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A ORAL BOARDS COACH 2016 > ICU > Flashcards

ICU Flashcards

1
Q

SCIP protocol for sepsis in a sending cholangitis

A

IV antibiotics within one hour

2 L bolus

Arterial line in central venous line

Levophed (norepinephrine) 2-20 micrograms per kilogram per minute

Vasopressin 0.03

–

If you still sick:

Hold the course twelve– twenty four hours! then ERCP

Or transit hepatic percutaneous

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2
Q

Treatment of delirium tremens

A

Ativan

Banana bag:
thiamine, 
folic acid, 
3 grams of magnesium sulfate
Multivitamin
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3
Q

Status of exclusion of ARDS with cardiac failure

A

no more

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4
Q

What is normal I:E ratio and what do you change it to with ARDS

A

Normal :

Inspiratory:Expiratory
1:3

(this just feels natural when breathing) - yoga breath)

Recruitment manuver:

1:1 or even reverse 2:1

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5
Q

what is ECMO annula vessle

A

Adults: IJ - honking cannula

Kids: common carodtid!

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6
Q

what does APRV stand for

A

Airway pressure release ventilation

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7
Q

How does NO work as advanced ventilation technique

A

Dilated pulmonary vasculature (remember medical school study)

Alveoli then see more gas exchange

MAY help get off of vent

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8
Q

How do you ask to be someone for end-of-life

“taking off of support”

A

Morphine for anxiety

decrease fio2

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9
Q

Supportive measures for myoglobinemia

A

Sodium bicarb to alkalize the the urine
sodium bicarbonate 50 mEq/L.

pH greater than 7.5

Sodium 160

Consider manitol

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10
Q

what check be PCO to be to confirm endotracheal integration

A

Greater than 15×3 breaths

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11
Q

what other blood vessel contribute to anterior spinal cord

A

besides the artery of a Adamkowitz

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12
Q

DDx of high pressure alarm on the vent

A 
check ETT
Sucking
check circuit
machine
Bag mask

Interthoracic:
PTX!
stiff lung

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13
Q

What is estimated distatance of ETT from incisors

A

22-24 cm

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14
Q

What does rising BU win indicate regarding fluid status

A

Indications of dehydration

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15
Q

What is rising creatinine and associated with

A

Decreased renal function

How well creatinine is being cleared

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16
Q

Noninvasive method of monitoring central venous fluid resuscitation status

A

Echocardiogram

Demonstrate hepatic vein collapse

17
Q

Main algorithm to assess hypoxia

A

Perfusion versus ventilation

Perfusion:
MI!
Shock - bleeding / third space
PE (not getting blood to the gas exchange)

Ventilation:
ARDS
Emphysema

Shunt

Mechanical (pneumothorax)

18
Q

Maximum size of the inferior vena cava to use standard IVC filter

A

28 millimeters

19
Q

Algorithm for hyperkalemia

A

Cardiac monitor

D50 1 amp: 20 – 50 mL of 50% solution

Insulin 10 units

Calcium gluconate 10 mg and 10% solution over five minutes

Kayexalate 30 g PO / 50 g rectal enema

Sodium bicarb one amp q 10 minutes

Dialysis
AEIOU
Acidosis
Electric light
Uremia

A – Acidosis – metabolic acidosis with a pH 6.5 mEq/L or rapidly rising potassium levels; see previous postfor a review of the causes and management of hyperkalemia

I – Intoxications – use the mnemonic SLIME to remember the drugs and toxins that can be removed with dialysis: salicylates, lithium, isopropanol, methanol, ethylene glycol

O – Overload – volume overload refractory to diuresis

U – Uremia – elevated BUN with signs or symptoms of uremia, including pericarditis, neuropathy, uremic bleeding, or an otherwise unexplained decline in mental status (uremic encephalopathy)

20
Q

If normal measures to correct potassium are not working what should you consider giving

A

Magnesium

21
Q

SIADH

A

Basically concentrating urine to hold onto water

Increased antidiuretic hormone

Increase urine osmolality
Increase urine sodium

Decreased systemic sodium
Decreases systemic osmolality

Treatment is fluid restriction

22
Q

Cerebral salt wasting

A

Decreased serum sodium
Increase serum osmolality
(lose fluid more than you lose sodium)

