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critical care 1 > LAST CHANCE! > Flashcards

LAST CHANCE! Flashcards

1
Q

normal base deficit/excess

A

-2 to 2

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2
Q

normal PaO2

A

80-100

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3
Q

what does pH represent?

A

pH is an inverse log of hydrogen ions
-% of hydrogen ions

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4
Q

what does CO2 indicate

A

acid

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5
Q

Co2 over 45

A

acidotic
apnea
hypotentilaton

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6
Q

Co2 under 35

A

hyperventilation

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7
Q

replacement formula for bicarbonate

A

0.1 x (-BE) x weight in kg = needd bicarb

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8
Q

base deficit pver-4

A

need blood transfusions

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9
Q

what happens in left shift?

A

LOW
HIGH affinity

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10
Q

relationship between O2 dissociation shifts and affinity for oxygen

A

opposite
left = low data= high affinity
right = high data = low affinity

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11
Q

relationships in O2 dissociation curve

A

left = high affinity, LOW values
H, temp, 2,3-DPG, PCO2

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12
Q

O2 shift if lot of CO2 is retained

A

CO2 is an acid so it makes the ABG more acidotic and moves left

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13
Q

O2 shift if lots of bicarbonate

A

bicarbonate is a base so more alkalotic and moves right

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14
Q

how to tell if it is compensated

A

the compensation mechanism is opposite of hte primary problem
r. acidosis is compensated by bicarb

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15
Q

partial compensation

A

pH outside of normal, values
both reps and metabolic are outside of normal values

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16
Q

fully compensated

A

pH normal|
both bicarb and cow are not normal

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17
Q

is it respiratory of acidotic?

A

if co2 folows pH = respiratory
if bicarbonate follows pH = metabolic

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18
Q

acid-base balance if Diamox

A

m. alkalosis

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19
Q

acid-base balance if steroids

A

m. alkalosis

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20
Q

criteria for lactic acidossi

A

lactate over 4

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21
Q

acid-base in seizures

A

m. acidosis

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22
Q

acid-base in rhabdomyolysism

A

acidosis

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23
Q

acid-base if breathing too fast

A

r. alkalosis.

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24
Q

intervedntion if on m. vent and breathing too fast

A

r. alkalosis
1. Vt
2. F

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25
Q

acid-base if hypermetabolic state

A

r. alkalosis

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26
Q

acid-base if pregnant

A

r. alkalosis

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27
Q

acid-base if high altitude

A

r. alkalosis

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28
Q

acid-base if pain

A

r. alkalosis

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29
Q

acid-base if anxiety attack

A

r. alkalosis

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30
Q

what happens in ASA poisniong

A

it is a respiratory center stimulant

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31
Q

can’t remove CO2

A

breathing slowly/hyperventilation is r. acksosis

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32
Q

acid-base in CNS depression

A

r. acisosis

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33
Q

acid-base irf lung or chest injury

A

r. acidosis

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34
Q

intervente r. acidosis

A

breathing too slow. so buildup CO2. so increase RR

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35
Q

acid-base in asthma

A

r. acidosis

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36
Q

acid-base in COPD

A

r. acidosis

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37
Q

every __ ETCO2
pH changes __
in ___ direction

A

every 10 mm ETCO2
pH changes 0.08
in opposite direction

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38
Q

10
0.08
__ direction

A

ETCO2
pH
oppsite

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39
Q

every __ pH
bicrab __
in __ direction

A

0.15 pH
10 bicarb
same direction

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40
Q

0.15
10
in __ direction

A

pH, bicarb, same

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41
Q

every __ pH
K shifts __
in __ direction

A

0.1
0.6
opposite

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42
Q

0.1
.6
__ direction

A

pH, K, opposite

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43
Q

every __ CO2
__ changes
__ direction

A

0.1 pH
K 0.5 shifts
same

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44
Q

0.1
0.5
__ direction

A

CO2, K, same

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45
Q

relationship between pH and K

A

as pH falls, K shifts outside the cell to make the K look false high
- when shifting imbalance by raising pH, K shifts intracellulary leaving life-threatening low K

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46
Q

shifts involving K

A

every 0.1 pH, shifts 0.5 in the same direction
every CO2 0.1m J sgufts 0.5 same

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47
Q

shifts involving pH

A

0.15 pH, bicarb 10 same direction
10 ETCO2, 0.08 opposite direction

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48
Q

ABG to intubate

A

only one off!
pH under 7.2
CO2 over 55
pAo2 under 60

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49
Q

LEMON

A

look
evaluate 3-3-2
mallampati
obstructions
neck mobnility

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50
Q

practice finger positions for the “E” of LEMON

A
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51
Q

mneumonic for the “E” of LEMON

A

3 fingers in mouth
3 fingers between jaw an dhyoid
2 fingers between hyoid and thyroid

