CRITICAL CARE/TRAUMA

Question 1

Your patient ABGs come back as follows: pH 7.37, HCO3 19, pCO2 24. What is the diagnosis?

Answer 1

Metabolic acidosis with resulting respiratory alkalosis

Question 2

Your anaphylactic patient is wheezing and states she feels like her throat is closing. What is the priority action?

Answer 2

Intubate

Question 3

Your patient has tachycardia, anxiety, urticaria in recovery from a cardiac catheterization. What is the treatment?

Answer 3

IV methylprednisolone, H2 Blocker, and IV Benadryl (Epi was one incorrect option)

Question 4

What kind of shock is exhibited by the following values? PCWP 18, CI 2.0, SVR 1800

Answer 4

Cardiogenic (only one with high wedge)

Question 5

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?

Answer 5

Order sedation with holidays for neuro checks

Question 6

Your ventilated pt has these settings: SIMV, FiO2 60%, PEEP 5. You notice pulmonary shunting. What is your action?

Answer 6

Increase PEEP to 10 (shunting d/t atelectasis)

Question 7

Your intubated pt has sounds coming out from around the tube. What is the cause?

Answer 7

Cuff insufficiency (air leak)

Question 8

The NP correctly identifies the expected hemodynamic profile of a pt in hypovolemic shock as being most closely represented by which of the following?

Answer 8

CO 3.0 L/min, CVP 1 mmHg, PCWP 3 mmHg, SVR 1400 (everything is low except SVR)

Question 9

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?

Answer 9

Norepinephrine

Question 10

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?

Answer 10

Partial thickness burn

Question 11

Early septic shock

Answer 11

↑CO/CI (>8/4)

Question 12

First priority in a septic shock hypotensive patient?

Answer 12

ABC, then IVF

Question 13

How would you know cardiogenic shock

Answer 13

only shock with initially high wedge PCWP

Question 14

Pt was stung by a bee and is in respiratory distress what do you do first?

Answer 14

Administer Epinephrine

Question 15

54 yo M s/p acute MI on levophed, epi, vasopression and nitro. BP 160/75, now 81/50. Which med would you decrease?

Answer 15

Nitro

Question 16

What pathological finding can cause both cardiogenic and obstructive shock?

Answer 16

Cardiac tamponade

Question 17

Hypovolemic Shock: Tx

Answer 17

IVF, transfuse PRBCS as needed

Question 18

Cardiogenic Shock:

Answer 18

Acute pump failures, MI, dysrhythmia, pulmonary edema, tamponade
Tx – IVF then vasopressors ie. NE, dopamine, dobutamine, nitro IV if ischemia

Question 19

Obstructive shock:

Answer 19

Massive PE, Tension pneumo, tamponade. SWAN catheter = obstructive shock
Tx – IVF, maintain BP, tx underlying cause, vasopressors Norepi, dopamine

Question 20

Anaphylactic Shock (distributive):

Answer 20

Tx – Airway, Epi IM, Benadryl IV/IM, IVF, consider ranitidine (H2 antagonist), inhaled beta agonist

Question 21

Neurogenic Shock (distributive)

Answer 21

Spinal cord injury, regional anesthesia

Tx – Airway, IVF, vasopressors (dopamine, noepi, ephedrine

Question 22

Septic shock (distributive)

Answer 22

Tx – Bld Cx, IVF, vasopressors Norepi, dopamine, dobutamine; Abxs should be initiated in 1 hour

Question 23

Basic vent settings:

Answer 23

RR 12, PEEP 5-8, Vt 6-8 ml/kg

Question 24

Lung protective vent settings:

Answer 24

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)

Question 25

Pain scale to use in ventilated or unconscious patient:

Answer 25

CPOT

Question 26

Pt is 2 days post extubation, is now stable but failed a swallow eval in ICU:

Answer 26

needs step down unit

Question 27

Pt decompensating and family not sure if they want to intubate right now what do you do?

Answer 27

Intubate

Question 28

Sepsis Quality measure

Answer 28

treat w/abx within 1 hour

Question 29

What acid-base imbalance indication for CRRT?

Answer 29

Metabolic acidosis

Question 30

Resp acidosis

Answer 30

increase RR on vent to blow off acids

Question 31

Calculate anion gap

Answer 31

(Na + K) – (HCO3 + Cl-) normal is 7-17

Question 32

Central line is placed, pain develops, in respiratory distress + absent breath sounds.

Answer 32

Needle decompression

Question 33

Which valve condition is a contraindication for intra-arterial balloon pump?

Answer 33

Significant aortic regurgitation (regurgitation ↑’ed by counter-pulsation. Also: aortic dissection & big aortic aneurysm)

Question 34

Lab for Rhabdo

Answer 34

CK (creatine kinase)

Question 35

When to transfer burns

Answer 35

facial involvement

Question 36

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?

Answer 36

28 % (each arm 9% = 18%, head 9%, neck 1%)

Question 37

A bedside parasternal ultrasound reveals fluid in the pericardial sac. What is the initial action in managing this patient?

Answer 37

Emergent percicardiocentesis

Question 38

Cervical spine xray of guy who hung himself:

Answer 38

leave collar on

Question 39

Testicular torsion: treatment

Answer 39

emergency surgery

Question 40

A pt dx with compartment syndrome should immediately receive what?

Answer 40

Referral for surgery

Question 41

what is used To check for other sources of bleeding in a pelvic fracture

Answer 41

CXR and FAST scan

Question 42

There is a trauma hypotensive pt. distractor is blood transfusion

Answer 42

ATN (causes: ischemia-↓ perfusion, sepsis, nephrotoxins-drugs, IV contrast)

Question 43

LeForte Criteria

Answer 43

Malocclusion and x-ray: trauma referral, stabilize and ship if community hospital.

Question 44

Leforte: Your patient has Mx Facial fractures, malocclusion, broken palate & teeth. What do you do?

Answer 44

Stabilize and ship!