Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PICU > General PICU > Flashcards

General PICU Flashcards

1
Q

Coagulopathy in Critical Illness - determining liver failure vs consumption

A

Check factors V, VII, VIII

Liver failure - low V/VII with normal VIII
Consumption - all low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Markers of Haemolysis

A

Decreased haptoglobulin (consumed by free Hb clearance)
Increased LDH
Increased reticulocytes
Blood film - fragmented RBC’s, reticulocytes
Coombs +/-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cerebral complications of DKA - imaging

A

Cerebral oedema - plain CT head

Sinus venous thrombosis - need contrast CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Compassionate Extubation

A

Wean ventilation prior to extubation

  • allows CO2 to rise - avoids sudden stimulus to breathe
  • creates somnolent state

Premedicate prior to extubation

  • negates sudden feeling of lack of support/panic
  • opiate and benzodiazepine

Titrate to comfort post extubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initiating CVVH in acute on chronic renal failure/high urea

A

High urea = high risk of disequilibrium syndrome

Use CVVHDF - dialysate decreases risk
Pre commencement - give mannitol 
Decrease clearance - aim 1L/m2 BSA/hr 
- standard clearance 2L/m2/hr
- enhanced clearance > 3L/m2/hr
Dialysate rate = preblood flow rate
Start with low blood flow rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Conversion cmH2O to mmHg

A

1.3 cmH2O = 1 mmHg

10 cmH2O = 7 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Intubating Long Segment Tracheal Stenosis

A

Avoid intubation if at all possible - NIV, heliox, cautious sedation

ETT position best just below cords - don’t push beyond stenosis as makes lumen even narrower

Avoid muscle relaxation - active exhalation is helpful

Ventilate with high peak pressures and low RR, ensure full expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Role of HFOV in CDH

A

CO2 clearance at lower mean airway pressures

If need HFOV for oxygenation then probably unsurvivable lesion

cf Conventional use HFOV for recruitment of lung and oxygenation in severe ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mechanisms of Hyperinflation when Ventilating Asthmatics

A

Breathing near TLC
- mechanical ventilation increases volume further

Insufficient time to exhale
- increased end exp lung volume and auto peep

Dynamic hyperinflation adaptive initially

  • increased airway diameter and elastic recoil
  • over time becomes pathological - alveolar distension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

management of acute laryngospasm

A

Deal with laryngospasm:

  • PEEP - hold sustained PEEP with bag mask
  • Jaw thrust - open airway
  • Muscle relax if above fails and intubate

Remove perpetuating stimuli:

  • sedate
  • suction oropharynx
  • check iCa
  • decompress stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

TPA administration

A

Give 10ml/kg FFP prior

  • source of fibrinogen
  • ensure normal INR
Normalise coagulation
- INR < 1.6
- fibrinogen > 2
- plts > 100
Grp and Hold current

Reduce IV heparin infusion by half 30mins prior, continue during TPA infusion

TPA 0.5mg/kg/hr x 6hrs

Increase heparin to therapeutic at end of infusion

Neuro obs Q1H, coagulation blds Q2H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Jet Ventilation

A

Suction catheter - cut off tip

  • insert one end into O2 tubing 15L/min flow (10 in babies)
  • insert end into cricoid cannula - use suction port to provide intermittent O2 flow

Size 3 ETT cap into cannula

Size 7 ETT cap into 3ml syringe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

VV-ECMO initiation

A

Avoid rapid normalisation pCO2

  • brain ischaemia
  • slow increase flows

Slow weaning of ventilation

  • high pressures pre ecmo
  • rapid decrease can result in air bubble formation
  • match slow vent wean to slow rise in flows
  • wean to rest settings 10/10/10

Slow initiation also reduces haemodynamic effects on other organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

VV-ECMO disadvantages

A

No systemic BP support

Recirculation

  • increased SvO2, decreased SaO2
  • < 10% diff SaO2:SvO2 makes recirculation likely

Lower SaO2 and PaO2 than VA-ECMO
- sats 75-85%, SvO2 > 65%

Complex cannulation - dual venous cannula or double lumen cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

