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Critical Care 2 > ECCO 1 > Flashcards

ECCO 1 Flashcards

1
Q

6 P’s of limb ischemia

A

pain, pallor, polar, pulselessness, poikothermia, paralysis, paresthesia

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2
Q

complication of connective tissue disorders

A

higher risk of aneurysms

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3
Q

2 s/s of AAA

A

N/V, pain in lower back

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4
Q

s/s of thoracic aortic aneurysm

A

cough
hoarse
weak voice from pressure against the laryngeal nerve
dysphagia from pressure on the esophagus

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5
Q

why is your airway/esophagus affected by a thoracic aortic aneurysm?

A

cough/hoarse/weak voice/dysphagia from pressure against the laryngeal nerve/esophagus

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6
Q

most common cause of mortality from ascending aorta/aortic arch aneurysm

A

cardiac tamponade

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7
Q

complications of ascending aorta/aortic arch aneurysnm

A

most common cause of mortality = cardiac tamponade
MI
hematoma leads to stroke

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8
Q

what happens in abdominal aortic aneurysm

A

retroperitoneal bleed from rupture

renal ischemia due to renal artery involvement

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9
Q

organ affected by an abdominal aortic anueyrysm

A

retroperitoneal bleeding from the rupture

renal ischemia due to the renal artery involvement

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10
Q

type of aneurysm that can cause spinal ischemia

A

spinal ischemia can occur with descending aorta including spinal arteries

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11
Q

complication of descending aorta aneurysm

A

spinal ischemia

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12
Q

causes brief neuro dysfunction similar to stroke that can last 1-2hr

A

carotid stenosis has brief neuro dysfunction like stroke but s/s last 1-2hrs

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13
Q

carotid stenosis

A

carotid stenosis causes brief neuro dysfunction that looks like a stroke w/ s/s that last 1-2hrs

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14
Q

complication s/p carotid stenting

A

bradycardia b/c potential baroreceptor trauma

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15
Q

consider if sudden constant abdominal pain

A

AAA

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16
Q

s/s of AAA -3

A

sudden constant abdominal pain
low bp
faint pulses

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17
Q

EPS

A

study of the heart’s specialized tissue capable of rhythmic impulses

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18
Q

single versus dual chamber pacemakers

A

single = either atrium or ventricle

ventricle - A+V

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19
Q

what does dual chamber pacing allow

A

allows the clinican to program the AV interval which is similar to the PR interval

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20
Q

AV interval (pacemaker setting)

A

AV interval is similar to the PR interval
AV interval is typically set at 0.15 seconds . set it slightly longer than the pt’s AV itnerval to allow for the pt’s ventricle to function on its own. not feasible if pt already has a long PR interval

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21
Q

typically AV interval setting for pacemakers

A

0.15 seconds

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22
Q

intervention of a ventricular pacemaker is not detecting R waves

A

sensitivity needs to be decrease/lowered to make it more sensitive

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23
Q

too high sensitivity of a pacemaker

A

too high sensitivity = pacemaker is not able to sense R waves

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24
Q

what happens when you drop sensitivity of a pacemaker

A

dropping pacemaker sensitivity is like dropping a fence to make the “R” waves visible to the pacemaker

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25
Q

2 types of pacing

A

demand versus fixed/asynchronous pacing

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26
Q

demand pacing

A

provider sets the sensitivity so the pacemaker only generates pacing stimuluis if the pt’s heart failus to do so after a set amount of time
lack of intrinsic heart activity triggers the pacemaker to generate an impulse

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27
Q

what triggers a pacemaker operating under demand pacing?

A

lack of intrinsic heart activity triggers the pacemaker to generate an impusle

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28
Q

fixed pacing

A

aka asynchronous pacing

  • sensitivity is set so that the pacemaker cannot sense intrinsic heart activity and delivers output at a set rate regardless of if the pt has intrinsic heart drive
  • fixed pacing is risky b/c it can cause vfib if the pacemaker stimulus happens on the T wave
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29
Q

complication of fixed pacing

A

risky b/c it can cause vfib if the pacemaker stimulus happens on the T wave

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30
Q

“capture” (pacemaker)

