ITE ICU

Question 1

Ideal management goals for organ procurement?

Answer 1

• MAP 60-120 mmHg
• CVP 4-12
• Final Na ≤ 155, or 135-160 mmol/L
• Pressors < 1 ideal, or low dose pressor
• PaO2/FiO2 ratio > 300 (PaO2 > 300 on 100% FiO2, 5 PEEP)
• pH on ABG 7.25-7.5
• Glucose < 150
• Urine Output 0.5-3 mL/kg/h
• LV EF (%) > 50
• Hgb > 10 mg/dL

Question 2

Patient in ICU with 8 L NS after ex lap, what is expected acid-base?

Answer 2

Hyperchloremia leads to decrease HCO3 to maintain net neutrality, will be acidosis. Can also have fluid induced metabolic acidosis with .45% fluid due to reduction in SID rather than

Question 3

SID?

Answer 3

Accounting for HCO3-, albumin, phosphate, unmeasured ions. Decreased in SID results in decreased PH.

Question 4

Recommended practices to prevent catheter-related infections?

Answer 4

ultrasound guidance, chlorhexidine and alcohol solution, avoidance of femoral vein site, maintenance of aseptic technique with maximal sterile barrier precautions, and the use of antimicrobial-impregnated catheters

Question 5

Needle stick injury with bloody needle, unknown blood infection….what blood infection has highest rate of seroconversion?

Answer 5

Hepatitis B, e antigen positive. 37-62%

Question 6

45 yo M intubated 3 days after TBI, develops gastric stress ulcer.What will reduce incidence of VAP?

Answer 6

sucralfate. Reduced gastric acidity and volumes increased bacteria overgrowth. Sucralfate does not change gastric ph, however is less effective against GI bleeding.

Question 7

Dehydration effect on SID?

Answer 7

increased SID and metabolic alkalosis(contraction alkalosis). hypovolemia, sodiium in

Question 8

Patient with decreased CO, increased SVR, increased CVP?

Answer 8

Obstructive shock ( vs cardiogenic do ECHO and pay attentiont o clinical scenario, PA pressure)

Question 9

Types of obstructive shock?

Answer 9

tension penumo, anterior mediastinal mass, pericardial tamponade, pulmonary embolism (PE may not have elevated pulmonary artery occlusion pressure)

Question 10

Decreased CVP and decreased PCWP?

Answer 10

Hemorrhagic shock.

Question 11

Clostridium botulinum MOA and tx?

Answer 11

neurotxoin causes inhibition of of exocytosis of acetylcholine. tx with huhman derived immune globulin in atients less than a year and equine derived if greater than a year

Question 12

Fluid goals in sepsis?

Answer 12

> 30 ml/kg crytalloid within 3 hours