Day 5

Question 1

Where are Intra-cranial lines place

Answer 1

Right lateral ventricle line placed for Intra Ventricular pressure of the brain

Question 2

What must invasive lines be placed in to transduce

Answer 2

Liquid

Question 3

ICP monitoring, what are the waves?

Answer 3

Intra-Cranial pressure, level to tragus (with patient 30-45 degrees), B waves made from arterial pulse 1-4mmhg, C waves made from respiratory cycle 2-10mmhg.
P1 Percussion wave, P2 tidal wave, P3 Dicrotic wave, will not be able to see on our monitors
An abnormal ICP waveform indicates poor compliance but we can not use this one data point to make a diagnosis.

Question 4

Important ICP values

Answer 4

ICP
Normal ICP < 15 mmhg
Pathological ICP > 20mmhg
Contents by volume:
Parenchyma 80%
CSF 10%
Blood 10%

Question 5

Zeroing sentence

Answer 5

(OFF TO THE PATIENT, OPEN TO AIR, ZEROING LINE, CONFIRM LINE HAS BEEN ZEROED)

Question 6

causes for overdamping

Answer 6

Causes for overdamping: Frequently most common
1. Loose connections or not enough pressure in the pressure bag, or bad is empty
2. Air bubble in the line
3. Kink in line, Overcompliance of tubing
4. Blood clot in catheter
5. Arterial spasm (distal to catheter the body squeezes shut to protect the artery and block blood flow., This will resolve)

Question 7

causes for underdamping

Answer 7

Causes for underdamping:
1. Catheter whip (artifact)
2. Tight line (if cold or frozen)
3. Hypothermia, Tachycardia
(or patient dying)

Question 8

Square waveform test

Answer 8

Normal damping is 1.5-2 oscillations on normal patient, overdamped doesn’t bounce, underdamped bounces a lot (wobbly line more than 2 oscillations)

Question 9

Why do we use distal port for pressure checks

Answer 9

Have to use the Distal port to check waveform as it’s the most direct port to the area being measured

Question 10

Does CVP equal volume status?

Answer 10

CVP does not equal volume status by itself

Question 11

What lines do we measure

Answer 11

CVP
ART Line
EVD

Question 12

Reasons to perform drug therapy

Answer 12

Prevent, Cure, and Control

Question 13

Pharmacokinetics

Answer 13

what the body does to the drug) Absorption, distribution and redistribution, metabolism, excretion

Question 14

Pharmacodynamics

Answer 14

Effects, Side-effects, Mechanism of action

Question 15

Every drug will cross one or more cell membranes, list them

Answer 15

Every drug will have to cross one or more cell membranes
Passive (Concentration Gradient), Small, Lipid-soluble, Non-polar drugs
Facilitated (Channels/Carrier Proteins), Large, Water-soluble, Polar drugs
Active Transport (Against Concentration Gradient)
Bulky Transport (Endocytosis), Very large drug molecules, the cell itself surrounds and takes in the molecule

Question 16

Bioavailability

Answer 16

How much is available to be used, the fraction of an unchanged drug that reaches circulation in the unchanged form (F)
The drug may not just be metabolized or excreted and that’s why it’s not having an effect, it may no longer be having an effect as it’s been redistributed to another area of the body

Question 17

What is distribution and what is it dependant on

Answer 17

Distribution: Movement of a drug from the circulation into body tissue
Dependent on:
Tissue blood supply (More rapidly to Brain, Liver &Kidneys, less rapid to the skin, and adipose tissue)
Size and Polarity of the drug (smaller hydrophobic or lipid soluble drugs more easily cross cell membranes, Larger hydrophilic drugs tend to remain in the plasma)
Plasma protein binding (Partly bound to plasma proteins [reservoir] party unbound [free to diffuse into tissue]

Question 18

Whats a selective barrier? one example

Answer 18

Selective Barriers
Strictly regulated
Restrict large water-soluble drugs
Allows smaller, lipid-soluble drugs to cross
Protects the brain from toxins and pathogens
Regulate brain environment

Question 19

Whats phase 1 metabolism

Answer 19

Phase 1 Metabolism
-Oxidation (cytochrome P450)
-Reduction
-Hydrolysis
-Converts parent drug to move water-soluble active metabolite by inserting a polar function

Question 20

Whats phase 2 metabolism

Answer 20

Phase 2 Metabolism
-Glucuronidation, Acetylation, Sulphation
-Converts parent drug to a more water-soluble inactive metabolite but conjugation groups to function, group,
-Renal excreted
-Slow acetylators may have toxic drug levels due to decreased rate of metabolism

Question 21

First-order Kinetics

Answer 21

The rate of drug metabolism is directly proportional to the concentration of the drug (to a point where it maxes out)

Question 22

Zero order kinetics

Answer 22

A constant amount of drug metabolism per unit of time (ASA, ethanol, phenytoin) important if patient is drunk cant make a determination until sober

Question 23

Whats drug clearance?

Answer 23

Volume of plasma in which all drugs appear to be removed in a given time. Can be used to calculate drug half-life, More drug is distribution means a longer time to clearance.

Question 24

What are the two types of deicing fluid

Answer 24

Type 1 Orange fluid heated fluid melts
Type 4 Green (LIKE MONEY ITS EXPENSIVE LASTS LONGER) Anti icing, adheres to wing that allows aircraft to take off as ice can’t stick (roughly 45min in YVR)

Question 25

CVP Waves

Answer 25

A Wave - due to atrial contract during diastole, absent in AFib, enlarged in tricuspid stenosis, pulmonary stenosis and pulmonary hypertension
c wave - due to the bulging of the tricuspid valve back into RA with systole
v wave -due to a rise in atrial pressure from venous return through the vena cava during systole and before the tricuspid opens at the onset of diastole, which Is enlarged in tricuspid regurgitation
x wave - descent due to atrial relaxation
y wave - descent due to atrial emptying into the ventricle during diastole

Question 26

Absorption

Answer 26

Route of entry, water solubility, Lipid solubility, Ionisation properties, concentration gradient, pH

Question 27

Phlebostatic axis

Answer 27

4th intercostal, A-P Line level with Right Atrium 2-6 CVP

Question 28

Whats PICO

Answer 28

Population, Patient, Problem (Who are the patients, what is the problem)
Interventions of exposure (what do we do to them, what are they exposed to?)
Comparison (what do we compare the invention with?
Outcome (What happens, what is the outcome?)