CRITICAL CARE/TRAUMA Flashcards
Your patient ABGs come back as follows: pH 7.37, HCO3 19, pCO2 24. What is the diagnosis?
Metabolic acidosis with resulting respiratory alkalosis
Your anaphylactic patient is wheezing and states she feels like her throat is closing. What is the priority action?
Intubate
Your patient has tachycardia, anxiety, urticaria in recovery from a cardiac catheterization. What is the treatment?
IV methylprednisolone, H2 Blocker, and IV Benadryl (Epi was one incorrect option)
What kind of shock is exhibited by the following values? PCWP 18, CI 2.0, SVR 1800
Cardiogenic (only one with high wedge)
Your patient has had treatment for a hematoma. He is confused and combative. It is necessary that he lie still for several hours. What do you do?
Order sedation with holidays for neuro checks
Your ventilated pt has these settings: SIMV, FiO2 60%, PEEP 5. You notice pulmonary shunting. What is your action?
Increase PEEP to 10 (shunting d/t atelectasis)
Your intubated pt has sounds coming out from around the tube. What is the cause?
Cuff insufficiency (air leak)
The NP correctly identifies the expected hemodynamic profile of a pt in hypovolemic shock as being most closely represented by which of the following?
CO 3.0 L/min, CVP 1 mmHg, PCWP 3 mmHg, SVR 1400 (everything is low except SVR)
A pt presents to the ED with intense abdominal pain that worsens when she coughs. A physical exam indicates abdominal tenderness, abd guarding. During the PE, the NP elicits RLQ pain when pressure is applied to LLQ. Her labs are: HR 140, SV 70ml/min, CVP 8 mm Hg, PCWP 4 mm Hg, SVR 600 dyn sec/cm3. Which of the following should be initiated for this pt?
Norepinephrine
A 42 yr old F is brought to ED after spilling a pot of boiling water on her arms and chest. On exam you see that burned skin is broken, swollen with edema, and covered in blisters. She rates pain as “extremely painful.” You determine that the pt has burns over 20% of her TBSA. Which of the following most accurately describes the pts burn?
Partial thickness burn
Early septic shock
↑CO/CI (>8/4)
First priority in a septic shock hypotensive patient?
ABC, then IVF
How would you know cardiogenic shock
only shock with initially high wedge PCWP
Pt was stung by a bee and is in respiratory distress what do you do first?
Administer Epinephrine
54 yo M s/p acute MI on levophed, epi, vasopression and nitro. BP 160/75, now 81/50. Which med would you decrease?
Nitro
What pathological finding can cause both cardiogenic and obstructive shock?
Cardiac tamponade
Hypovolemic Shock: Tx
IVF, transfuse PRBCS as needed
Cardiogenic Shock:
Acute pump failures, MI, dysrhythmia, pulmonary edema, tamponade
Tx – IVF then vasopressors ie. NE, dopamine, dobutamine, nitro IV if ischemia
Obstructive shock:
Massive PE, Tension pneumo, tamponade. SWAN catheter = obstructive shock
Tx – IVF, maintain BP, tx underlying cause, vasopressors Norepi, dopamine
Anaphylactic Shock (distributive):
Tx – Airway, Epi IM, Benadryl IV/IM, IVF, consider ranitidine (H2 antagonist), inhaled beta agonist
Neurogenic Shock (distributive)
Spinal cord injury, regional anesthesia
Tx – Airway, IVF, vasopressors (dopamine, noepi, ephedrine
Septic shock (distributive)
Tx – Bld Cx, IVF, vasopressors Norepi, dopamine, dobutamine; Abxs should be initiated in 1 hour
Basic vent settings:
RR 12, PEEP 5-8, Vt 6-8 ml/kg
Lung protective vent settings:
for ARDS. Low tidal volume ventilation 4 to 8 mL/kg predicted BW. Can also Adjust Vt to goal inspiratory plateau pressure ≤30 cm H2O. ↓ Vt = ↓r/o alveolar over-distension, VALI (ventilator-associated lung injury)
Pain scale to use in ventilated or unconscious patient:
CPOT
Pt is 2 days post extubation, is now stable but failed a swallow eval in ICU:
needs step down unit
Pt decompensating and family not sure if they want to intubate right now what do you do?
Intubate
Sepsis Quality measure
treat w/abx within 1 hour
What acid-base imbalance indication for CRRT?
Metabolic acidosis
Resp acidosis
increase RR on vent to blow off acids
Calculate anion gap
(Na + K) – (HCO3 + Cl-) normal is 7-17
Central line is placed, pain develops, in respiratory distress + absent breath sounds.
Needle decompression
Which valve condition is a contraindication for intra-arterial balloon pump?
Significant aortic regurgitation (regurgitation ↑’ed by counter-pulsation. Also: aortic dissection & big aortic aneurysm)
Lab for Rhabdo
CK (creatine kinase)
When to transfer burns
facial involvement
Pt was burned in explosion. Burns feature moisture on the skin w/ blisters and redness (2nd degree burns). He was burned on each arm, his face, and his neck. The pt wants to know how much of his body was burned. The NP states?
28 % (each arm 9% = 18%, head 9%, neck 1%)
A bedside parasternal ultrasound reveals fluid in the pericardial sac. What is the initial action in managing this patient?
Emergent percicardiocentesis
Cervical spine xray of guy who hung himself:
leave collar on
Testicular torsion: treatment
emergency surgery
A pt dx with compartment syndrome should immediately receive what?
Referral for surgery
what is used To check for other sources of bleeding in a pelvic fracture
CXR and FAST scan
There is a trauma hypotensive pt. distractor is blood transfusion
ATN (causes: ischemia-↓ perfusion, sepsis, nephrotoxins-drugs, IV contrast)
LeForte Criteria
Malocclusion and x-ray: trauma referral, stabilize and ship if community hospital.
Leforte: Your patient has Mx Facial fractures, malocclusion, broken palate & teeth. What do you do?
Stabilize and ship!
