ICU Flashcards
What can you use Sugammadex for?
rapid reversal of neuromuscular blockade from rocuronium or vecuronium
when can you safely use neostigmine to reverse neuromuscular blockade
patient must have at least 1-2 twitches on train of four
when in breathing cycle do you measure intra-abdominal pressure?
end-expiration
what is the best initial treatment for cardiogenic shock?
administration of an ionotrope (e.g. dobutamine w/goal of CI > 2.0)
what is a clinically relevant dose of dobutamine?
5-20 ug/kg/min
Parkland Formula
4 mL/kg per percent of body burned
- half of volume in first 8 hours
normal PCWP
4-12 mmHg
normal SVR
900-1400 dyn/s/cm
normal Cardiac Index
2.5-4 L/min/m^2
how do corticosteroids cause hyperglycemia
- decrease insulin production
- decrease insulin secretion
- increase gluconeogenesis
how quickly can you correct hyponatremia
no more than 0.5 mEq per hour OR 8 mEq per 24 hours
how do you determine the mEq of sodium needed to correct someone’s sodium
(desired Na - measure Na) x total body water
initial resuscitation goal for sepsis
30 mL/kg as a bolus over two hours
If this does not correct hypotension start vassopressor
first line treatment for DIC
- supportive care of sepsis
- low dose heparin 5-8 units/kg/hr
what metabolic derangements would you expect with refeeding syndrome
- hypophosphatemia
- hypomagnesia
- hypokalemia
what kind of culture do you perform on a BAL for suspected VAP?
quantitative culture
threshold of 10,000 or 100,000 to indicate positive culture
you’re trying to get femoral vein access for an IVC, what maneuver can you perform when you are unsure if the structure you are looking at is in fact the femoral vein?
locate greater saphenous vein (superficial and medial) and tract it back to femoral vein
Patient with hypocalcemia, what EKG changes would you expect
prolonged QT interval
- hypocalcemia specifically lengthens the ST segment
What is the main benefit of providing 100% oxygen in a patient with carboxyhemoglobin toxicity
reduces half life of carboxyhemoglobin to 1 hour from 3 hours
How does increasing PEEP increase arterial oxygen content?
increases functional residual capacity by recruiting alveoli
would you give larger or smaller doses of opioids to a cirrhotic patient and why
- smaller
- opioids are protein bound, patient is presumed to have hypoalbunemia therefore plasma concentration of opioids is going to be higher
most sensitive test to detect species causing ventilator associated pneumonia
bronchiole alveolar lavage
Respiratory Quotient 0.7
- fat metabolism
Respiratory Quotient 0.8
protein metabolism
