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ABSITE Flash Cards > ICU > Flashcards

ICU Flashcards

1
Q

What can you use Sugammadex for?

A

rapid reversal of neuromuscular blockade from rocuronium or vecuronium

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2
Q

when can you safely use neostigmine to reverse neuromuscular blockade

A

patient must have at least 1-2 twitches on train of four

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3
Q

when in breathing cycle do you measure intra-abdominal pressure?

A

end-expiration

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4
Q

what is the best initial treatment for cardiogenic shock?

A

administration of an ionotrope (e.g. dobutamine w/goal of CI > 2.0)

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5
Q

what is a clinically relevant dose of dobutamine?

A

5-20 ug/kg/min

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6
Q

Parkland Formula

A

4 mL/kg per percent of body burned

  • half of volume in first 8 hours
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7
Q

normal PCWP

A

4-12 mmHg

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8
Q

normal SVR

A

900-1400 dyn/s/cm

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9
Q

normal Cardiac Index

A

2.5-4 L/min/m^2

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10
Q

how do corticosteroids cause hyperglycemia

A
  • decrease insulin production
  • decrease insulin secretion
  • increase gluconeogenesis
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11
Q

how quickly can you correct hyponatremia

A

no more than 0.5 mEq per hour OR 8 mEq per 24 hours

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12
Q

how do you determine the mEq of sodium needed to correct someone’s sodium

A

(desired Na - measure Na) x total body water

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13
Q

initial resuscitation goal for sepsis

A

30 mL/kg as a bolus over two hours

If this does not correct hypotension start vassopressor

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14
Q

first line treatment for DIC

A
  • supportive care of sepsis
  • low dose heparin 5-8 units/kg/hr
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15
Q

what metabolic derangements would you expect with refeeding syndrome

A
  • hypophosphatemia
  • hypomagnesia
  • hypokalemia
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16
Q

what kind of culture do you perform on a BAL for suspected VAP?

A

quantitative culture

threshold of 10,000 or 100,000 to indicate positive culture

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17
Q

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?

A

locate greater saphenous vein (superficial and medial) and tract it back to femoral vein

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18
Q

Patient with hypocalcemia, what EKG changes would you expect

A

prolonged QT interval

  • hypocalcemia specifically lengthens the ST segment
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19
Q

What is the main benefit of providing 100% oxygen in a patient with carboxyhemoglobin toxicity

A

reduces half life of carboxyhemoglobin to 1 hour from 3 hours

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20
Q

How does increasing PEEP increase arterial oxygen content?

A

increases functional residual capacity by recruiting alveoli

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21
Q

would you give larger or smaller doses of opioids to a cirrhotic patient and why

A
  • smaller
  • opioids are protein bound, patient is presumed to have hypoalbunemia therefore plasma concentration of opioids is going to be higher
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22
Q

most sensitive test to detect species causing ventilator associated pneumonia

A

bronchiole alveolar lavage

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23
Q

Respiratory Quotient 0.7

A
  • fat metabolism
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24
Q

Respiratory Quotient 0.8

A

protein metabolism

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25
Q

Respiratory Quotient 1.0

A

carbohydrate metabolism

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26
Q

Respiratory Quotient > 1.0

A

overfeeding

27
Q

which sedative provides good hypnotic dosing and opioid sparing analgesia

A

Ketamine

also doesn’t suppress cardiac function

28
Q

What kind of cardiac complications can you expect with hypermagnesia?

A
  • peaked T waves
  • prolonged PT interval
  • prolong QRS complex
  • essentially first degree AV block
29
Q

findings of severe hypokalemia on EKG

A
  • U wave elevation
  • T wave depression
30
Q

findings of severe hyperkalemia on EKG

A
  • peaked T waves
  • P wave flattening
  • wide QRS complex
31
Q

what kinds of medications are contraindicated in a right sided heart attack

A
  • nitric oxide (decreases pre-load)
  • alpha-1 agonists (increase after load)
32
Q

what is the range for severe hypothermia

A

< 28 degrees celsius

33
Q

what minimizes the rate of tracheal stenosis after intubation

A
  • cuff pressures less than 30 mm Hg
  • minimizing the size of the ETT in comparison to the trachea
34
Q

