ITE Crit Care Flashcards by Nebuchadnezzer II

sepsis

life threatening organ dysfunction caused by a dysregulated host response to infection

How well did you know this?

Not at all

Perfectly

then anterior pituitary secretes ACTH and stimulates the zona glomerulosa of the adrenal cortex to secrete _____

aldosterone

How well did you know this?

Not at all

Perfectly

humoral response activates ____

macrophages, monocytes, neutrophils –> release proinflammatory cytokines

How well did you know this?

Not at all

Perfectly

septic shock is diagnosed when a pt has ______

sepsis and requires vasopressors to maintain MAP > 65 mmHg and a lactate of > 2 mmol/L
despite adequate fluid recuscitation

How well did you know this?

Not at all

Perfectly

pts with septic shock NOT responsive to fluid resuscitation should get ______

200 mg IV hydrocortisone

- pt may have adrenal insufficiency

How well did you know this?

Not at all

Perfectly

Hydrocortisone inhibits ____

nitric oxide synthesis

How well did you know this?

Not at all

Perfectly

Phosgene, used as chemical warfare, exposure can cause ______, which can cause significant morbidity and mortality

severe pulmonary damage

- targets type I and II pneumocytes

How well did you know this?

Not at all

Perfectly

Phosgene is a colorless gas that smells like _____. After dissolving, it spreads _____

freshly cut gas,

close to the ground

How well did you know this?

Not at all

Perfectly

Dual latency action of phosgene

Immediate:
- intense URI irritation

Latent:
- 2-24hrs later, pulmonary edema and circulatory collapse

How well did you know this?

Not at all

Perfectly

_______ are typically reported with ABG, but needs to be derived from other measured data

base excess
HCO3-
SaO2

How well did you know this?

Not at all

Perfectly

ABG directly measures ______

pH
PaCO2
PaO2

How well did you know this?

Not at all

Perfectly

Neurological sx of hypophosphatemia

AMS
sz
central pontine myelinolysis

How well did you know this?

Not at all

Perfectly

Hypophosphatemia decreases 2,3 DPG, causing a (Right/Left) shift in the oxyhemoglobin curve, and have poor oxygen release

Left

How well did you know this?

Not at all

Perfectly

Prolonged QT is associated with (Hyper/Hypo)phosphatemia

HYPERphosphatemia

How well did you know this?

Not at all

Perfectly

Refeeding syndrome causes:

Hypophosphatemia
Hyponatremia
Hypocalcemia
Hypomagnesemia
Hypokalemia

Hyperglycemia

How well did you know this?

Not at all

Perfectly

Why does hypoglycemia with the abrupt stopping of TPN?

TPN causes pancreas to secrete excess insulin to prevent hyperglycemia during infusion

How well did you know this?

Not at all

Perfectly

(Freshwater/Saltwater) is quickly absorbed by the pulmonary circulation

freshwater

- can cause hyponatremia

How well did you know this?

Not at all

Perfectly

(true/false) most drowning victims die without aspiration

false

- 90% do

How well did you know this?

Not at all

Perfectly

_________ is the most common cause of death in hospitalized near drowning pts

post-hypoxic encephalopathy

How well did you know this?

Not at all

Perfectly

______ is the most common cause of death in drowning pts

hypoxic cardiac arrest

How well did you know this?

Not at all

Perfectly

large aspiration of fluid in drowning victims result in (4)

more V/P mismatch
More surfactant washout
more electrolyte shifts
coagulopathy

How well did you know this?

Not at all

Perfectly

Botulinum is a neurotoxin that inhibits ____, which can result in paralysis

exocytosis of ACh at autonomic nerve terminals

How well did you know this?

Not at all

Perfectly

Key feature of botulism

b/l cranial nerve deficits with symmetric weakness

How well did you know this?

Not at all

Perfectly

Treatment of botulism in infants < 1 y.o and > 1 y.o

< 1 y.o: human-derived immune globulin

> 1 y.o: equine serum antitoxin (contains antibodies to 7/8 of known botulism type)

How well did you know this?

Not at all

Perfectly

Treatment for hypermagnesemia

1. accelerated elimination - Loop diuretics + D5W - dialysis 2. counteract it - calcium*

Why does PaCO2 decrease with sepsis?

Sepsis -> lactic acid production -> body compensates with tachypnea -> respiratory alkalosis

Sepsis leads to hypermetabolism, which includes protein (catabolism/anabolism)

catabolism

Organism associated with early vs late onset VAP

early: MSSA, H influenzae late: MRSA, pseudomonas, acinetobacter

Orthodeoxia is commonly seen in hepatopulmonary syndrome. what is that?

