ICU

Question 1

The most common electrolyte disturbance following resuscitation in extensively burned patients is

Answer 1

hypernatremia - even though you are using LR

because this is a consequence of inadequate replacement of insensible water loss.

At the completion of resuscitation, a patient with an extensive burn typically has a serum sodium concentration approaching that of Ringer’s lactate solution 130

Question 2

Anterior cord syndrome occurs when

Answer 2

the blood supply to the anterior portion of the spinal cord is interrupted.

thoracoabdominal aneurysm repair.

Question 3

The anterior spinal cord blood supply is

Answer 3

anterior spinal,
intercostal,
lumbar arteries.

This blood supply becomes compromised when ligation of intercostal and lumbar arteries occur.

Question 4

Anterior cord syndrome is characterized by

Answer 4

loss of motor function below the level of injury,

loss of pain and temp carried by the anterior columns of the spinal cord

preservation of fine touch and proprioception carried by the posterior columns

Question 5

Brown-Séquard syndrome

Answer 5

hemisection injury to the spinal cord,

relatively greater ipsilateral loss of proprioception and motor function,

contralateral loss of pain and temperature sensation.

sparing.

Question 6

Central cord syndrome

Answer 6

cervical lesion,

greater motor weakness in the upper extremities

relative sparing of lower extremities, with sacral sensory sensory sparing

Question 7

Cauda equina syndrome

Answer 7

injury to the lumbosacral nerve roots in the spinal canal

areflexic bowel and/or bladder,

variable motor and sensory loss in the lower limbs.

Question 8

Posterior cord syndrome

Answer 8

interruption to the posterior spinal artery.

loss of proprioception and vibration sensation only.

Unlike anterior cord syndrome, it is a very rare condition.

It is possible for it to present as Brown-Séquard syndrome.

Question 9

With aneurysm repair, there is a risk of paralysis due to

Answer 9

compromise of lumbar and intercostal artery blood flow to the

anterior spinal artery, the artery of

Adamkiewicz.

Question 10

Active expiration is defined as a forced exhalation using what muscles

Answer 10

abdominal wall,
INTERNAL intercostal muscles,
diaphragm.

The internal intercostal muscles are involved in inhalation and chest wall expansion and forced expiration. They assist in expiration by pulling the ribcage down. They do not play a role in relaxed exhalation.

During active expiration, the most important muscles are those of the abdominal wall (including the rectus abdominus, internal and external obliques, and transversus abdominus), which drive intra-abdominal pressure up when they contract, and thus push up the diaphragm, raising pleural pressure, which raises alveolar pressure, which in turn drives air out.
Bottom Line: The primary muscle involved in expiration is the diaphragm. The secondary muscles involved in expiration include the internal and external intercostals, external oblique, internal oblique, transverse abdominal and rectus abdominis.

Question 11

common side effect of the various topical burn agents

Answer 11

Silver Nitrate - broad-spectrum antimicrobial activity in the treatment of burn wounds.

Due to the need to dilute the solution before application, its topical applications can lead to extravasation of sodium resulting in subsequent hyponatremia.

methemoglobinemia.

Silver Sulfadiazine

transient neutropenia.

Mafenide acetate

absorbed systemically

cause metabolic acidosis through the inhibition of carbonic anhydrase.

Neomycin, Bacitracin, and Polymyxin B

topical ointments that are useful for superficial partial- thickness facial burns.

most common associated side effect of these agents is nephrotoxicity when used on large burns.

Polymyxin B should not be used on large burn areas due to the concern for nephrotoxic effects.

Question 12

Torsadeselectrolyte disturbances

Answer 12

hypokalemia

and

hypomagnesemia

Question 13

Treatment of intermittent torsades in stable patients is

Answer 13

correcting any underlying metabolic or electrolyte abnormalities

INCRASE! the heart rate to shorten ventricular repolarization.

Intravenous magnesium sulfate is also effective in treating paroxysmal torsades.

Question 14

Drugs used to tx pulmonary hypertension

Answer 14

Milrinone acts to increase pulmonary vasculature dilation which can lower pulmonary hypertension.

Milrinone works by blocking the degradation of cyclic adenosine monophosphate (cAMP). Milirone improves pulmonary hemodynamics and right ventricular function in chronic pulmonary hypertension.

Milrinone is a phosphodiesterase type III inhibitor that is used as a contractility agent in patients with cardiogenic shock.

viagra

Question 15

The indications for a PA catheter include and name contraindicaiton

Answer 15

can yield valuable information in the critically ill patient.

treatment of myocardial infarction,

assessment of fluid status,

evaluation of pulmonary edema or pumonary hypertension,

evaluation of valvular disease

cardiac tamponade,

evaluation of postoperative heart surgery patients.

CONTRAINDICATION:
cardiac arrythmias, swan is arrhythmogenic.

Question 16

The average total caloric requirements by age:

Answer 16

NEWBORNs in the ICU might need up to 125 kcal/kg/day!!

