Intensive Care

Question 1

What are the additional components (beyond E) to consider in critical care?

Answer 1

F = finger in every orifice (gross)

G= glucose, NG tube if needed

H= hang fluids/antibiotics

I= inject (tetanus, pain medications, etc)

Question 2

what is the order of oxygen delivery devices, from least to most invasive?

Answer 2

nasal cannula

simple face mask

venti mask

nonrebreather

endotracheal intubation

Question 3

what is the difference between CPAP and Bi-Pap/NIPPV?

Answer 3

CPAP:

• same pressure during both inhale and exhale
• keeps large airways open and prevents alveolar collapse
• no addtional pressure during inhalation - does not support WOB
• Best for: OSA, cardiogenic Pulm Edema

Bi-PAP:

• expiratory pressure same as in CPAP
• assists ventilatory muscles to generate inspiratory flow
• additional pressure during inhalation supports WOB
• Best for: COPD, ALS, MD, myasthenia gravis

Question 4

how do you assess if NIV is effective?

Answer 4

improvement of dypnea

decrease in PaCO2

increase in pH

correction of respiratory acidosis

Question 5

when do you intubate in the ICU?

Answer 5

respiratory arrest

decreased LOC

worsening dyspnea and WOB

symptomatic dysrhythmias hemodynamic instability

ICP

PaO2 < 50 or SaO2 persistently < 92%

Question 6

What are the SIRS criteria?

Answer 6

Any two

Temp

RR >20 or PaCO2 <32mmHg

HR > 90/min.

WBC > 12,000 or <4000 or >10% bands

Question 7

What are the criteria for the stages of sepsis?

Answer 7

Sepsis = SIRS + infection

Severe Sepsis = SIRS + end organ damage

(AMS, ARDS, acidosis, oliguria, lactate >2)

septic shock = severe sepsis + hypotension
(despite fluid administration)

Question 8

what is happening in early sepsis?

Answer 8

cytokine storm (hyper-inflammatory response)

knock down inflammation to treat

Question 9

what is happening in late sepsis?

Answer 9

apoptosis of immune cells and depletion of TH2

*enhance immune function or block apoptosis

death is due to overwhelming or secondary infection at this point

Question 10

What pressors are useful in sepsis when MAP is low?

Answer 10

Question 11

What antibiotic do you want?

Answer 11

Question 12

What fluid do you want?

Answer 12

Question 13

What happens in adrenal crisis?

Answer 13

cortisol production drops dramatically because of a shock to the adrenal glands

symptoms are AMS, fever, convulsions, metabolic derangements, vomiting, diarrhea

Question 14

how do you treat adrenal crisis?

Answer 14

high dose steroids