General PA Review Set 2 Flashcards
What measures can prevent early delivery?
- Tocolytics
- beta mimetics
- Antenatal Corticosteroids
What Tocolytics are used to relax/slow the progression of labor/contractions? (4)
- Mag sulfate
- indomethacin (or any other NSAID)
- Nitroglycerin
- Salbutamol (within 48hrs)
What are contraindications for Tocolytic use?
Hypoglycemia and renal failure
What is the difference between Omphalocele and Gastroschisis?
Both are fetal abdomen issues
- Omphalocele = protruding sac of organs near umbilical cord
- Gastroschisis = no sac, just organs
What is Eclampsia?
BP Crisis
- > 160/110
- Seizures
- GERD
- Oliguria
- Headaches
What risks are associated with blood pressure disorders, such as hypertension or preeclampsia to maternal mothers and babes?
High maternal and babe risk, could cause
- Placental abruption
- preterm delivery
How would you treat or manage eclampsia?
Antihypertensive
- immediate delivery
- mag sulfate if not appropriate or stable enough
Normal RR and HR for newborns?
- RR= 30-60/min
- Preterm = more erratic (>60 is tachypneic)
- Periodic breathing - breathing with short period of apnea (10 seconds), common with preemies
- HR = 110-160 bpm
What is the oxygenation index (OI) used to assess?
Is used as a marker of respiratory failure
- commonly used in pphn
- Measures the amount of respiratory support needed to maintain a level of oxygenation
- How much FiO2 is needed to maintain adequate O2 sats and PaO2
What does a high oxygenation index (OI) indicate?
Increased oxygen demand; higher = increased fiO2 demand = sicker pt
What is Mean Airway Pressure (MAP)?
MAP reflects the average pressure in the pts airway throughout the resp cycle during mech ventilation (average of PIP and PEEP)
Why is Mean Airway Pressure (MAP) important in oxygenation?
MAP contributes to alveolar recruitment and keeps the alveoli open which aids in improving oxygen delivery and v/q matching
- aka increasing MAP improves lung inflation and oxygenation
What is a Empyema?
Pockets of pus that have collected inside a body cavity; they can form if bacterial infection is left untreated or fails to respond to treatment
- develops commonly in the pleural space
How can you clinically assess if between a blood gas is arterial or venous?
If SpO2 >90%, PaO2 shouldn’t be less than 60.
- if below, it could be a VBG
what is peripheral neuropathy?
When the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged.
- Causes weakness, numbness and pain, usually in the hands and feet.
- Can affect digestion and urination.
What is Transient ischemic attack (TIA)?
A TIA is a stroke that lasts only a few minutes. It occurs when the blood supply to part of the brain is briefly interrupted.
- TIA symptoms similar to stroke but do not last as long.
What does an increase in Troponin indicate?
Heart or blood issue of some sort
- Troponin is leaking into blood stream from heart
- Check for hypovolemia
TBI protocol goals?
- PaO2 = 80-120
- PEEP up to 15 (max)
- PCO2 high normal
- O2 low normal
- Need to verify and adjust —> if Pao2 >65
Nitric Oxide (iNO)
ppHn and refractory hypoxemia
- verify and add more if needed
Heated vs cold humidity indications
- heated to mobilize
- cold to prevent drying
Indications of DKA?
- Elevated glucose (blood sugar)
- Acidosis
- Anion Gap
- Add more later……
White blood cell (WBC)
4-11x10^9L
Normal RBC?
3.8-5.2 x10^12
Normal hemoglobin
120-160
Normal Hematocrit
0.36-0.48 l
Normal platelet count
140-400x10^9L
Normal monocyte
0-1.1x10^9L
Normal Eosinophil
0-0.7x10^9L
Normal Basophil
0-0.3x10^9 L
What is the function of Granlocytes?
Granulocytes are a type of WBC that contain the following in their cytoplasm:
- Neutrophils
- Eosinphils
- Basophils
Granulocytes are apart of the immune response to infection
What is the function of Granlocytes?
Granulocytes are a type of WBC that contain the following in their cytoplasm:
- Neutrophils
- Eosinphils
- Basophils
Granulocytes are apart of the immune response to infection
Neutrophil function?
The innate immune response, acts as the first responders to microbial infection. Engulf and digest (phagocytosis)
- Enzymes are released to kill microbes
Eosinophil function
Immune response to parasitic infections and allergic reaction’s
- They release proteins to kills parasites
- They modulate inflammatory response by releasing cytokines and growth factors as the allergic response (inflammation and damage)
Basophil function
Mediation of allergic and inflammatory response
- release histamines and other mediators during allergic reactions and asthma
- Contributes to vasodilation, increased vascular permeability, and smooth muscle contraction.
- Release heparin (anticoagulant) to prevent blood clotting
Neutrophil vs Lymphocyte function?
Innate (neutrophil) vs adaptive (lymphocyte) response to infection
- Neutrophils are the first responders and are quick to act
- Lymphocytes arrive after neutrophils as adaptive response
Describe methods used to control ICP
- Therapeutic hyperventilation to lower PaCO2 causing cerebral vasoconstriction which decreases blood in brain.
- Extraventricular drain
- Mannitol (osmotic diuretic)
How do spontanous respirations and PPV affect pulmonary artery pressure?
