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Surgery > Fiser ABSITE Ch. 16 Critical Care > Flashcards

Fiser ABSITE Ch. 16 Critical Care Flashcards

1
Q

What is the normal range for CO?

A

4-8 L/min

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2
Q

What is the normal range for Cardiac Index?

A

2.5-4

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3
Q

What is the normal range for systemic vascular resistance? and systemic vascular resistance index?

A

800-1400, 1500-2400

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4
Q

What is the normal PCWP?

A

11 +- 4

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5
Q

What is the normal CVP?

A

7 +- 2

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6
Q

What is the normal pulmonary artery pressures?

A

20-30/6-15

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7
Q

What is the normal mixed venous oxygen saturation SvO2?

A

75+-5

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8
Q

What percentage of CO does the following organs get? kidney, brain, heart

A

25, 15, 5 respectively

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9
Q

What is the formula for MAP?

A

CO x SVR

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10
Q

What is the formula for ejection fraction?

A

stroke volume/EDV

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11
Q

Cardiac output increases with HR up to 120-150 bpm, then starts to go down, why?

A

decreased diastolic filling time

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12
Q

Atrial kick accounts for what % of LVEDV?

A

15-30%

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13
Q

Automatic increase in contractility secondary to increase in afterload. What is this effect called? What about automatic increase in contractility secondary to increased HR?

A

Anrep effect

Bowditch effect

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14
Q

What is the normal O2 delivery-to-consumption ratio? What increases to keep this ratio constant?

A

5:1, CO

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15
Q

What is the normal SvO2?

A

75%

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16
Q

What measurement can be thrown off by pulmonary htn, aortic regurg, mitral stenosis, mitral regurg, high PEEP, porr LV compliance?

A

Wedge

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17
Q

What is the only way to measure pulmonary vascular resistance?

A

swan

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18
Q

Which zone of the lung do you place a swan?

A

zone III (lower lung)

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19
Q

Hemoptysis after flushing Swan. Name three interventions.

A

increase PEEP to tamponade the pulmonary artery bleed,
mainstem intubate the nonaffected side,
try to place a Fogarty down the affected side,
may need thoracotomy and lobectomy

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20
Q

Name two relative contraindications to a swan.

A

previous pneumonectomy, LBBB

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21
Q

In this pulmonary artery wedge tracing, wedge pressure is measured at end expiration. Which point is for spontaneous breathing pts and which is for pts undergoing positive pressure ventilation?

A

//fce-study.netdna-ssl.com/images/upload-flashcards/154221/870299_m.png\A is for spontaneous, B is for vent

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22
Q

What are the two primary determinants of myocardial O2 consumption -> can lead to myocardial ischemia?

A

increased ventricular wall tension and HR

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23
Q

Why is LV blood 5 mmHg of PO2 lower than pulmonary capillaries?

A

unsaturated bronchial blood empties into pulmonary veins

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24
Q

What is the normal alveolar-arterial gradient in a non ventilated pt?

A

10-15 mmHg

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25
Q

Where is blood with the lowest venous saturation located?

A

coronary venous blood (30%)

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26
Q

Cardiovascular collapse; characteristically unresponsive to fluids and pressors.

A

Acute adrenal insufficiency

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27
Q

hyperpigmentation, weakness, weight loss, GI sx, increased K, decreased Na, fever, hypotension.

A

chronic adrenal insufficiency

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28
Q

Steroid potency:
1x - cortisone, hydrocortisone
___ - prednisone, prednisolone, methylprednisolone
___ - dexamethasone

A

5x; 30x

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29
Q

Neurogenic shock - loss of sympathetic tone. Usually have decreased HR, decreased BP, warm skin. Tx?

A

give volume 1st, then phenylephrine after resuscitation; give steroids for blunt spinal trauma with deficit

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30
Q

What is the initial alteration in hemorrhagic shock?

A

increased diastolic pressure

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31
Q

What is the tx for cardiac tamponade?

A

fluid resuscitation initially; need pericardial window or pericardiocentesis

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32
Q

What is the CO and SVRI in hemorrhagic shock (increased or decreased)? and septic shock?

A

CO is decreased, SVRI is increased in hemorrhagic shock; CO is increased, SVRI is decreased in septic shock

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33
Q

What is the triad of hyperventilation, confusion and respiratory alkalosis?

A

early sepsis triad

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34
Q

What is the insulin and glucose in early vs late gram-negative sepsis?

A

Early is decreased insulin and increased glucose due to impaired utilisation; Late is increased insulin and increased glucose due to insulin resistance

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35
Q

When does hyperglycemia occur in sepsis?

A

just before pt becomes clinically septic

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36
Q

What is activated protein C (Xigris) used for and what is the mechanism?

A

used for sepsis; mechanism is fibrinolysis

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37
Q

What stain can be used to find fat in sputum in urine to help dx fat emboli?

A

sudan red

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38
Q

PA systolic pressures >40, decreased PO2 and PCO2, respiratory alkalosis, chest pain, cough, dyspnea, increased HR

A

PE

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39
Q

What is the tx for air emboli?