VV-ECMO advantages

A

Preserves arteries

Maintains pulsatility - better solid organ function

Pulmonary oxygenation/circulation maintained

Efficient CO2 removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

VA-ECMO advantages

A

Provides CO and oxygenation

Efficient CO2 removal

SaO2 > 90, SvOw > 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

VA-ECMO disadvantages

A

Arterial cannulation

  • requires reconstruction or ligation
  • late stroke risk

Cardiac standstill - emergent LA vent

May not generate sufficient flows in sepsis - cool, muscle relax, run sats at 80

18
Q

Alveolar gas equation

A

PAO2 = (Patmospheric - Pwater) x FIO2 - PaCO2/resp quotient

PAO2 = (760 - 47) x FIO2 - PaCO2/0.8

19
Q

Oxygenation Index

A

OI = (FIO2 x MAP / PaO2) x 100

Rising OI indicates worsening lung disease.

Useful to track in cases of severe lung disease.

20
Q

Central Cyanosis - causes

A

Alveolar Hypoventilation

VQ mismatch

R to L shunt

Diffusion restriction

Abnormal Hb with decreased O2 affinity
- metHb

21
Q

Oxygen dissociation curve

A

Left Shift:

  • alkalosis
  • low pCO2
  • cold temp
  • decreased 2,3DPG
  • fetal Hb

Right Shift: decreased oxygen affinity - increased oxygen delivery to tissues

  • fever
  • acidosis
  • increased 2,3DPG
22
Q

Lung Recruitment Neonates

A

Difficult to recruit lungs

  • compliant chest walls
  • relative surfactant deficiency
  • underdeveloped pores of cohn, can’t take advantage of time constants/differential alveolar filling

Increase minute volume to improve oxygenation
- small fast breaths
PEEP/staircase recruitment limited value until develops pores of cohn.

23
Q

TBI pathophysiology

A

Loss of autoregulatory mechanisms

  1. BP autoregulation lost first
  2. Oxygen responsiveness second
  3. CO2 responsiveness last

CO2 provides most predictable change in perfusion

24
Q

Extracranial causes raised ICP

A

Ventilation issues
- Increased PEEP, high CO2, PaO2 < 60

Hyperthermia

Obstructed cerebral venous return

DKA

Hepatic Failure

Metabolic crisis - high ammonia

Toxins/medications - lead, doxycyclin, tetracycline, rofecoxhib

25
Q

Cerebral perfusion pressure targets

A

CPP targets:

< 6yrs 45-55mmHg

> 6yrs 50-60mmHg

26
Q

Vasospasm post SAH

A

Occurs several days post SAH, peak severity at 1 wk

Presentation:
- unilateral change neuro exam or increased somnelance

Represents ischaemia, expect normal ICP. Raised ICP suggests irreversible infarction

Prevention:

  • avoid hypovolaemia/ hyponataemia
  • Hb > 9g/dL
  • nimodipine - prevents increase in intracellular Ca, neuroprotective
27
Q

Management of Cerebral Vasospasm

A

Ensure adequate cerebral perfusion pressure

Triple H therapy - hyperhydrate, hypertension, haemodilution
- titrate BP to resolution of symptoms - target increase systolic BP 20mmHg

Vasodilation - milrinone

Nimodipine - neuroprotective effect seondary to reduced Ca metabolism in vulnerable brain

Interventional - balloon angioplasty

28
Q

CVP wave

A

A - atrial contraction

C- TV closure, TV bulges as ventricle starts to contract

V - filling of RA during diastolic phase

x decent - atrial relaxation and change in ventricular geometry

y decent - opening of TV and atrial emptying

29
Q

Adequate Cardiac Output on ECMO

A

Normal cardiac output
- 2.2 - 2.5L/min/m2

2 ventricle heart - usually achieved with 100ml/kg/min

Single ventricle heart - requires higher flows to maintain same cardiac index

  • 150-180ml/kg/min
  • higher flows also mitigate risk of shunt thrombosis (high haematocrit in cyanosed pt, high risk thrombosis)
30
Q