A

pacing spike after P/QRS

artierial capture is difficult to see bc the atrialcom[plexes are small

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31
Q

set up tempoary pacemaker

A
  1. connect lead wires
  2. turn on & set mode
  3. set rate (60 -80 bpm or per orders)
  4. set output (increase mA) until capture
    - if emergency, start at max mA to quickly gain capture)
  5. set sensitivity. start at the highest number and decrease until “the fence drops low enough so you can see the intrinsic beats/R wave”
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32
Q

rate chosen when you set up a tempoary pacemaker

A

60-80 bpm

or per orders

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33
Q

set output for tempoary pacemaker

A

increase output (mA) until capture. if emergency, start at maximum mA and decrease until “the fence drops low enough so you can see the intrinsic beats/R wave”

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34
Q

set sensitivity for tempoary pacemaker

A

start at the highest number and decrease “untilt eh fence drops low enough so youcan see intrinsic beats/R wave”

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35
Q

setting sensitivity for tempoary pacemakers

transcutaneous versus transvenous

A 
transcutaneous = 20 -200 mA
transvenous = 0.1 -25 mA
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36
Q

symptomatic bradycardia

A

atropine

pacing

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37
Q

placement of the transvenous pacemaker

A

goes in via the subclavian vein

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38
Q

batteries of pacemakers

A

last 8 -10 years

might nbot be able to get MRI (check pt’s card)

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39
Q

3 types of tempoary pacemakers

A 
transcutanous = skin pads
transvenous = via subclavian vein
epicardial = electrodes placed during heart surgery
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40
Q

intervention once you have set up capture for a tempoary pacemaker

A

once capture is obtained, increase output by 2 mA to p rovide a safety margin so pacing will continue if pt’s condition changes

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41
Q

pacemaker assessment

A

need a palpable pulse for each QRS

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42
Q

placement of transcutaneous pacing pads

A

option 1: right sternum between clavicle & left chest wall. negative anterior or 4-5the intercostal space left mid clavicular under breast not below

option 2: right sternum between clavicle & left scapula

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43
Q

difference in output setting transcutaneous verus transvenous/epicardial pacing

A

transcutaneous pacing has higher mA setting b/c paces through the skin

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44
Q

how to tell the difference between epicardial pacing wires

A

(wires directly placed onto the heart during surgery)

atrial wires are on the right of the sternum; ventricular on the left)

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45
Q

important thing to remember about handling epicardial pacemaker wires

A

atrial = wire on the right of the sternum
ventricular = wire on the left of th sternum
*wear gloves, keep wires separated, insulated

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46
Q

things to know when receiving report about transcutaneous/venous/epicardial pacemakers

A

pacing mode
rate
sensitivity in mV
output in mA

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47
Q

unit to express sensitivity (pacing)

A

mV

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48
Q

unit to express output (pacing)

A

mA

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49
Q

decipher pacemaker codes

A 
#1: chamber paced
#2: chamber sensed
#3: response to a sensed event
#4: programmable function
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50
Q

pacemaker code (1st letter)

A

what chamber is paced?
A = atrial
V= ventricle
D = dual|*pace both to get ventricular kick

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51
Q

pacemaker code (2nd letter)

A 
What chamber sensed?
O = none.  sensing function is not enabled
A = atrial sensing
V= ventricle sensing
D = dual sensing
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52
Q

pacemaker code (3rd letter)

A 
response to sensing
O= none
I= inhibited
T= triggered
D = dual
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53
Q

sensing (with regards to pacing)

A

ability to detect the pt’s intrinsic atrial/ventricualr activity and respond appropriately

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54
Q

ability to detect the pt’s intrinsic atrial/ventricular activity and to reponse appropriately

A

sensing

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55
Q

pacemaker code (4th letter)

A

if “R” rate modulation is present

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56
Q

4 pacemaker problems

A

failure to pace
failure to sense
oversensing
undersensing

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57
Q

failure to pace

A

generator fails to deliver an electrical impulse at the preprogramemd interval

  • no pacing spike on the EKG strip &
  • intrinsic rate is lower than the programmed pacing rate
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58
Q

failure to capture

A

stimulus is delivered but doesn’t result in a depolarization of the paced chamber

  • no p wave after atrial spike
  • no QRS after ventricular spike
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59
Q

pacemaker problem if there is no pacing spike on EKG

A

failure to pace

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60
Q

pacemaker problem if the intrinsic rate is lower than the programmed pacing rate

A

failure to pace

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61
Q

pacemaker problem if there is n p wave after atrial spike

A

failure to capture

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62
Q

pacemaker problem if there is no QRS after ventricular spike

A

failure to capture

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63
Q

what do pacing spikes tell you

A

pacing spikes indicate pacemaker fired but doesn’t ensure capture. to achieve capture, the elctrode must deliver the impusle and the heart must respond

