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Anesthesia based on Nebuchanedzzer II > ITE Crit Care 2 > Flashcards

ITE Crit Care 2 Flashcards

1
Q

Any abx that treats GNB may directly cause lysis and release ____

A

outer bacterial membrane, Lipopolysaccharide

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2
Q

How does TPN cause hypophosphatemia?

A

Glucose loading –>
cellular uptake of glucose and phosphate

*often, phosphate is added to TPN when first started

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3
Q

3 causes of severe hypophosphatemia in ICU setting

A
  1. refeeding syndrome
  2. DKA
  3. Large decreases in PCO2 (hyperventilation)
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4
Q

Refeeding syndrome symptoms (4)

A
  1. Respiratory insufficiency
  2. Rhabdo
  3. Red cell dysfunction
  4. Sudden death
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5
Q

_________ is the most common cause of distributive shock characterized by severe peripheral vasodilation

A

septic shock

- high cardiac output state (9L)

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6
Q

Obstructive shock is mostly d/t _____ causes of cardiac pump failure and often associated with poor RV output and increased systemic vascular resistance

A

extracardiac

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7
Q

Normal cardiac output in L/min

A

5 L/min

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8
Q

Non anion gap metabolic acidosis is used to determine ______

A

if the kidneys are functioning appropriately and acidifying urine in the setting of systemic acidosis
- the kidneys also serve as the body’s primary means of eliminating excess H+ during acidemia

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9
Q

_________ is used to differentiate between etiologies of non-anion gap metabolic acidoses

A

Urine anion gap aka urinary strong in difference

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10
Q

How to measure urine anion gap. What is normal?

A

Na + K + Cl

Nl: 0-5 mEq/L

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11
Q

If the urine anion gap is NEGATIVE, this indicates a higher than expected amt of NH4+, indicating __________ response to systemic acidosis.

A

appropriate

- by acidifying the urine through trapping of H+ in the NH4+ molecule

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12
Q

Type 1 renal tubular acidosis is caused by a failure of the kidney to excrete H+ in the ____ part of the nephron, and results in (excess/poor) secretion of potassium

A

distal nephron

excess
- HYPOKALEMIA

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13
Q

Type I RTA is a classic presentation of systemic acidemia and paradoxical _____.

A

hypokalemia

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14
Q

Type __ RTA will cause hyponatremia and hyperkalemia

A

Type 4 RTA

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15
Q

When renal secretion of H+ is impaired (RTA), the urine anion gap will be _____, despite a systemic acidosis

A

neutral or elevated

Normal urine anion gap is 0-5 mEq/L

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16
Q

______ can be used for prophylaxis against chemical warfare nerve agents soman, sarin gas, and VX, which all act as acetylcholinesterase inhibitors (organophosphate poisoning)

A

pyridostigmine

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17
Q

Cholinergic effects

A

SLUDGE ME

Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis
Miosis
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18
Q

_____ is a drug that binds to acetylcholinesterases that have been inactivated by organophosphate compound, causing the organophosphate compound to dissociate and allowing the acetylcholinesterase to become active again. (removes nerve agent from binding site on enzyme)

A

Pralidoxime

- Cannot cross BBB

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19
Q

Treatment for nerve agent exposure (not prophylaxis)

A

Atropine or pralidoxime

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20
Q

_____ is an anti-muscarinic that can be used to treat the muscarinic effects of nerve agents, but not prophylaxis

A

atropine

*only one that can cross BBB

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21
Q

_____ is a cholinergic agent which helps attenuate/block muscarinic effects of nerve gasses. _____is an acetylcholinesterase reactivator and actively removes nerve agent from the binding site on the enzyme

A

atropine

pralidoxime

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22
Q

_____ and ____ can manage acid-base status during CPB, where hypothermia plays a major role in reducing cerebral metabolic demands