Commonly found organisms in ventilator associated pneumonia

A
  • Staphylococcus aureus
  • Pseudomonas Aeruginosa
  • Haemophilus Influenzae
  • Streptococcus Pneumoniae
  • Enterobacter Cloacae
35
Q

what is a positive value for a protected specimen brush on a ventilated patient

A

> 1000 CFU/mL

36
Q

what is part of the qSOFA score

A
  • GCS (<15 = 1 point)
  • respiratory rate (>22 = 1 point)
  • Systolic BP (< 100 = 1 point)
37
Q

what is the maximum score for qSOFA

A

3

38
Q

what does a qSOFA score of 2-3 mean

A

3-14 fold increased risk of in-hospital mortality

39
Q

what kind of central venous catheter is associated with the lowest rates of line infection

A

subclavian CVCs

40
Q

what CVCs are associated with the highest rates of mechanical complications

A

subclavian CVCs

41
Q

Components of a qSOFA

A
  • respiratory rate > 22
  • GCS < 15
  • SBP < 100

1 point for each

42
Q

Neurogenic shock

A

disruption of hemodynamic parameters (typically hypotension associated with bradycardia)

43
Q

Spinal shock

A

loss of:
reflex
motor
sensory function

  • below the level of spinal cord injury
44
Q

in morbidly obese critically ill patients, which equation should be used to estimate energy requirements (assuming indirect calorimetry is unavailable)

A

Penn state equation

45
Q

What is the vasopressor of choice in refractory anaphylactic shock

A

epinephrine

46
Q

Dose and frequency of naloxone for respiratory depression in the setting of opioid use/administration?

A

40 mcg doses at 5 minute intervals till spontaneous recovery occurs

47
Q

what does crossmatching look for prior to a transfusion

A

looks for potential antibodies to blood that is about be given

48
Q

mechanism of action of Dexmedetomidine

A

highly selective, centrally acting alpha-2 agonist

  • anxiolytic, sedative, and some analgesic properties
49
Q

two greatest risk factors that lead to the development of stress gastritis

A
  • > 48hours on ventilator
  • coagulopathy
50
Q

What receptors does norepinephrine work on?

A
  • predominant alpha agonist
  • some beta agonist activity
51
Q

what receptors does epinephrine work on

A
  • predominant beta agonist at low doses
  • predominant alpha agonist at high doses
52
Q

why is norepinephrine preferred over epinephrine when treating septic shock?

A

Norepinephrine is less cardio-active and less arrhythmogenic when compared to epinephrine

53
Q

first line agent in cardiogenic shock

A

dobutamine

54
Q

which receptors does Dobutamine work on

A
  • primarily a beta agonist
  • mild alpha agonist
55
Q

dosing for epinephrine IM, anaphylaxis

A

0.3-0.5 mg every 10-15 minutes

56
Q

dosing for epinephrine IV, anaphylaxis

A

50-100 ug every 10-15 minutes

57
Q

Why do you not use epinephrine in cardiogenic shock?

A

can cause increase in afterload from alpha agonist activity. in cardiogenic shock you don’t want to increase afterload and tax the heart further

58
Q

best way to determine resting energy requirements?

A

Indirect Calorimetry

  • via metabolic cart
59
Q

what dose of hydrocortisone can you use in patients with hypotension refractory to volume and pressors?

A

200 mg daily, followed by taper

60
Q

what amino acid is considered “semi-essential” in regards to wound healing

A

Arginine

61
Q

liver lesion associated with elevated AFB and Neurotensin, what is this most likely?

A

Hepatic Fibrolamellar carcinoma

62
Q

first line treatments for SVT

A
  • Vagal maneuvers
  • Adenosine 6mg first then 12 mg
63
Q

cause of anion gap metabolic acidosis

A

MUD PIILES

Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Isoniazid , Iron, Lactic acidosis, ethylene glycol, Salicylates

64
Q

Long term complications of TPN

A

Metabolic bone disease
liver disease
cholelithiasis
nephrolithiasis
bloodstream infections

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