with exercise:

PVR > 190 dynes/sec/cm^5

Maximum VO2 < 15 mL/kg/min

A decrease in arterial oxygen saturation > 2-4%

32
Q

Phase 1 pneumonectomy testing includes?

A

ABG analysis and spirometry

33
Q

CAM ICU is used for?

A

Assessing delirium not dementia

Components:

Is there a change in mental status or fluctuating course of mental status?

-AND-

Is the patient inattentive or easily disracted?

-PLUS

Is there an altered level of consciousness?

-OR-

Is there disorganized thinking?

34
Q

Alveolar gas equation formula?

A

PAO2 = [FiO2 x (Patm - Ph2o)] - (PaCO2/RQ)

RQ = 0.8

Ph2o = 47 mmHg (unless otherwise specified)

35
Q

qSOFA scoring and criteria?

A

scoring from 0-3

criteria:

altered mental status GCS < 15

RR > 22

systolic bp < 100

score > 3 indicates a worse prognosis

36
Q

Risk factors for multi-drug resistant ventilator associated pneumonia:

A

five or more days of hospitalization

prior IV antibiotic use within 90 days

septic shock at the time of occurrence

acute respiratory distress syndrome or acute renal replacement therapy PRIOR to the occurrence

37
Q

ABX treatment for multi-drug resistant ventilator associated pneumonia when MRSA prevalence is GREATER than 10% or UNKNOWN

A

MRSA Coverage:

vanco -OR- linezolid

-PLUS- antipseudomonal beta-lactam based agents:

piper/tazo -OR- cephalosporins (cefepime/ceftazidime) -OR- carbapenems (imipenem/meropenem) -OR- aztreonam

-PLUS- antispeudomonal NON-beta-lactam based agents:

fluroquinolones (floxacins) -OR- aminoglycosides (amikacin/gentamycin/tobramycin) -OR- polymixins (colistin)

38
Q

Changes in respiratory parameters in elderly patients?

A

increased:

CC>FRC

RV

Decreased:

IC

TLC

VC

39
Q

Common derangements in hyperalimentationother than hypophosphatemia?

A

hypo- or hyperglycemia

acute liver injury with elevated PTT

**patients often require vit K supplementation

40
Q

Severe causes of decreased phosphate?

A

Refeeding syndrome Diabetic ketoacidosis (via incr insulin) Large decr in PCO2 (hyperventilation) Diuretics (acetazolamide)

Advanced Anesthesia (11 decks)

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