A

place pt head down and roll to left to keep air in RV and RA then aspirate air out with central line or PA catheter to RA/RV

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40
Q

When is IABP used? what is the contraindication? what does it improve?

A

cardiogenic shock, aortic regurgitation, improves coronary perfusion

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41
Q

Name the receptor: vascular smooth muscle constriction; gluconeogenesis, glycogenolysis

A

Alpha 1

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42
Q

Name the receptor: venous smooth muscle constriction

A

Alpha 2

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43
Q

Name the receptor: mycocardial contraction and rate

A

Beta 1

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44
Q

Name the receptor: relaxes bronchial smooth muscle, relaxes vascular smooth muscle; increases insulin, glucagon, rennin

A

Beta 2

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45
Q

Name the receptor: relax renal and splanchnic smooth muscle

A

dopamine

46
Q

Name the three receptors and associated effects for dopamine at low (0-5 ug/kg/min), medium (6-10), and high (>10) doses.

A

low - dopamine receptors (renal)
medium - beta-adrenergic (heart contractility)
high - alpha-adrenergic (vasoconstriction and increased BP)

47
Q

What receptors and affects does dobutamine affect at low (5-15 ug/kg/min) and high (>15) doses.

A

low - beta-1 (increased contractility)

high - beta 2 (vasodilation, increased HR)

48
Q

Name the drug that is a phosphodiesterase inhibitor (Increases cAMP). Results in increased Ca flux and increased myocardial contractility. Also causes vascular smooth muscle relaxation and vasodilation.

A

Milrinone

49
Q

What receptor does Phenylephrine affect?

A

alpha-1, vasoconstriction

50
Q

What receptors does Norepinepherine affect at low and high doses?

A

Low - beta-1 (increased contractility); High - alpha-1 and alpha-2

51
Q

What receptors does Epinephrine affect at low and high doses?

A

Low - beta 1 and beta 2 (increased contractility and vasodilation). Can decrease BP at low doses.
High - alpha-1 and alpha-2 (vasoconstriction). Increased cardiac ectopic pacer activity and myocardial O2 demand.

52
Q

Name the drug that hits Beta-1 and beta-2 receptors, increasing HR and contractility, vasodilates. Side effects: extremely arrhythmogenic; increased heart metabolic demand (rarely used); may actually decrease BP.

A

Isoproterenol

53
Q

Name the Vasopressin receptor: vasoconstriction of vascular smooth muscle

A

V-1

54
Q

Name the Vasopressin receptor: water reabsorption at collecting ducts

A

V-2 (intrarenal)

55
Q

Name the Vasopressin receptor: mediate release of factor VIII and vWF

A

V-2 (extrarenal)

56
Q

What is the concern with Nipride (arterial and venous dilator)?

A

Cyanide toxicity at doses ?3 ug/kg/min for 72 hrs; check thiocyanate levels and signs of metabolic acidosis

57
Q

How does nitroglycerin decrease myocardial wall tension?

A

decreasing preload

58
Q

What is the MOA of hydralazine?

A

alpha blocker

59
Q

What is the formula for compliance? What does high compliance lungs mean?

A

change in volume/change in pressure.

easy to ventilate

60
Q

Pts with ARDS, fibrotic lung disease, reperfusion injury, pulmonary edema all have reduce what?

A

pulmonary compliance

61
Q

Which part of the lungs has the highest V/Q ratio? the lowest?

A

highest in upper, lowest in lower

62
Q

On a ventilator what can be increased to improve oxygenation (alveoli recruitment) -> improves FRC

A

increased PEEP

63
Q

On a ventilator what 2 things can be increased to decrease CO2?

A

increased rate or volume

64
Q

Normal weaning parameters:
negative inspiratory force (NIF) > ___,
FiO2 ___
PCO2 ___

A 
negative inspiratory force (NIF) > 20,
FiO2  60
PCO2  93%
off pressors,
follows commands,
can protect airway
65
Q

Barotrauma on vent - high risk if plateus >___ and peaks >___ -> consider prophylactic ___

A

30,50, chest tubes

66
Q

What does pressure support on a vent do?

A

decreases the work of breathing (inspiratory pressure is held constant until minimum volume is achieved)

67
Q

Excessive PEEP complications include decreased RA filling, decreased CO, decreased renal blood flow and decreased urine output and increased ___

A

pulmonary vascular resistance

68
Q

What 3 types of pts where high frequency ventilation is used?

A

kids, tacheoesophageal fistula, bronchopleural fistula

69
Q

Why is inverse ratio ventilation used? (normal 1:2 I:E phase; go to 2:1)

A

helps reduce barotrauma

70
Q

What is the formula for minute ventilation?

A

TV x RR

71
Q

What class of lung disease is represented by decreased TLC, decreased RV, decreased FVC, FEV1 can be normal or increased?

A

restrictive lung disease

72
Q

What class of lung disease is represented by increased total lung capacity, increased residual volume and decreased FEV1?

A

obstructive lung disease

73
Q

What is the most common cause of ARDS?

A

sepsis

74
Q

Acute Lung Injury is defined by acute onset, bilateral pulmonary infiltrates, PaO2/FiO2

A

PaO2/FiO2

75
Q

What two cytokines mediate SIRS?