Decreased urine osmolality
Increase urine sodium

23
Q

Diabetes insipidus

A

This is liters of urine per hour of dilute urine

Increase serum sodium
Increase serum osmolality

Decreased urine osmolality
Decreased urine sodium

24
Q

Protective measures for intracranial hemorrhage

A

Headed at 30°
Permissive HYPOcapnea PCO2 35

Mannitol 1 g per kilogram Q6 six hours:
serum osmolality goal of 330

3% saline started 50 mL in our drip max with serum sodium goal 155

Paralyze
Barbiturate coma

ICP pressure goal less than 30

Cerebral perfusion pressure goal 60

25
Q

myoglobinuria

A

Positive on dipstick

Microscopic evaluation shows absence of RBCs

26
Q

Best way to protect kidneys from contrast

A

Start fluids 12 hours before in continue 12 hours after

Better than Mucomyst

27
Q

If you have to take a number to start transfusing by hematocrit what would you choose

A

24 percent if asymptomatic

30% of cardiac

28
Q

Spontaneous breathing trial

A

This is the best for weaning

Turn off sedation

FiO2 40%

PEEP5

29
Q

What is the rapid shallow breathing index

A

Respiratory rate / title vol in Liters

Measurement is done with a handheld spirometer attached to the endotracheal tube while a patient breathes room air for one minute without any ventilator assistance.

As an example, a patient who has a respiratory rate of 25 breaths/min and a tidal volume of 250 mL/breath has an RSBI of (25 breaths/min)/(0.25 L) = 100 breaths/min/L

Goal is less than 105 “Tobin”

30
Q

What isn’t important burn lab to get when patient comes in after a house fire

A

carboxyhemoglobin level

The potential for carbon monoxide poisoning mandates that a carboxyhemoglobin level be obtained in all patients with moderate or severe burns.

A standard arterial blood gas reports the concentration of oxygen dissolved in blood and cannot be used

A serum lactate measurement and end-tidal CO2 (EtCO2) monitoring may provide useful information when determining management of these patients and should be performed if cyanide poisoning is a possibility. Cyanide toxicity poisons mitochondria forcing cells to use anaerobic metabolism. This results in a lactic acidosis and a compensatory drop in EtCO2.

We suggest treatment for cyanide toxicity to be initiated in severe burn victims with an unexplained lactic acidosis or a low or declining EtCO2 level. If these measurements are unavailable, we suggest treatment be initiated in any patient demonstrating a depressed level of consciousness, cardiac arrest, or cardiac decompensation. Particularly with severe burn victims, we strongly prefer hydroxocobalamin to alternative cyanide antidotes.

Hydroxocobalamin (vitamin B12a supplement and cyanide antidote):
Initial: 5 g as single infusion;

31
Q

What does FAST stand for

A

Focused assessment with sonography for trauma

32
Q

What do “comet tails mean on FAST”

A

this is NORMAL

streaks from the plural surfaces siding past each other.

33
Q

What is the normal split thickness skin graft pickiness

A

10 one thousandth of an inch

34
Q

brain death criteria

A

Warm
Off sedatives barbiturates benzo’s
Electrolytes corrected

Dolls eyes
Cold caloric
Pupillary reflex
Corneal reflex
Gag reflex

Apnea test

35
Q

Apnea test

A

Standard procedure — The apnea test is performed after all other criteria for brain death have been met. Core temperature ≥36ºC or 97ºF, systolic blood pressure ≥100 mmHg, eucapnia (PaCO2 35 to 45 mmHg), absence of hypoxia, and euvolemic status are prerequisites [5,6].

The test is not valid in patients who chronically have high PaCO2 values (CO2 retainers or high cervical spinal cord lesions.

 In a positive apnea test there is no respiratory response to a 
PaCO2 >60 mmHg 
or 
20 mmHg greater than baseline values 
and 
final arterial pH of
36
Q

best medicaiton of for afib if low pressure

A

Amioderone

yes, same med used for code

37
Q

Patient with stroke loses their peg tube what is the management

A

Number one peg tube study

(CT scan would be okay)

If contrast week must go to operating room washout

Resect old peg tube site with primary nastiness is

Place gastrostomy tube in new sites.

38
Q

Basic Swan set up

A

Trendelenburg
Flush Swan
Check balloon
Leave the transducer on

Prep Right IJ

39
Q

What tells you that you are in the pulmonary artery on the waveform

A

Dicrotic notch

A ORAL BOARDS COACH 2016 (30 decks)

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