A

pH stat, alpha stat

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23
Q

______ management technique corrects the alkaline drift by maintaining a neutral pH during hypothermia during CPB

A

pH stat

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24
Q

______ management allows the natural alkaline drift to occur without correction during CPB

A

alpha-stat

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25
Q

Disadvantages of pH-stat

A

increased delivery of embolic load to the brain

Loss of cerebral autoregulation

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26
Q

_____ management couples CBF with CMRO2 during CPB

A

alpha stat

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27
Q

_______ controlled ventilation is characterized by decelerating inspiratory flow rate and more homogenous distribution of tidal ventilation across alveoli with different time constants

A

pressure

- as well as constant inspiratory pressure

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28
Q

______ controlled ventilation is characterized by constant inspiratory flow delivery

A

volume

- as well as achieving same tidal volumes regardless of changes to external factors

29
Q

With volume controlled ventilation, ______ may fluctuate depending on increase or decrease in respiratory system compliance or airway resistance

A

airway pressure

30
Q

With pressure controlled ventilation, _______, may fluctuate with altering respiratory system compliance or airway resistance

A

tidal volumes

31
Q

(Pressure/Volume) controlled ventilation is associated with higher mean airway pressure

A

Pressure controlled ventilation

32
Q

(Pressure/Volume) controlled ventilation is associated with more homogenous distribution of tidal ventilation

A

pressure controlled ventilation

33
Q

Hypoxic ischemic encephalopathy sx

A

cerebral edema and elevated ICPs

34
Q

After drowning, victims lungs looks show (consolidations/pulmonary edema)

A

generalized pulmonary edema

35
Q

tidal volumes should be based off of people’s (height/weight)

A

height

36
Q

(pressure/volume) control mode ventilation will result in lower peak airway pressure

A

Pressure

37
Q

Predicted weight in men vs women

A

women: height (cm) - 110
men: height (cm) - 105

38
Q

Hematologic manifestations of hypophosphatemia

A

immune dysfunction and higher risk of sepsis

39
Q

Hypophosphatemia will decrease production of 2,3-DPG and shift the oxygen dissociation to the (Right/Left)

A

Left

  • decrease oxygen delivery to the tissues
  • oxygen will dissociate from hgb at a lower PaO2
40
Q

How do drowning lung injuries result in V/P mismatch?

A

Forced inhalation against a closed glottis during laryngospasm ->
Pumonary edema ->
decrease lung compliance ->
V/P mismatch

41
Q

If hypertonic seawater is aspirated what happens to the lungs compared to freshwater?

A

Seawater:
- hypertonic solution draws more fluid into the alveoli and pulmonary interstitium -> worse pulmonary edema

Freshwater:
- rapidly absorbed into the circulation, resulting in potential transient hypervolemia and eventual pulmonary edema as fluid is redistributed

42
Q

Drowning victim of hypotonic fresh water results in ____ of the blood vessels. Blirubin will show _____ and urine will show

A

hemolysis

hyperbilirubinemia

hemoglobinuria

43
Q

Serratia marcescens is a GNB that grows in indwelling catheters and is naturally resistant to _____

A

ampicillin,
macrolides,
1st gen cephalosporins

44
Q

Tx choice for serratia is usually _____

A

Aminoglycosides

45
Q

Treatment choice of E. faecalis is (PCN/Ampicillin). ____ is reserved for resistant cases

A

ampicillin.

Linezolid, dapto

46
Q

_______ is superior to H2 blockers (cimetidine, ranitidine) in preventing ventilator-associated PNA, while _______increases the risk of ventilator-associated PNA

A

Sucralfate

PPIs (pantoprazole)

47
Q

The ____ view on TTE allows visualization of the RV and LV as well as the ventricular septum.