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64
Q

undersensing

A

sends out pacing spikes even though the heart is generating p wave/WRS at adequate intervals
*pacing spikes appear too soon after intrinsic heart events

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65
Q

pacing problem if pacing spikes appear too soon after intrinsic heart events

A

undersensing

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66
Q

oversensing

A

interprets non cardiac acitvity as intrinsic activity. senses waveforms it should not like t waves
*pacing occurs at less than the programmed rate

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67
Q

pacing problem if the pacing occurs at less than the programmed rate

A

oversensing

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68
Q

causes of failrue to pace

A

low battery
loose lead wires
dislodge
programmed rate is lower than order

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69
Q

troubleshoot failure to pace -5

A 
CXR to check for dislodgement
new batteries
tighten wires
validate rate as ordered
do sensitivity threshold
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70
Q

causes of failure to capture -6

A 
low battery (can't send out signal for depolarization)
output set too low to stimulate 
acid-base imbalance
fibrosis at catheter tip
nonresponsive ischemic tissue
hypoxia
high CO2
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71
Q

troubleshoot failure to capture -3

A

tighten wires
new batteries
increase mA

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72
Q

causes of undersensing

A

low battery
disconnected/dislodged
sensitivity too high

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73
Q

troubleshoot undersensing

A

replace batteries
tighten wires
validate sensitivity or decrease mV
CXR for lead integirty

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74
Q

causes of oversensing -4

A

low battery
dislodgement
artifact r/t shivering/seizing or other electrical equipmenbt in the room
sensitivity (mV) too low so pacemaker senses other heart activity

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75
Q

troubleshooting oversensing -5

A

replace batteries
tighten wires
unplug/remove unnecessary electrical equipment in the room
validate sensitivity so increae mV so pacemaker is less sensitive
CXR for lead wire integrity

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76
Q

hallmarks of undersensing

A

ventriclar spikes shortly after intrinsic QRS so the pacemaker doesn’t recognize heart’s own tintrinsic

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77
Q

what is happening in failure to capture

A

spikes fall where they should produce a QRS but dont’

  • need more energy to capture
  • increase mA setting
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78
Q

who should get a ICD

A

implantable cardioverter defibrillator

  • anyone at risk for sudden heart death
  • HF with low EF, sustained vtach or congenital filure with ventriclar life-theatening dysrhythmias,
  • shock feels liek a chest blow lightheadedness r/t dysrhythmia
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79
Q

use of the magnet

A

magnet over ICD to suspend the antidysthrmic feature

  • Pacemaker feture is okay. once the magnet is off, ti can continue to shock
  • if tempoarty suspend it, interrogate it to ensure the programming is still correct
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80
Q

definition: oversensing

A

electrical signal inappropriately recognized as native heart activity

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81
Q

electrical signal inappropriately recognized as native heart activity

A

oversensing

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82
Q

definition: failure to pace

A

paced stimulus not generated despite intrinsic rate lower programmed rate

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83
Q

paced stimulus not generated despite intrinsic rate lower programmed rate

A

failrue to pace

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84
Q

definition: undersensing

A

pacing stimulus delivered too after intrinsic event

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85
Q

pacing stimulus delivered too soon after intrinsic event

A

undersensing

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86
Q

definition: falure to capture

A

paced stimulus doesn’t result in a palpable pusle or depolarization

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87
Q

paced stimulus doesn’t result in a palpable pulse or depolarization

A

failure to capture

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88
Q

troubleshooting for all types of pacemaker problems

A

check battery
wire/cable connection/lead
CXR

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89
Q

troubleshooting specifically for failure to pace

A

validate rate settings. evaluate sensitivity threshold

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90
Q

troubleshooting specifically for failure to capture

A

increase mA,

Turn patient ont left side

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91
Q

troubleshooting specifically for undersensing

A

validate sensitivity settings

decrease mV

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92
Q

troubleshooting specifically for oversensing

A

unplug/remove unnecessarily electrical equipment in the room
validate sensitivity setting
adjust mV to a higher number

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93
Q

what type of pacing error can be troublshooted by unplugging/removing unnecessary electrical equpment from the room