0-1: 90-125 kcal/kg/day 1-7: 75-90 kcal/kg/day 7-12: 60-75 kcal/kg/day 12-18: 30-60 kcal/kg/day > 18: 25-30 kcal/kg/day
The average protein requirement also varies by age:
0-1: 2.0-3.5 g/kg/day 1-7: 2.0-2.5 g/kg/day 7-12: 2.0 g/kg/day 12-18: 1.5 g/kg/day > 18: 1.0 g/kg/day

Question 17

Criteria for the diagnosis of ARDS include

Answer 17

an acute onset, bilateral pulmonary infiltrates on chest x-ray,

absence of cardiogenic pulmonary edema (i.e., PAWP <18 mm Hg)

this is NOT absence of cardiac path on echo

hypoxemia (Pao2/Fio2 ≤200)

On the same continuum, ALI is a milder form, with Pao2/Fio2 ranging from 201 to 300.

Question 18

early Sepsis produces

Answer 18

high output cardiac failure,

SVR is decreased due to toxins that produce vasodilation.

SvO2 should be HIGH because the tissues are unable to extract oxygen from the blood effectively.

Question 19

The arterial oxygen content is calculated with the formula:

Answer 19

CaO2 =

1.34 x Hgb x SaO2) + (0.003 x PaO2

Question 20

what type of line has the highest DVT risk

Answer 20

Femoral catheters

Question 21

list order of lest to greatest infection risk with lines

Answer 21

Sublavian (lowest infection)
IJ
Femoral (highest infection)

Question 22

In ARDS, three populations of alveoli can be distinguished.

Answer 22

Bottom Line: In acute respiratory distress syndrome (ARDS), the flooding of the alveolar space with inflammatory exudate and other chemical mediators rapidly inactivates alveolar surfactant resulting in collapse of alveoli leading to pulmonary shunting and loss of lung compliance.

normal alveoli which are always inflated and engaging in gas exchange

flooded alveoli which can never, under any ventilatory regime, be used for gas exchange

atelectatic or partially flooded alveoli that can be “recruited” to participate in gas exchange under certain ventilatory regimens.

The recruitable aveoli represent a continuous population, some of which can be recruited with minimal PEEP, and others which can only be recruited with high levels of PEEP.

Question 23

Ventilation-perfusion (V/Q) mismatch

Answer 23

cause of hypoxemia in pulmonary embolism

Question 24

increase the p50 of normal hemoglobin

Answer 24

Increased:
2,3-DPG, 
temperature, 
PCO2 
(incr Hydrogen /  decreased pH

Question 25

Norepinephrine mech

Answer 25

stimulates alpha-1, alpha- 2, and beta-1 adrenergic receptors.

The effect
increased contractility
peripheral and splanchnic vasoconstriction.

Norepinephrine is a common medication used in the treatment of SEPTIC shock.

Question 26

Acute respiratory distress syndrome (ARDS) first phase is

Answer 26

exudative

protein rich fluid move into the alveolar spaces

Leukocytes will proliferate and cause intrinsic lung injury.

The saturation of alveoli with protein rich fluid results in poor oxygenation.

Question 27

Acute respiratory distress syndrome (ARDS) The second phase

Answer 27

The second phase is fibroproliferative

associated with fibrosis and collagen formation

This creates a stiff, non-compliant lung, but the process is reversible over time

Question 28

Acute respiratory distress syndrome (ARDS) he third phase is

Answer 28

The third phase is

resolution

lung tissue will begin remodeling and clearing the pulmonary edema.

Question 29

Arterial oxygen content is determined by the formula:

Answer 29

CaO2 = (1.34 x Hgb x SaO2) + (0.003 x PaO2).

Question 30

The most important determinant of Arterial oxygen content

Answer 30

The most important determinant in this equation is the hemoglobin level

1.34 x Hgb

CaO2 = (1.34 x Hgb x SaO2) + (0.003 x PaO2).

The SaO2 and the PaO2 play a smaller percentage in determining the overall content.

Question 31

A sudden drop in end tidal CO2 upon induction of pneumoperitoneum should raise the suspicion for

Answer 31

a CO2 embolus from the pneumoperitoneum.

Careful, this is paradoxical that endtital CO2 is low with too much CO2 collected in vascular system -> heart!

Question 32

Managment of A sudden drop in end tidal CO2 upon induction of pneumoperitoneum

Answer 32

Suspect a CO2 embolus from the pneumoperitoneum

First,
the ventilator tubing should checked

treatment for a CO2 embolus
discontinue the pneumoperitoneum,
place the patient in the left lateral decubitus position,
attempt to aspirate the air from a central line in the right atrium.
Hyperventilating can help to diffuse the carbon dioxide.

Question 33

increase in end tidal CO2 is indicitive of what beside MH and what is treatment

Answer 33

alveolar hypoventilation

Increasing the tidal volume is the treatment for

Question 34

best choice of topical burn agent with sulfa allergy

Answer 34

Silver nitrate
Although it has limited eschar penetration, of the

Silver sulfadiazine (Silvadene) and mafenide acetate (Sulfamylon) are contraindicated in patients with sulfa allergies