ICU

Question 1

What does atrial fibrillation do to cardiac output?

Answer 1

decreases preload–>decreases CO by 10-20%

Question 2

What does a central venous catheter (CVC) measure

Answer 2

Central venous pressure (CVP)–R. atrial pressure goes up with CHF and down with hypovolumia

Question 3

What is the equation for mean arterial pressure (MAP)?

Answer 3

=Diastolic pressure+1/3(Systolic-Diastolic pressure)

Question 4

What is a lower-end cutoff for safe MAP?

Answer 4

65 (shouldn’t be lower)

Question 5

What does a pulmonary artery catheter (PAC) measure?

Answer 5

Multiple ports inserted via internal jugular or subclavian vein-measure central venous pressure (CVP)=right atrial pressure, right ventricle pressure, pulmonary artery pressure (PAP), Cardiac output (CO). Pulmonary capillary wedge pressure (PCWP); Pulmonary artery occlusion pressure (PAOP)

Question 6

What is an indication for pulmonary artery catheter (PAC)

Answer 6

hemodynamic instability–can measure a variety of indicators

Question 7

What does and Arterial catheter/A-line measure?

Answer 7

Systolic, diastolic, and mean arterial pressure
provides access for arterial blood gas sampling
note transducer height

Question 8

How high would a respiratory rate need to be concerning?

Answer 8

10 or 12-20 normal, over 30 or 35 may be red light

Question 9

what is gold standard for determining if patient has adequate ventilation?

Answer 9

arterial blood gas

Question 10

what are categories/strategies for ventilation?

Answer 10

negative pressure ventilation (like iron lung–not used much)
positive pressure ventilation (forcing air into lungs)
-pressure ventilation/pressure cycled modes have constant pressure, variable volume (prob=volutrauma)
- volume ventilation/volume-cycled modes have constant volume, variable pressure (prob=barotrauma)

Question 11

Modes of ventilation (volume)

Answer 11

Assist: patient initiates breath, ventilator gives preset volume
control: ventilator initiates set breaths per minute and delivers volume
assist/control: assist unless RR falls below set level, then control takes over
Synchronous intermittent mandatory ventillation (SIMV)=specific number of breaths each minute with set volume (e.g. if patient breathing spontaneously but not enough volume)–synced to patient, simv 8 with RR20 means patient taking 12 breaths independently

Question 12

How does continuous positive airway pressure (CPAP) work?

Answer 12

pressure applied constantly to maintain open airway for spontaneous inspiration and expiration

Question 13

What are options for articificial airways?

Answer 13

Endotrachial tube–short term t torque!

Question 14

what are good mental status tests in the ICU?

Answer 14

RASS and CAM ICU

Question 15

Risk factors associated with ICU acquired weakness

Answer 15

ventilator longer than 7 days, sepsis/multiorgan failure, ARDS

Question 16

what are signs of ICU acquired weakness?

Answer 16

symmetric weakness with facial sparing; difficulty weaning from ventilator for unknown reason; abnormal electrophysiological findings

Question 17

medical research council scoring for weakness

Answer 17

Maximum score: 60 (four limbs; 3 movements per extremity with maximum score of 15 points per limb); Minimum score: 0 (quadriplegia)

<48 can suggest ICU acquired weakness