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Pulmonary > ICU > Flashcards

ICU Flashcards

1
Q

Dx of carbon monoxide poisoning:

Treatment:

A
  1. Carboxy Hg >15%
  2. 100% NRB
    - if uncons, MS changes, end organ damage, CO-Hg >25% (20% in pregnancy)–> hyperbaric
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2
Q

Methemoglobinemia

  • Mechanism
  • Drugs
  • Signs
  • diagnosis
  • treatment
A
  • Converts ferrous Fe to ferric Fe in heme, cannot bind oxygen, leftward shift, impaired O2 delivery
  • benzocaine/lidocaine, dapsone, NO, nitroglycerin, nitroprusside, reglan, sulfonamides
  • cyanosis, chocolate brown blood, sat gap (desat on monitor, PaO2 normal)
  • Co-oximetry (Met-Hg 631nm); tx if Me-Hg >30%
  • discontinue cause and Methylene blue (1-2mg/kg watch for hemolysis, never give if G6PD)
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3
Q

Cyanide Poisoning

  1. mechanism
  2. Cause
  3. signs
  4. treatment
A
  1. inhibits oxidative phosphorylation by binding ferric ion of cytochrome oxidase–>acidosis
  2. Some drugs (nitroprusside)
  3. “cherry red” lips, severe lactemia, bright red venous blood (venous hyperoxia)
  4. Give hydroxycobalamine (induce mehemoglobinemia), sodium thiosulfate, amyl nitrate (avoid in concommitant CO)
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4
Q

Causes of Distributive Shock

A 
SLAM D ANT
SIRS (sepsis, pancreatitis, burns, trauma)
Liver failure
Anaphylaxis
Myxedema coma
Drugs/Toxin (insect bite, transfusion reaction, heavy metal poisoning)
Adrenal Insuffic
Neurogenic
Toxic Shock syndrome
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5
Q

BP Goals in Various HTN Emergencies

A 
Aortic dissection: SBP <120
Acute hemorrhage stroke: SBP <140
Acute ischemic stroke: <220mmHg
HTN Encephalopathy: Dec by 20-25%
Pre-eclampsia: DBP <110
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6
Q

Definition of Preeclampsia

A

Proteinuria >300mg/d, HTN >140/90 after 20th week of pregnancy.
-May also have: AST/ALT >2x normal, plt <100k, cerebral/visual symptoms, pulmonary edema, Cr >1.1

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7
Q

HELLP:

  • Features
  • Treatment
A

weak 28-36 to 7d postpartum
Hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, low plt (<100k)-Treatment: prompt delivery if DIC, pulmonary edema, liver hemorrhage, renal failure

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8
Q

Risk Factors for Sheehan Syndrome:

A
  1. panhypopit due to pituitary necrosis
  2. Typically 2-12 months postpartum
  3. Risk factor- postpartum hemorrhage with hypotension and multiple blood transfusions
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9
Q

Timing for peripartum cardiomopathy

A

New LVEF <45%

-last month of pregnancy or up to 5 months postpartum

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10
Q

Most common cause of noncardiogenic pulmonary edema in pregnancy

A
  • tocolytics (terbutaline, ritodrine)- biggest predictor is duration of therapy
  • other aspiration, preeclampsia, TRALI, large volume rescus
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11
Q

Most common cause of postpartum hemorrhage

A

Uterine atony

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12
Q

Preeclampsia and risk of hemorrhagic stroke with:

A

SBP >160

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13
Q

Anticoag for VTE in pregnancy

A
  • LMWH is preferred
  • hold 24hr or switch to heparin gtt until 4-6h, or place IVC
  • anticoag throughout preg, at least 6 weeks postpartum
  • total duration 3-6 mo
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14
Q

Treatment of Air Embolism:

A
  • left lateral decubitus position
  • supportive care
  • hyperbaric oxygen
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15
Q

ARDS NET Settings

A

Vt 4-6mL/kg IBW
Pplat <30
pH >7.3
PEEP ladder: PaO2 55-80, SpO2 88-95%

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16
Q

Differentiate ariway obstruction from respiratory system compliance in AC/PC.

A

Both reduce flow and volume.

Expiratory flow graphic–> slower with airway obstruction, faster with resp system stiffening

17
Q

Organophosphate Poisoning:

-presentation

A

salivation, lacrimation, urination, defecation, emesis, bronchospasm, bradycardia

18
Q

Target BP in Acute Aortic Dissection

A

SBP <120

19
Q

Acute hemorrhagic Stroke: Target BP

A

SBP <140

20
Q

Acute Ischemic Stroke: Target BP

A

<220/110 (permissive HTN)

<185/110 if candidate for reperfusion therapy

21
Q

General Goal for BP in HTN Emergency

A

Lower MAP by 10% in first hour and then additional 5-15% over the next 23h

22
Q

Pre-Eclampsia: Target BP

A

DBP <110

23
Q

Risk of TRALI highest with which blood product?

A

FFP

24
Q

Different type of HIT:

A

Type I: mild, transient drop within first 2d of heparin exposure. Direct effect of heparin on plt (non-immune plt aggregation), nadir ~100k, plt improve with continued use

Type II: >50% drop in plt, 5-10d after exposure, mediated by Ab against heparin-platelet factor 4 complex

  • AV thrombosis
  • limb gangrene
25
Q

Distinguish DIC and TTP:

A

TTP- normal fibrinogen, PT/PTT, d-dimer

DIC: low fibrinogen, prolonged PT/PTT, elevated d-dimer

26
Q

Preeclampsia= ?

A

Proteinuria >300mg/d, HTN (>140/90) after 20th week of gestation

-Can lack proteinuria if have other end-organ damage- Plt <100k, Cr >1.1, AST/ALT >2x normal, pulmonary edema, visual symptoms

27
Q

Most important predictor of hemorrhagic stroke in pre-eclampsia is ?

A

SBP >160

28
Q

Apnea test: positive if

A

pCO2 > or = 60mmHg or 20mmHg increase over baseline

Pulmonary (14 decks)

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