ITE Flashcards
qSofa (quick sequential organ failure assessment) score
Help help identify adult ICU patients with a suspected infection. It is scored 0 to 3 with one point each for altered mental status respiratory rate above 22 systolic blood pressure below 100. A score of greater than to indicates a worse prognosis
PONV options
Aprepitant - NK1 Receptor antagonist. Associated with nausea and rash
Droperidol - antidopa. Associated with dystonic reactions, QT, black box.
Scope- antimusc. Crosses BBB. Dry mouth, blurry vision.
Propofol- not for pancreatitis
Surviving sepsis - guidelines
Antibiotics within 1st hour, aggressive hydration (>30 ml per kg within first 3 hours, pressors to map > 65
Absolute indications for TPN
Short bowel syndrome. Small bowel obstruction. Active gastrointestinal bleeding. Pseudo-obstruction. High output enteric-cutaneous fistula
TPN Complications
Hyperglycemia
Ischemia-reperfusion injury during liver tx
Disruption of Na-K pump
Absolute contraindication for TPN
TPN should not be started within first 7 days of ICU admission
Marker of liver synthetic function
PT is best. Albumin is not used bc if it’s long half life (3 weeks)
Use of FFP to reverse elevated INR due to warfarin
Urgent or emergent cases when INR is above 1.5.
Use Vit K for elective surgery that can be delayed for 24 hours
Elemental diets
Originally developed as a treatment for diarrhea and patients with diarrhea on polymeric and high fiber but have fallen out of favor
Laryngospasm reflex
Mediated by internal branch of SLN. Provides sensation to entire larynx above glottis
Gas laws
Henry - at constant temp, the Concentration of a gas dissolved in a solution is directly proportional to the partial pressure of the gas
Boyle - A fixed mass of gas at constant temperature will have a constant pressure volume product. PV = PV
Albumin and pregnancy
Albumin concentration decreases during pregnancy because of plasma expansion. Many other serum constituents such as fibrinogen, tranferrin and globulins increase
Frequency and resolution
Higher frequency means better resolution but worse penetration. Lower frequency gives better penetration but sacrifices resolution
Viral cardiomyopathy (coxsackie b)
Viral cardiomyopathy is he dilated cardiomyopathy with signs and symptoms including peripheral edema, dyspnea on exertion orthopnea and decreased functional status
Other causes of dilated cardiomyopathy include alcohol, cocaine, HIV, hypertension, and peripartum state
Standard error
SE = SD/square root N
The standard error is a type of standard deviation and is a measure of the precision of the sample mean
Decreases and increases in P50
P50 on the oxy-HGB curve Is the oxygen tension at which hemoglobin is 50% saturated
Decrease in P50 (left shift) = less unloading of oxygen. Alkalosis, decr temp, decr 2,3 DPG, CO and MetHgb
Increase of P50 (right shift) = more unloading if oxygen. RIGHT - rise in 2,3 DPG, hydrogen ions (acidosis) and temperature.
Use of helium/oxygen 70/30
Heliox Is useful in situations where airway radius is decreased with resultant turbulent gas flow (subglottic
stenosis). Helium has a decreased gas density as compared to oxygen or air and dust resistant to gas flow is reduced. The low gas density decreases resistance with the turbulent flow and increases the chance for development of laminar flow
Venous air embolisms
VAE occur when air enters the low pressure venous system. Most common sites during cranis include venous sinuses, bone, and spinal epidural veins.
More likely to occur when surgical site above heart.
Can cause circulatory collapse by impeding RV filling leading to hypotension and decr CO
Pedi patients can develop VAE in both supine and prone position Since they are relatively large head sits above the level of the heart in both positions. Children are also more likely to become symptomatic from VAE since their smaller circulatory volume and heart size arw more easily overwhelmed by smaller volumes of entrained air
Detecting VAE
Most sensitive: TEE (adults) or precordial Doppler (kids)
Others EtCO2 (sudden drop), cardiac output/CVP (inc), pulse ox changes
Treatment of VAE
Hemodynamic support and preventing more air from entering. To stop air entrainment, surgical field can be flooded with saline and surgical site lowered below level of heart.
Static respiratory compliance
Static compliance of the respiratory system indicates the stiffness of the respiratory system which includes the lungs and chest wall. It is determined at the end of inspiration When there is no airflow, hence “static”
Static compliance = tidal volume/plateau pressure - peep.
Dynamic respiratory compliance = TV/peak pressure - peep
Superior laryngeal nerve
Branch of vagus
Divides into internal and external
External is a motor nerve. Innervates cricothyroid muscle
Internal is sensory. Lower pharynx, inferior epiglottis and vallecula (ie larynx above VC
Recurrent laryngeal nerve
From vagus
Mixed motor and sensory. Sensation to VC and below. Motor to all laryngeal mm except cricothyroid
Glossopharyngeal n
CN 9. Afferent limb of gag
AHA definition of hypotension and hypertension
Hypo - SBP < 90, map < 65
Hyper- SBP > 130
Flow of ions of nAChR
K out and Na in
Barbiturates and the brain
Decr CBF and ICP via constricting cerebral vasculature
Also will decr CMRO2 up to suppressing all EEG activity
Sux and bradycardia
Repeat doses and young age are the greatest risk factors bradycardia with sux use. Bradycardia with repeat administration is a result of myocardium being sensitized by metabolic products of sux
Postobstructive pulmonary edema - Rx
Can follow laryngospasm. Rx is positive pressure ventilation with peep
Barbiturates - contraindications
- Pt with resp obstruction or inadequate airway, barb may worsen resp depr
- Severe CV instability, shock or hypovolemia
- Status asthmaticus
- Porphyria may be precipitated
TPN electrolyte disturbances
Hypophos, hypo and hyperglycemia, hypomag, liver injury
Post herpetic neuralgia- prevention
Prior vaccination
Factors that are reduced in liver dz
2, 7, 9, 10, 5, 11 and thrombin
Note - F8 and vWF are increased. These two factors are produced extra-hepatically
Coagulation mgmt in liver dz
Keep plts at 50-60. If high risk surgery, >100
Fibrinogen >100
Transfuse to maintain hgb > 7
Do not give FFP ppx or chase INR
Lowest p50
Lowest (18) in newborns. Oxygen affinity is high. Hgb F and low levels of 2,3 DPG
P50 is highest (30) in children over 1 yo. After age 10, p50 goes to adult level (27)
Only 2 factors that decrease during pregnancy
11 and 13
First order vs second order kinetics
First order - amount of drug removed is a constant fraction per time. Most drugs are done this way.
Zero order - constant amount removed. Phenytoin, etoh, aspirin
SAH complications
MCC is death is initial bleeding. Followed by re-bleeding on second day which peaks at 24 hours. Vasospasm rarely occurs within the first three days Typically peaks in 5 to 10 days. Other complications include hydrocephalus (via blood blocking ability to drain CSF). HypoNAT (siadh and csw)
MCC is SAH is cerebral aneurysm