A

oversensing

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94
Q

main step to consider when treating bradycardia

A

is there a reversible cause?

if not, do permanent pacemaker not tempoary

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95
Q

mV versus mA

A 
mV = sensitivity
mA = output
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96
Q

intervention if pacemaker spikes occur and aren’t followed by a ventricular complex

A

if pacemaker spike occurs and isn’t followed by a ventricular complex, increase mA level until capture is consistently acheived

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97
Q

first step to fix failure to pace

A

check/replace batteries

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98
Q

how to identify failrue to pace

A

HR is lower tha pacemaker set rate and no pacemaker spikes are seen

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99
Q

HR is lower than the pacemaker set rate and no pacemaker spikes are seen

A

failure to pace

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100
Q

why should you check pacing thresholds on tempoary pacemakers

A

b/c you need to know the amount of energy that will trigger depolarization

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101
Q

rx to avoid in idioventricualr rhythms

A

avoid giving lidocaine/antiarrythmics b/c that rhythm is protective

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102
Q

mA in an emergency

A

EEG to help dx electrical activity in the brain

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103
Q

intervention if pt is on a continuous EEG to help monitor events

A

if on a continous EEG, press a button if pt has unusual behavior/motor activity so the neurologist can correlate that behavior/activity with EEEG

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104
Q

site for lumbar puncture

A

3-4 or 4-5 lumbar

into subarachnoid spacesi

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105
Q

site of CSF

A

subarachnoid space = pia and arachnoid

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106
Q

between pia and arachnoid

A

subarachnoid = site of CSF

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107
Q

contraindications to LP

A

high ICP b/c risk of herniation

anticoagulants/antiplt b/c hematoma

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108
Q

risk of motor/sensory deficits of LP

A

low risk of motor/sensory deficits post LP b/c the spinal cord ends above the level at which the needle is inserted

109
Q

Lou Gehrig’s Disease

A

ALS = amylotrophic lateral sclerossi

110
Q

s/s of meningitis-4

A 
fever
vomit
HA
stiff neck
*inflammation of hte brain/spinal cord
111
Q

inflammation of the brain & spinal cord

A

meningitis

112
Q

between dura and skull

A

epidural

113
Q

between dura and arachnoid

A

subdural

114
Q

difference between epidural and subdural

A

epidural = dura & skull

subdural =- dura & arachnoid

115
Q

blood filled dilation

A

aneurysm

116
Q

consider if pt has contrast

A

contrast is nephrotoxic

117
Q

best test for early detection of brain ischemia

A

MRI can detect brain ischemia before it is present on CT

118
Q

risk of MRI if pt’ has metal/bacemaker

A

item moves or warms up

119
Q

surgical repair of a blood vessel

A

angioplasy

120
Q

angeiplasty

A

surgical repair of a blood vessel

121
Q

Transcranial Dopplers

A

doppler of hte brain to examine blood circulation

  • good for trendign blood flow venocities in subarachnoid hemorrhage and to evaluate for presence of vasospasm
  • if arterial passage is narrowed, blood flow veocity increase
122
Q

complication of femoral access sites

A

increase risk of retroperiotneal bleedign

123
Q

what is diabetes insipitus associate dwith

A

CNS dysfunction and TBI

124
Q

consider if pt has CNS dysfunction/TBI

A

diabetes insipitus

125
Q

urine in diabetes insipitus

A

lots of dilute urine

126
Q

ADH in diabetes insipitus

A

low ADH b/c peeding out

127
Q

low ADH

A

diabetes insipitus

128
Q

alterations in ADH

A

low ADH =diabetes insipitus

high ADH = SIADH

129
Q

urine in SIADH

A

low output and concentrated

130
Q

ADH in SIADH

A

high ADH so holds onto water

131
Q

cerebral salt wasting

A

ASSOCIATED WITH SUBARACHNOID HEMORRHAGE.
ALTERATIONS IN bnp
LOTS OF WATER ECRETED SO LOW na

132
Q

hallmarks of DI

A

excessive thirst
diluted urine
consider if TBI or CNS dysfunction

133
Q

potential complication of Guillain-barre

A

SIADH

134
Q

increased urine osmolarity

A

high solutes, low water

135
Q

goal of osmotherapy

A

induce dehydration to decrease water on the brain

136
Q

complication postop pituitiary tumor removal

A

risk of DI

137
Q

Cerebyx

A

antielipetic

138
Q

use of transcranial doppler post subarachnoid hemorrhage

A

measures b. flo & assess for vasospasm

139
Q

complications associated with TI

A

TBI is associate dwith low Na, hand hypnatremi r/t SIAD

140
Q

noninvasive ICP monitoring

A

quantitative pupillometery
(trending pupil size/reactivity
*useful when serial measurements are obtained by different providers