HFOV physiology

A

Higher MAP’s tolerated when lungs poorly compliant - not transmitted to cardiovascular structures

Lower Hz has greater lung excursion, increased risk barotrauma
- best to set Hz as high as tolerated, and continue to increase as lungs improve

31
Q

Congenital Diaphragmatic Hernia - prognosis

A 
Prenatal LHR (lung head ratio)
- predicts adequate lung for gas exchange
< 1 = poor
1-1.4 = associated with 38% survival
> 1.4 = improved survival

Preductal sats > 80-85R on FIO2 < 0.6 indicates adequate lung tissue

Predictors poor prognosis;

  • liver in chest
  • inability to clear CO2
  • post natal diagnosis
  • FETO study - 1/10 survival
32
Q

Congenital Diaphragmatic Hernia - management

A

Aim preductal sats > 85%

Minimal ventilation

  • HFOV
  • subphysiological TV
  • PIP < 22

PGE if RV strain/PHT

Low dose epinephrine infusion

iNO often not helpful - vascular bed not reactive. Document improved oxyenation and RV function.

33
Q

Airway Cast Management

A

Dornase Alpha
- breaks down cellular material

Inhaled heparin/urokinase/TPA
- breaks down fibrin

N-acetylcystine
- breaks down mucin

Trial agents to find most effective one
Can do ex-vivo testing on retrieved casts

34
Q

High Anion Gap Metabolic Acidosis

A

Anion gap = Na - (Cl + HCO3)
normal = 11

C   carbon monoxide, cyanide
A   alcohol, alcoholic ketoaciosis
T    toluene
M    metformin, mehtanol
U    uremia
D    DKA
P     phenformin, propylene glycol
I     iron, isoniazid
L    lactic acidosis
E    ethylene glycol
S    salicylates
35
Q

Toxidromes - cholinergic

A

Cholinergic:

  • pour fluid from all orifaces
  • diarrhoea, urination, salivation, vomiting
  • small pupils, bronchoconstriction, bradycardia

organophosphates, mushrooms, carbamates

36
Q

Toxidromes - anticholinergic

A

Anticholinergic:
- dilated pupils, hyperthermia, tachicardia, hypertension, flushing, seizures, thirst, dry skin

Atropine, TCA’s, antihistamines

37
Q

Toxidromes - sympathomimetic

A

Sympathomimetic:
- hypertension, tachicardia, dilated pupils, hyperthermia, CNS excitation

amphetamine, cocaine, ephidrine, caffeine

38
Q

Toxidromes - narcotics

A

Narcotics
- CNS depression, small pupils, apnoea/low RR, bradycardia, hypotension, pulmonary oedema

Morphine, methadone, heroin

39
Q

Serotonin Syndrome

A

Excessive stimulation of serotonin receptors

CNS - anxiety, agitation, confusion
Autonomic - diarrhoea, flushing, hypertension, hyperthermia, sweating, tachicardia, dilated pupils
Neuromuscular - clonus, hyperreflexia, increased tone, myoclonus, tremour, rigidity

SSRI, MAOI’s, amphetamines, lithium

40
Q

Desaturation during Lung Recruitment

A

Decreased venous return secondary to high ITP
- worsening SmvO2, desaturation

Increase blood flow through shunt
- overinflation of baby lung, increased PVR with blood diverted to non-recruited non-ventilated lung

Pneumothorax

41
Q

Acid Base Interpretation

A

Anion Gap = Na - (Cl + HCO3)
normal = 11

Normal AG - renal losses or GI losses

Urinary AG - (Na + K) - Cl

  • positive uAG = renal RTA
  • negative uAG = GI losses, NaHCO3
  • NH4 excreted with Cl - measured Cl will rise if kidney working appropriately

Raised AG - MUDPILES

Osmolar Gap = 2x Na + BUN + glucose

42
Q

Glucose Infusion Rate calculation

A

GIR = dextrose % x rate (ml/hr) / 6 x weight (kg)

= mg/kg/min

PICU (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions