Definitions Flashcards
HELLP Syndrome
A triad of:
- Hemolysis,
- Elevated Liver Enzymes and
- Low Platelets
It is considered to represent the extreme end of the pre-eclampsia spectrum of disease
DKA diagnosis
- Blood sugar more 250
- AG >10 -12
- Hco3 <18
- Positive ketone
TSS criteria
- Fever / rash / hypotension and 3 organs involved
- Organ involved: CNS/ GI/ renal / skin / muscle
Status epilepticus
Seizure for > 5 minutes or recurrent seizure with unresolved unconsciousness
Refractory status epilepticus
Seizure for more than 2 hours despite BDZ and non BDZ
Super refractory status epilepticus
Seizure more than 24 hrs despite GA
Delirium
Acute change in mental status with a fluctuating course characterized by inattention, an alteration in consciousness or disorganized thinking. It is a manifestation of brain dysfunction and occurs in up to 70% of the critically ill
Brain death prerequisites
- Clear cause of coma and irreversibility
- Normal core temperature (>36.5ºC)
- Normal SBP (>90 mmHg)
- Exclude confounding factors:
a) CNS Depressants
b) NMBA
c) Electrolyte disorders (Na<160)
d) Hypo, hyperglicemia
e) Acid base disorders
f) Uremia, hepatic failure
g) Endocrine disorders
- Panhypopituitarism
- Adrenal cortical insufficiency
- Mixedema coma
h) Poisoning
Massive transfusion
Definitions vary, they include:
- 10 unit transfusion in 24 h
- Transfusion of an entire blood volume in 24 h
- Replacement of 50% blood volume over 3 h
Damage control resuscitation
Damage control resuscitation has 3 components:
- Permissive hypotension (aka minimal normotension)
- Early hemostatic resuscitation
- Damage control surgery.
Intra-abdominal hypertension (IAH)
A sustained or repeated pathologic elevation of IAP 12 mmHg
Abdominal compartment syndrome (ACS)
A sustained intra-abdominal pressure (IAP) > 20 mmHg (with or without an abdominal perfusion pressure (APP) < 60 mmHg) that is associated with new organ dysfunction/failure. (Note that the normal IAP is approximately 5–7 mmHg in critically ill adults, and APP = MAP – IAP.)
ARDS
The essential components required to diagnose ARDS according to Berlin definition are:
- Development within one week of insult/worsening respiratory symptoms –acute
- Bilateral opacities on radiological studies not explained by effusions, collapse, or nodules
- Respiratory failure not explained by LVF or fluid overload
- PaO2/FiO2 < 300 mmHg on PEEP/CPAP ≥ 5 cmH2O with mention of oxygenation criteria
Febrile neutropenia
- Fever: single oral temp >38.3°C (101°F) or >38°C (100.4°F) for >1 h
- Neutropenia: ANC <500 cells/pL or <1000 cells/j.iL with predicted nadir <500 cells/uL
BPF
- A leakage of inspired air from the airways into the pleural space for more than 24 hours
Massive hemoptysis
> 600 ml of blood (hemoptysis) in 24 hrs
Tumor lysis syndrome (TLS)
The diagnosis of TLS requires ≥ 2 of the following clinical abnormalities:
- hyperuricemia (> 8 mg/dL)
- hyperkalemia (> 6 mmol/L)
- hyperphosphatemia (> 4.5 mg/dL)
- hypocalcemia (< 7 mg/dL)
A TLS diagnosis also requires one of the following:
- acute renal failure
- cardiac arrhythmia
- seizure
Near miss (close call)
Errors that occur in the process of providing medical care that are detected and corrected before reaching the patient. (AHRQ).
Medical error
- Failure of a planned action to be completed as intended.
- Preventable adverse medical offense.
- Act (or omission of an act) that would have been judged wrong by knowledgeable peers at the time it occurred.
Sentinel event
Any unanticipated event in a healthcare setting resulting in death or a serious physical or psychological injury to patient(s), that is not related to the natural course of illness.
Simple weaning
Pass their first spontaneous breathing trial (SBT)
Difficult-to-wean
Fail their first SBT and then require up to three SBTs or seven days to pass an SBT
Prolonged weaning
Patients who require more than three SBT or 7 days of weaning after the first SBT.
Eclampsia
The development of seizures in association with pre-eclampsia
Pre-eclampsia
MedStudy
There are 4 categories of HTN in pregnancy:
- Chronic HTN: preexisting HTN or HTN diagnosed before the 20th week of gestation
- Preeclampsia: New onset of HTN + proteinuria or other significant organ dysfunction after the 20 week of gestation in a woman with no history of HTN
- Gestational HTN: Onset after the 20th week and no proteinuria in a woman with no history of HTN
- Chronic HTN with superimposed preeclampsia: worsening HTN new-onset proteinuria after the 20th week of gestation in a woman with history of chronic HTN
Autonomy
Respect for the patient’s right to self-determination
Beneficence
The duty to ‘do good’
Non-maleficence
The duty to ‘not do bad’
Justice
To treat all people equally and equitably.
Submassive PE
Signs of RV dysfunction plus elevated cardiac Troponin-I but without systemic shock/hypotension
It is intermediate-high risk
Brain Death
A. Prerequisites before brain death exam
B. Neurologic assessment
1. Coma (absence of response to pain)
2. Absence of brain stem reflexes
3. Apnea test
a) Prerequisites:
- Core temperature ≥ 36.5°C
- Euvolemia. positive fluid balance in the previous 6 hours
- Normal PCO2. arterial PCO2 ≥ 40 mm Hg
- Normal PO2. preoxygenation to arterial PO2 ≥ 200 mm Hg
b) Procedure
c) Special situations
C. Ancillary Tests
D. Documentation
- time of death the time of completion of the first set of tests confirming brainstem death
Acute severe asthma
- PEFR 33-50% best or predicted
- RR ≥25/min
- HR ≥110 bpm
- Inability to complete sentences
CSW
- Low or normal serum Na+
- High or normal serum osmolality?
- High or normal urine osmolality
- Urinary sodium >40Meq