141
Q

2 most common sites for ICP monitoring

A

brain parenchyma

ventricles

142
Q

ICP catheter that measures CSF

A

intraventricular catheter

143
Q

why are intraventicular catheters difficlut to place

A

difficult to place if cerebral edema b/c the ventricles get smaller as edema worsens. becasue as ICP incrases, CSF is shunted out (Monroe Kellie)

144
Q

landmark fo the forament of Monroe

A

tragus of the ear (tragus isn’t the earlobe)

145
Q

use of an intraventricular catheter

A

transducer and CSF drainage

146
Q

ICP waveforms

A
  • pulsations that originate in teh choroid plexus of the ventricels
  • triphasic w/peaks at P1, P2, and P3
147
Q

3 points, peaks, stages

A

triphasic

148
Q

waveform that has P1, P2, P3

A

ICP waveform

149
Q

what does decreased intracranila complicance indicate

A

decreased intracranial complicance indicates the theere is a laock of space within the cranium to accommodate for blood/CSF/brain tissue (Monroe Kelli)

150
Q

positioning if you need to ensure ICP

A

neutral head poistion
avoid extreme hip flexion b/c that improves jugular venous return b/c decreases intrathoriacif and intrabdominal pressure
HOB 30 degrees

151
Q

effect of fever on the brain

A

increased cerebral metabolism demands which incrases ICP

152
Q

crainotomy versus crainectomy versus crainoplasty

A

ectomy = bone flap removed and not replaced
crainotomy = bone flap is replaced
crainoplasty: surgical repair of bone defect post previous operation

153
Q

serum Na in diabetes insipitus

A

DI = high serum Na

154
Q

leading causes of secondary brain injury

A

low BP

hypoxia

155
Q

Train of 4

A

measures magnitude/type of neuromusclar blockade based on teh ratio of the amplitude of the 4th evoked mechanical repsonse to the 1st one when a total of four 2 Hz electrical ipluses are appleid for 2 second sto a peripheral motor nerve

156
Q

brain in seiure/agniation/fever

A

increased metabolic demand

157
Q

decreases oxygen suypply to brain

A

hypooxia
low bp
vasospasm
thrombus

158
Q

calculate CCP

A

MAP - iCP

159
Q

MAP - ICP

A

CCP

160
Q

goal of CCP if brain injury

A

60-70

161
Q

interstitial

A

fluid filled areas surround the cells of a givne tissue

162
Q

PbtO2

A

partial pressure of oxygen in brain tissue

-use b/c ICP and CCP values desn’t always represent tissue oxygenation in an injured brain

163
Q

partialpressure of oxygen in brain tissue

A

PbTO2

164
Q

goal PbTO2

A

partial pressure of oxygen in brain tissue

goal = over 20 mm hg

165
Q

rate of CSF drainage if the device is working properly

A

if a CSF device drain is working properly, CSF will drip into the chamber at a rate determined by the height of hte collection chamber

166
Q

causes of a dampened ICP waveform

A

air bubbles in teh tube
blocked tubing
stopcock open
brain compartment isn’t completely rigid

167
Q

intervention if you notice dampenin go nthe ICP monitor

A

check for air bubbles

168
Q

intervention of the ICP waveform has P2 higher than P1

A

there is a decrease in intracranial compliance an the pt might not be able to compensate for intracrainal volume changes

169
Q

most common type of stroke

A

ischemic (blockage) = 80%

170
Q

aka blood clot

A

thrombus

embolis

171
Q

s/s of stroke

A 
aphasia
trouble speaking
vision loss
loss of balance/coordinatino
numbness/weakness on one side of the body
172
Q

s/s that are less likely to be seen in ischemic stroke

A

LOC and HA

173
Q

s/s of hemorrhagic stroke

A

HA b/c blood irritatesthe cerebal tissue
high ICP so LOC
increased ICP b/c blood acting on space occupying lesion