A

Parasternal short axis

48
Q

In the setting of acute cocaine use, pts MAC (increases/decreases)

A

increases

49
Q

_____ is used in management of HTN and tachycardia in pts with NSTE-ACE and signs of acute cocaine or methamphetamine intoxication

A

BDZ +/- nitroglycerin

50
Q

Structural heart changes seen in chronic Cocaine use

A

LVH

dilated cardiomyopathy

51
Q

Rate of transmission from contaminated needle

  • HIV
  • HCV
  • HBV
A
  • HIV: 0.3%
  • HCV: 0.5%
  • HBV: 30%
52
Q

Normal values for:
CVP:

RA pressure:
RV systolic pressure:
RV end-diastolic pressure:

PA systolic pressure:
PA end-diastolic pressure:

Mean PAP:
Pulm cap wedge pressure aka LVEDP:

A

CVP: 0-7

RA pressure: 0-7
RV systolic pressure: 15-25
RV end-diastolic pressure: 3-12

PA systolic pressure: 15-25
PA end-diastolic pressure: 8-15

Mean PAP: 10-22
Pulm cap wedge pressure/LVEDP: 6-15

53
Q

Obstructive shock is caused by extra cardiac conditions that lead to poor _____. This can be divided into ___ and ____

A

poor RV output

pulmonary vascular and mechanical

54
Q

Septic Shock

What gets affected 1st:

What is the response mechanism:

A

Decrease SVR

increase CO

55
Q

Cardiogenic shock

What gets affected 1st:

What is the response mechanism:

A

Increase LVEDP aka PCWP aka LV preload

increase SVR

56
Q

Cardiac tamponade

What gets affected 1st:

What is the response mechanism:

A

Increase PAP aka Pressure after RH
and
LVEDP aka PCWP aka LV preload

response: increase SVR

57
Q

PE

What gets affected 1st:

What is the response mechanism:

A

PVR (a measured value via swan ganz, thermal dilution, TEE)

response: increase SVR

58
Q

Hypovolemic shock

What gets affected 1st:

What is the response mechanism:

A

Decrease CVP

Increase SVR

59
Q

Neurogenic shock

What gets affected 1st:

What is the response mechanism:

A

Decrease CO (spinal shock/bradycardia)

no sympathetic response

60
Q

Vasoconstrictors (increase / decrease) venous compliance

A

decrease

  • highly compliant veins: soft flexible tube
  • Decreased compliance: hard stiff tube
61
Q

Angiotensin II leads to venous (constriction / dilation)

A

Constriction

- decrease compliance

62
Q

Adenosine and furosemide (increase / decrease) venous compliance

A

increase

- both have venodilating properties

63
Q

Compounds that are significantly metabolized by the pulmonary cells

A
  1. Norepi
  2. Serotonin
  3. Bradykinin
  4. Angiotensin-1
64
Q

Organophosphate, parathion, malathion, fenthion result in cholinergic toxicity (increase ACh in nicotinic and muscarinic synapse. Sx?

A
  1. Miosis
  2. Salivation
  3. Lacrimation
  4. Urination
  5. Diarrhea
  6. GI cramps
  7. Emesis
  8. Bronchoconstriction
  9. Muscle weakness

*Sludge + Miosis + bronchoconstriction + muscle weakness

65
Q

Intraabdominal HTN is defined as IAP > ____ mmHg

A

> 12 mmHg

66
Q

Pulsus paradoxus (seen with tamponade or constrictive pericarditis) occurs when the heart is dependent on (positive/negative) intrathoracic pressure

A

negative
- venous return is highly dependent on neg intrathoracic pressure during spontaneous ventilation

  • Positive pressure ventilation can cause hemodynamic collapse
67
Q

Distant heart sounds is not diagnostic of tamponade. What is pathognomonic for it?

A

Beck’s triad

  1. Hypotension
  2. Distended neck veins
  3. Muffled/distant heart sounds
68
Q

When are ACE-i contraindicated?

A
  1. Pregnancy (teratogenic)
  2. Angioedema
  3. Allergy to ACE-i
69
Q

The RAAS is responsible for releasing ____ into plasma with _____

A

Renin

  1. Hypotension
  2. Hyponatremia
  3. B1-receptor activation

Anesthesia based on Nebuchanedzzer II (38 decks)

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