ICU stuff

Question 1

main mechanism of Bipap in COPD failure

Answer 1

recruitment alveoli to improve oxygenation

also reduce work of breathing and reduce LV load to improve CO

Question 2

Effects of BiPAP

Answer 2

reduce mortal
reduce ETT
reduce length stay
reduce treatment failure

Question 3

Norad effects

Answer 3

beta 1
alpha 1
alpha 2

alpha 1 intense stim can SLOW heart rate
adren and norad SAME effect on beta 1

NO beta 2 action

adverse effects are from alpha 2 vasoconstriction–>periph hypoperfusion and ischaemia

Question 4

How do you tell the difference between pericardial tamponade and LVF on cath?

Answer 4

Looks the same, except in tamponade the CVP will be up- in LVF will be normal

In RVF the PAWP will be normal or reduced, but in tamponade will be up.

So in tamponade, CO reduced, CVP/RA/RV/PAWP/SVR will all be up.

Question 5

What improves survival in ARDS?

Answer 5

low tidal volume ventilation

Question 6

Cath tracing in tamponade- what do you expect to see

Answer 6

equalisation to about 5mmHg of RA, RV diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure

+prominent X descent and ABOLISHED y descent

Question 7

Cyanide toxicity treat how?

Answer 7

HYDROXYCOBALMIN

Question 8

requirements for TPN

Answer 8

CHO 2g/kg/day glucose
amino acid 1.3-1.5g/kg amino acids per day
0.2-0.4 g /kg/day lipids

Question 9

aim for CO2 post cardiac arrest

Answer 9

normal aim

actively treat PYREXIA- worse outcomes
mild hypothermia good for improving outcomes and reduces cerebral oxygen requirements

Question 10

normal PAWP

Answer 10

6-15 with mean of 9

Question 11

what rhythm complicates r heart cath placement

Answer 11

RBBB
if pre exist LBBB then increase risk CHB

also SVT and VT

Question 12

How do you predict poor outcome post cardiac arrest?

Answer 12

CANNOT rely on neuro signs within first 24 hours
non sedated patient with no corneal or pupillary reflex at 72 hours is an accurate predictor
MYCOLONUS NOT RELIED UPON FOR PREDICTING POOR OUTCOME

Question 13

Best treatment for conscious fast VT

Answer 13

lignocaine- if ischaemia or MI

procainamide if slow and stable- but can drop BP

amiodarone slower onset and variable success

Question 14

If hypercapnoeaic after extubation, what is impact

Answer 14

increase risk of reintubation

Question 15

cut off for pulm pressures and cannot have liver transplant

Answer 15

40 mmHg

Question 16

Why give flecanide in AF with accessory pathway?

Answer 16

Because slows both AV and accessory pathway, so less prone to accelerating the accessory pathway

neg inotropic

Question 17

what causes increased and decreased 2,3 DPG

Answer 17

Increased in

• high altitude
• anaemia
• chronic hypoxia
• hyperthyroidism
• chronic ALKALosis

Decreased in

• blood stored for ages
• hypothyroid
• low phosphate
• acidosis

Question 18

Normal cath values

Answer 18

RA 0-8
RV systolic 20-30
RV diastolic 0-8
PAP 20-30/8-15
PCWP 8-12

CO over 5L/min
CI over 2.4L/min/m2