174
Q

type of stroke that is more likely to cause HA

A

hemorrhagic b/c blood irritates teh brain tissue

175
Q

Broca’s area

A

frontal lobe

expressive aphasia

176
Q

expressive aphasia

A

Broca’s area

frontal lobe

177
Q

Wernicke area

A

parietal/temporal junction

receptive aphasia

178
Q

receptive aphasia

A

Wernicke area

parietal/temporal junction

179
Q

can’t speakl or comprehend

A

aphasia

180
Q

can’t recognize own neuro deficits s/p stroke

A

hemi-inattention. more common in right sided stroke

181
Q

mneumonic for early s/s of stroke

A 
BEFAST
balance
eye
face
arms
Speech
time
182
Q

imaging for stroke

A

noncon CT
ischemic doens’t show up for 6-8hrs
hemorrhagic stroke imemdiatley shows

183
Q

use of MRI for stroke

A

ischemia
blood
masses

184
Q

type of MRI sensitive to ischemic stroke

A

Diffusion-weighted imaging

185
Q

area of ischemia in brain during stroke that can be restored

A

penumbra

186
Q

penumbra

A

area of ischemia in a strooke that can be restored

187
Q

rx for strokke

A

ischemic stroke gets TPA but hemorrhagic doesn’t

188
Q

most important question to ask if suspect stroke

A

last known well

189
Q

stroke questionaire for strokes

A

National Institute of Health Stroke Scale

190
Q

BP for TPA

A

under 185/110

fist line BP control is labatalol

191
Q

first line rx for BP control so you can give TPA

A

under 185/110

fist line antiHTN is labatolol

192
Q

if pt is diagnosed with ischemic stroke post CT

A

if not a candidate for TPA post ichemic stroke, do intrartia fibrolysis if udner 6hrs

193
Q

more likely s/s with ischemic stroke

A

vision changes and weakness

194
Q

more likely s/s with hemorrhagic shock

A

HA and LOC

195
Q

stroke more likely if vision changes

A

ischemic

196
Q

stroke more likely if headache

A

hemorrhagic

197
Q

stroke more likely if LOC

A

hemorrhagic

198
Q

what is fibrolytics use for strokes based on

A

last known well

hemorrhagic stroke is r/o

199
Q

terminal product of anaerobic glycolysis

A

lactate

200
Q

what is lactate

A

terminal product of anaerobic glycolyssi

201
Q

loss of SNS tone

A

neurogenic shock

202
Q

3 stages of shock

A

compensatory
progressive
refractory

203
Q

cellular processes in 3rd spacing

A

increased capillary permeability

decreased oncotic presusr

204
Q

low aldosterone

A

Addison’s disease

205
Q

Addison’s disease

A

low aldosterone

206
Q

generalized edema

A

anasarca

207
Q

anasarca

A

generalized edema

208
Q

exxample of a rx that can cause reflex bradycardia

A

phenylephrine

209
Q

excessive perspiration

A

phenylephrine

210
Q

phenylephrine

A

excessive perspiration

211
Q

effect of histamine on vessels

A

vasoD

permeable vessel walls

212
Q

what is serotonin

A

neurotransmitter that vasoC

213
Q

neurotransmitter that vasoC

A

serotonin

214
Q

neurotransmitter that vasoD

A

histamine

215
Q

effect of serotonin on blood vessels

A

neutrotransmitter that vasoC

216
Q

low serotonin

A

depression

217
Q

cells that provide heparin

A

mast cells

218
Q

mast cells

A

mast cells are resident cells of contnectiv etissue that contains many granules of histamine and heparin

219
Q

labs that go up in anaphylaxis

A

IgE
eosinophils
mast cells
H&H b/c hemoconcentraion

220
Q

epinephrine concentration for anaphylaxis

A

1:1K

221
Q

1:on thousand epinephrine

A

anaphylaxis

222
Q

SIRS

A

sepsis inflammatory response criterial

223
Q

SOFA

A

sequential organ function assessment

224
Q

qSOFA

A

quick sequential organ functioal assessment

225
Q

SIRS

A

body’s systemic inflammatory repnsoe to critical insults

226
Q

SIRS criteria

A

WBC under 4 or over 12
HR over 90
RR over 20
temperature ouside of 36-38

227
Q

effect of ntric oxide

A

vasoD

228
Q

programmed cell death

A

apoptosis

229
Q

glucose level that is ideal in sepsis

A

keep glucose under 180g

230
Q

bleeding directly into the brain tissue

A

intracerebral hemorrhage

231
Q

tope cause of hemorrhagic shock

A

intracerebral hemorrhage

232
Q

type of stroke where seizures are more common

A

seizures are more common w/hemorrhagic stroke b/c blood irritates the brain

233
Q

s/s more likelly in hemorrhagic shock

A

N/V
eizures
HA, weakness, LOC

234
Q

what does the CT look like in hemorrhagic shock

A

blood on CT r/t hemorrhagic stroke appears as hyperdensity (bright white)