Hypoxia worsens when pt stands and improves when pt lies flat *standing worsens V/P mismatch since gravity causes increased perfusion and pooling in less ventilated lower lung segments

Hepatopulmonary syndrome is defined as _____ and increased A-a oxygen gradient in the setting of ESLD

intrapulmonary vascular dilatations (IPVDs)

Mean pulmonary artery pressures (PAP) > ___ mmHg is an absolute contraindication to liver transplantation

> 50 mmHg

Most nosocomial infections arise from ____

endogenous flora

Use of PPIs (increase/decrease) the incidence of nosocomial infections

increase | - gastric acidity inhibits bacterial overgrowth. Use of PPIs allows GNB to migrate into oropharynx

Septic shock effects on: - TNF-a - TF - Complement - Interferon gamma

- TNF-a: increases - TF: increases - Complement: increases - Interferon gamma: increases

The ARDS network states that pts should be ventilated at a tidal volume of 6 mL/kg of PBW and ______

plateau pressures < 30 cm H2O

RASS +4, 0, -4

+4: combative violent 0: calm, alert, appropriate - 4: unconscious, deep sedation

_____ electrolyte fluctuations are not commonly seen with TPN.

sodium

(hyper/hypo) phosphatemia normally results from TPN

hypophosphatemia

TPN is often administered via _____

central line, but peripheral can be used if osm low enough

Hepatic steatosis is (common/uncommon) with TPN

common | - excess sugar is stored as fat in liver

(Hypercarbia/Hypocarbia) commonly occurs with TPN infusion

Hypercarbia | - more carbohydrates -> sugar is metabolized to increase CO2 production -> respiratory acidosis

Corticosteroid myopathy presentation

insidious disease of proximal muscles in upper and lower limb and neck flexors

Muscle biopsy of corticosteroid myopathy

muscle atrophy without any inflammation

If the change in PaCO2 follows the change in pH, the condition is primarily _____

metabolic

If the change in PaCO2 is opposite the change in pH, the condition is primarily _____

respiratory

Metabolic disturbance associated with excessive diuresis

constriction alkalosis - excessive amt of low bicarbonate containing fluid is lost - intravascularly depleted

Metabolic disturbance associated with salicylate toxicity

respiratory alkalosis, + overlying metabolic acidosis

Metabolic disturbance associated with pulmonary embolism, PNA, asthma

respiratory alkalosis | - inc in minute ventilation

Metabolic derrangements seen in respiratory alkalosis

1. hypocalcemia 2. hypokalemia 3. hypophosphatemia

Metabolic changes during SIRS (4)

1. Hyperglycemia 2. Proteolysis (catabolism) 3. Lipolysis 4. Increased B-2 adrenergic stimulation

How does hyperventilation result in hypocalcemia?

In response to respiratory alkalosis -> H+ bound to neg charged albumin is released -> Ca2+ then binds to albumin (decreases free/ionized calcium)

How does hyperventilation result in hypokalemia?

In response to respiratory alkalosis -> Hydrogen-Potassium transporters pump H+ OUT of cells -> K+ is pumped INTO cells

How does alkalosis cause hypophosphatemia?

rising pH -> stimulates glycolytic pathway -> triggers cellular uptake of phosphorous

_____ is the most common cause of acute liver failure in US

acetaminophen toxicity

Acute respiratory acidosis | Acute 10mmHg increase in PaCO2 causes a ______ in HCO3-

increase of 1 mEq/L

Chronic respiratory acidosis | Sustained 10mmHg increase in PaCO2 causes a ______ in HCO3-

4-5 mEq/L increase

Acute respiratory alkalosis | Acute 10mmHg decrease in PaCO2 causes a ______ in HCO3-

decrease of 2 mEq/L

Chronic respiratory alkalosis | Sustained 10mmHg decrease in PaCO2 causes a ______ in HCO3-

decrease of 5-6 mEq/L

What phase of the capnograph is best to analyze for presence of acute or chronic obstructive respiratory pattern?

Upstroke phase (B-C) - normal: sharp upstroke caused by rapid increase in CO2 detected during expiration - obstructive pattern: slower, blunted upstroke

What limits the time that jet ventilation can be used?

Hypercarbia with respiratory acidosis (not hypoxemia) - small tidal volumes used increases dead space ventilation:alveolar ventilation

How can jet ventilation cause necrotizing tracheobronchitis (very rare complication)?

Dehydration of respiratory mucosa, impaired respiratory cilia fxn - high pressure nonhumidified oxygen - usually only occurs with prolonged use

How does sepsis cause an increase in ETCO2?

Increased metabolism (lactic acid and CO2) -> inc CO2 production -> ETCO2

Shivering (increases/decreases) ETCO2

increases - enhanced skeletal muscle metabolism *note: hypothermia -> decreased metabolic activity -> lower ETCO2

Hypothermia (increases/decreases) ETCO2

Decreases | - decreased metabolic activity -> lower ETCO2

How does cardiac arrest affect PaCO2 and ETCO2

Increased pathologic dead space - poor perfusion in setting of adequate ventilation Increased PaCO2 Decreased ETCO2

Which disorders are associated with gradual increase in ETCO2?

Thyroid storm | MH

metabolic demand for oxygen in an adult

3 ml/kg/min * pt weight

Why is PT the most useful diagnostic tool in acute abnormalities in hepatic SYNTHESIS?

Many coagulants are synthesized in liver Short half lives

Symptoms of HYPERmagnesemia

>7 mg/dL 1. Hypotension 2. Bradycardia 3. Vasodilation 4. Wide QRS, prolonged PR 5. Reduced DTR > 10 mg/dL 6. Respiratory arrest 7. Asystole *depress contractile force of muscles/vessels/myocardium

Magnesium sulfate is administered in preeclamptic pts why?

Prevent seizure activity through NMDA antagonism in CNS