A

TNF-alpha and IL-1

76
Q

What are the 4 SIRS criteria?

A

Temp >38 or less than 36

RR >20 or Pco2 12,000 or 90

77
Q

SIRS -> Sepsis -> Septic Shock -> ___

A

MOD (Progressive but reversible dysfunction of 2 or more organs arising from an acute disruption of normal homeostasis)

78
Q

What is the name of the syndrome of chemical pneumonitis from aspiration of gastric secretions.

A

Mendelson’s

79
Q

Most common cause of fever in the first 48 hours after operation?

A

atelectasis

80
Q

What effect does the following have on the lungs? bradykinin, PGEi, prostacyclin (PGI2), nitric oxide

A

pulmonary vasodilation

81
Q

What effect does the following have on the lungs? histamine, serotonin, TXA2, epinephrine, norepinephrine, hypoxia, acidosis

A

pulmonary vasoconstriction

82
Q

What effect does alkalosis have on pulmonary vasculature? and acidosis?

A

alkalosis - pulmonary vasodilator

acidosis - pulmonary vasoconstrictor

83
Q

What does nitroprusside, nitroglycerine, and nifedipine do to the pulmonary vasculature?

A

pulmonary shunting

84
Q

What is the most common cause of postoperative renal failure?

A

hypotension

85
Q

What percentage of nephrons need to be damaged before renal dysfunction occurs?

A

70%

86
Q

What is the best test for azotemia?

A

FeNa

87
Q

What are the three steps to treating Oliguria?

A

1st make sure pt is volume loaded (CVP 11-15 mmHg), 2nd try diuretic trial (Lasix or butanamide); 3rd dialysis if needed

88
Q

Renin is released in response to decreased pressure sensed by ___ in kidney. Also in response to increased Na concentrations sensed by ___

A

juxtaglomerular apparatus, macula densa

89
Q

What does renin do?

A

converts angiotensinogen to angiotensin I

90
Q

What converts angiotensin I to angiotensin II?

A

angiotensin converting enzyme in the lung

91
Q

What structure releases aldosterone in response to angiotensin II?

A

adrenal cortex

92
Q

What specifically does aldosterone do to the kidney?

A

Acts on distal convoluted tubule ATPase to increase resorption of water and sodium and secretion of potassium.

93
Q

What does atrial natriuretic peptide do to the kidney? to the blood vessels?

A

inhibits Na and water resorption at the collecting ducts; vasodilator

94
Q

What specifically does ADH do to the kidney? the blood vessels?

A

Acts on the collecting ducts for water resorption; vasoconstrictor

95
Q

How do NSAIDs cause renal damage?

A

Inhibit prostaglandin synthesis, resulting in renal arteriole vasoconstriction

96
Q

How do aminoglycosides cause renal damage?

A

direct tubular injury and later renal vasoconstriction

97
Q

Myoglobin causes direct renal tubular injury. What is the tx?

A

alkalinize urine

98
Q

Contrast dyes cause direct tubular injury. What is the tx?

A

premedicate with N-acetylcysteine and volume

99
Q

The following things preclude what diagnosis?

uremia, temp

A

brain death

100
Q

How long must the following exist to declare brain death:
unresponsive to pain, absent caloric oculovestibular reflexes, absent oculocephalic reflex, positive apnea test, no corneal reflex, no gag reflex, fixed and dilated pupils.

A

6-12 hours

101
Q

What two testing modalities can be used to prove absence of brain activity?

A

EEG - electrical silence; MRA - will show no blood flow to brain

102
Q

Apnea test - disconnected from ventilation; CO2 >___ mm Hg or increase in CO2 by ___ is a positive test for apnea. If arterial pressure drops to

A

60, 20

103
Q

Can you still have deep tendon reflexes with brain death?

A

yes

104
Q

What does carbon monoxide do to a pulse oximeter?

A

Can falsely increase reading

105
Q

What does carbon monoxide do to hemoglobin?

A

binds hemoglobin directly creating carboxyhemoglobin

106
Q

What is an abnormal carboxyhemoglobin level? and in smokers?

A

> 10%, >20%

107
Q

What is tx for carbon monoxide poisoning?

A

100% O2 on a ventilator; may need hyperbaric O2 if really high

108
Q

Methemoglobinemia can occur from nitrites such as Hurricaine spray; nitrites bind Hgb. What is the O2 saturation? What is the tx?

A

85%, methylene blue

109
Q

Critical illness polyneuropathy - motor > sensory neuropathy; occurs with ____; can lead to failure to wean from ventilation

A

sepsis

110
Q

In endothelial cells, forms toxic oxygen radicals with reperfusion, involved in reperfusion injury. Also involved in the metabolism of purines and breakdown to uric acid

A

Xanthine oxidase

111
Q

When do seizures occur with ETOH withdrawal?

A

48 hrs

112
Q

ICU (or hospital) psychosis generally occurs after which postoperative day? What do you need to rule out?

A

3rd, metabolic and organic causes

Surgery (33 decks)

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