235
Q

why is intracranial hemorrhage a medical emergency

A

b/c hemotoma is a space occupying lession that directly causes cerebral edema

236
Q

what do you need to do in intracranial hemorrhage

A

needs bp control, intubation to protect airway, EVD placement

237
Q

type of IVF to use in strokes

A

only use normal saline as IVF in stroke b/c both too high/low glucose worsens shock outcomes

238
Q

why do you need a blue top in strokes

A

need coagulation profile if intracerebral hemorrhage

*if on warfainr & INR over 1.4, give prothormbin complex concentrate as a blood clotting factor prepared from FFP

239
Q

interventions for intracerebral hemorrhage

A

ventricular drain, monitor for changes, surgically evacuate clot

240
Q

accumulation of fluid in the brain ventricles

A

hydroocephalus

241
Q

accumulatin off fluid in the brain ventricels

A

hydrocephalyt

242
Q

management of hydrocephalusq

A

ventricualr shunt

243
Q

intervention if you have a CSF obstruction

A

ventri cualtr drain

244
Q

NHISS

A

national institute of health stroke scale

245
Q

interventino if you have a impendign herniation

A

surgical evacuation

246
Q

why do hemorrhagic stroke pts immediately have increased ICP

A

b/c compression of hte expanding hematoma

247
Q

ICP nursing treatments-5

A 
CPP 60-70
neutral head position
HOB elevated
airway secure
hypertonic IVF
248
Q

EVD

A

exte ventricualr drain

249
Q

“worst headache of life”

A

subarachnoid hemorrhage”

250
Q

suspect subarachnoid hemorrhage

A

worst headache of life

251
Q

cause of 50% of subarachnoid HA

A

aneurysm

252
Q

what happens in subarachnoid hemorrhage

A

brain bleed when a cerebral aneurysm ruptures a blod fille dsubarachnoid space filled with CSF

253
Q

cause of subarachnoid hemorrhage

A 
aneurysm (50%)
AVM
bleeding disorder
trauma
anticoagulation
254
Q

calculation for the Fick Method

A

CO = VO2
divided by
Ca-Cv

255
Q

Fick Method

A

says that blood flow is proprtional to the difference in concentration of a substance in the blood as it enters and leaves an organ

256
Q

how do you use the Fick Method

A

determine CO from the blood before it enters and after it leaves the lungs and from the rate at which oxygen is consumed

257
Q

dye dilution method to measure CO

A

method to measure CO in which a known quanityt and concentraiton of indocyanine or lithium is injected into the blood stream. flow and voluem are calculated by measuring the dye concentraiton at selected time intervals

258
Q

catheter tip that measures temperature

A

thermistor

259
Q

thermodilution method to measure CO

A

measruing a change in temperature of the bloodstream after injecting cool saline

260
Q

proper positioning of a PA catheter

A

PAcatheter is properly placed if proximal port is in teh R atrium and sistal in teh PA

261
Q

PAOP

A

pulmonary artery occlusion pressure

*indirect estimate of left atrium pressure

262
Q

central venous pressure

A

right atrium pressure

  • pressure in the thoracic vena cava near the right atrium
  • CVP is a major determinant of filling pressure and thus, RV preload
263
Q

what does CO/CI assess

A

forward flow of blood (blood delivery)

264
Q

what does SV/SI assess

A

pump performance (contractility)

265
Q

what does CVP/PAOP assess

A

cardiac fillling pressure and ventiuclar volume before a contraction (preload)

266
Q

what does SVR/PVR assess

A

resistance to forward flow or both sides of the heart (afterload)

267
Q

aka circulation

A

hemodynamics

high versus low blood flow states

268
Q

2 basic definitions of low CO states

A

hypovolemia

LV dysfunction

Critical Care 2 (5 decks)

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