- Spontaneous respirations increase venous return and can relax pulmonary arteries to allow more blood flow
- PPV can cause a decreased venous return and can cause higher pulmonary artery pressure
When do we measure CVP in the respiratory cycle?
End expiratory since intrathoracic pressures are affecting CVP less at that point.
- Less significant if a catheter is in bc it is constantly measured.
Describe the relationship between PADP and PAWP?
They should be similar if mitral valve is functional
what do we need to monitor when giving ino to treat pulmonary hypertension.
hemoglobinemia: treat with methylene blue
what would be an indicator of excessive peep?
increased cvp, pap and decreased pawp, bp, and co
if untreated, what could occur with chf?
- management stat?
pulmonary edema
- tx would involve 1.0 fio2 with cpap of 8 to 10 followed by early furosemide
What is reticular honeycombing associated with on a chest x ray?
Any interstitial lung disease
- i.e pulmonary fibrosis
- asbestosis
- add more lol
What are lung abscesses commonly associated with on a chest x ray?
lung abscess are usually associated with aspiration or any foreign object that goes into the lungs
- The theory is that it necrotizing tissue in the lungs/aleovli and encapsulates it into a sphere
- the lung marking looks like a sphere with a horizontal line through it on the chest x ray (half dark/white)
- air/fluid filled cavity
What is an empyema?
Collection of pus in a space
What can decreased urine output perfusion indicate?
Decreased u/o can indicate decreased perfusion to kidneys
Gold standard for measuring BP in neonates?
Umbilical artery catheter or intra arterial catheter
What kind of drug is used as a bridging treatment until a solution can be found to resolve the underlying cause, such as the case in shocks?
Inotropes are used as bridging therapies until shock is resolved
NICU inotropes
- Dopamine
- Dobutamine
- Epineprhine
- norepinephrine
Abnormal neonatal HR
> 220
How can you calculate a new RR given new CO2 goals but no MV?
(([Current CO2-Goal Co2]/Goal CO2)+1) x RR
You are caring for a patient who requires vasopressor support for his blood pressure. Which of the following can be used to increase blood pressure without causing peripheral vasoconstriction?
a) Epinephrine
b) Dopamine
c) Dobutamine
d) Norepinephrine
e) Vasopressin
C) Dobutamine
What is the first pass effect?
When a drug is taken in orally, it is absorbed in the GI tract and then transported to the liver via the portal vein where its metabolized before reaching systemic circulation.
- If a drug has a high pass effect, much of it is inactivated in the liver before it can have a therapeutic effect
- (oral → gut → portal vein → liver)
What enzyme to ACE inhibitors prevent from forming?
Angiotensin 2
Hypovolemic Shock profile
- Clues + Hx?
Cause: Blood/fluid loss (trauma, dehydration, burns)
- CVP: ↓ (not enough blood volume)
- PCWP: ↓ (left heart underfilled)
- CO: ↓ (not enough preload to pump)
- SVR: ↑ (body clamps down to compensate)
Clues:
- Flat neck veins
- Tachycardia, hypotension
- Cool, clammy skin
- Hx of vomiting, bleeding, or surgery
Cardiogenic Shock profile
- Clues + Hx?
Cause: Pump failure (e.g. MI, CHF, arrhythmia)
- CVP: ↑ (backing up from RV)
- PCWP: ↑ (fluid backlogs into lungs)
- CO: ↓ (poor pump)
- SVR: ↑ (compensatory vasoconstriction)
Clues:
- Crackles, S3 gallop
- Cool extremities
- Low urine output
- May have hx of CAD or acute MI
Obstructive Shock profile
- Clues + Hx?
Cause: Physical block to blood flow:
- (PE (pulmonary embolism), Cardiac tamponade, Tension pneumothorax)
- CVP: ↑ (can’t eject to lungs)
- PAP: ↑ (esp. in PE)
- PCWP: N or ↑ (backlog if tamponade)
- CO: ↓ (heart can’t fill or eject)
- SVR: ↑ (trying to compensate)
Clues:
- Sudden dyspnea, chest pain
- JVD (↑ CVP), muffled heart sounds (tamponade)
- Pulsus paradoxus
- May need needle decompression or thrombolytics
Warm vs cold shock profile (Early vs late sepsis)
- clues + Hx
9
Common clues for:
- MI, PE, Cardiac Tamponade, Sepsis, CHF, Pneumothorax
Define Autoclave (steam under pressure)
Normal operating levels are 15 min at
121 C and 15psig (2atm)
- Autoclaving sterilizes equipment
- Kills organisms by coagulation of the cell protein.
Define Pasteurization
Pasteurization disinfects equipment, but
spores are not killed.
What do early, late, and variable decelerations indicate?
Think VEAL CHOP
- Variable (w or V dips) = cord compression
- Early (mirror contractions) = head compression
- Accerlerations (temp HR increase) = Okay
- Late (lowere HR after contractions) = placental insufficiency
What are 3 lung volume tests?
HE dilution, nitrogen washout, pleth
What lung volume test do we not perform for COPDers?
Nitrogen washout; test gives 100% O2 and we don’t do that for COPDers
What lung volume test should you perform?