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52
Q

predictor for diffiuclt airway

A

LEMON
HEAVEN - emergency difficult airway predictor

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53
Q

Mallampati II

A

tonsilar pillars are hidden by tongue

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54
Q

Mallampati III

A

only base of uvula can be seen

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55
Q

Mallampati IV

A

can’t see uvula

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56
Q

can’t see uvula

A

mallampati IV

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57
Q

only can see the base of the uvula

A

Mallampati III

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58
Q

can’t see the tonsilarpillars

A

Mallampati II

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59
Q

HEAVEN criteria

A

for difficult airway prediction in emergency
Hypoxemia under 93%
extremes of size (under 8,, obesity)
anatomic challenges
vomit/bood/fluid
exsanguination/anemia
neck mobility

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60
Q

blood concern that make an emergency intubation difficult

A

HEAVEN
= blood in oral cavity
- suspected anemia can potentially accelerate the rate of decompensation during RSI apneic period

61
Q

ramping

A

ear to sternal notch

62
Q

problems of supine transport/intubation

A

low runctional reserve capacity, Vt, preload

63
Q

lifts epiglottis via vallecula

A

McIntosh blade

64
Q

Macintosh blade

A

lifts the epiglottis via the vallecula

65
Q

directly dispacement epiglottis

A

miller blade

66
Q

miller blade

A

direct displacement of epiglottis

67
Q

preferred intubation blade for pediatrics

A

miller

68
Q

size bougie

A

adults 15 Fr
pediatic 10 Fr

69
Q

inflate ETT cuff

A

20-30 mm hg
only use the amount you need to create a good seal

70
Q

CXR confirms ETT

A

distal tip 4-5 cm above carina
level of T3-T4 (visualizing Murphy’s eye where the clavicle meets)

71
Q

ETCO2 waveform

A
72
Q

7 P’s for success

A

preparation
preoxygenate
pretreatment
paralysis with induction
protect and position
placement with proof
post intubation management

73
Q

the D of LOAD

A

RSI pretreatment
- desfasiculating dose: 1/10 roc or vec

74
Q

purpose of lidocaine as a RSI pretreatment

A

blunts the cough reflex preventing ICP

75
Q

purpose of atripoine as RSI pretratmetn

A

prevents reflexive bradycardia in udner 1 yo

76
Q

caution if use fentanyl for RSI

A

caution if low bp
chest wall rigidity

77
Q

DO NOT use etomidate for RSI

A

adrenal suppression
shock
septic shock
COPD
asthma

78
Q

DO NOT use as induction if shock

A

etomidate

79
Q

side effect of the reversal agent for benzos

A

flumazenil 0.2 mg adversely affectsw bp

80
Q

description of propofol

A

hypnotic with no analgesic properties

81
Q

good induction agent for shocky patients

A

ketamine

82
Q

contraindication for propofol

A

head injury b/c decreases CPP and MAP
not for hemodynamically unstable

83
Q

not a good induction agent if head injury

A

propofol b/c decreases CPP and map

84
Q

not a good induction agent if hemodynamically unstable

A

propofol
versed -bp

85
Q

description of propofol

A

hypnotic without analgestic properties

86
Q

electproblem of Succ

A

high K

87
Q

burns where you shouldn’t use succ

A

over 24 hrs

88
Q

contraindications to succinycholine - 7

A

crush
eye
narrow-angle glaucoma
malignant hyperthermia
burns over 24 hours
high K
nervous system disorder

89
Q

problem of malignant hyperthermia

A

defect in the skeletal muscle sarcoplasmic reticulum
can’t remove Ca form teh cell

90
Q

reverse Roc

A

sugammadex 16mg/kg

91
Q

use sugammadex

A

reverse Roc

92
Q

changes to make to RSI dosing if hemodynamically unstable

A

1/2 inducton dose (less needed b/c depleated catecholamine stores)
double paralytic ( low CO means slow onset of action)

93
Q

SALAD tercnique

A

suction assisted laryngoscopy airway decontaminatin
-suction, once the airway is clear, place suction tube in esophagus while pass tube

94
Q

post intubatin rx

A

fentanyl, ketamine, versed

95
Q

Pediatic cric guidelines

A

surgical if over 8
needle if under 8

96
Q

Fick’s Law of Diffusion

A

gases travel from high to low concentrations

97
Q

gases travel from low to high concentration

A

Fick’s Law of Diffusion

98
Q

apneuristic breathing

A

decerebrate posturing
deep gasiping inspiration with pause at full inspiration then breief insufficient release

99
Q

deep gasping inspiration with a pause at full inspiration followed by a brief insufficient release

A

apneuristic

100
Q

ataxic

A

complete irregular breathing with irregulart pauses and increasing periods of apnea

101
Q

irregular breathing, pasues, and apnea

A

ataxic

102
Q

BIots

A

shallow inspiration with apnea

103
Q

shallow inspiration iwth apnea

A

Biots

104
Q

brainstem heriniation breathign patern

A

cheyne-stokes

105
Q

DKA breathing

A

Kussmaul

106
Q

deep rapid and gasping breathign

A

Kussmaul

107
Q

Kussmaul breathing

A

deep rapid and gasping breathing

108
Q

Cheyne-Stokes breathign

A

progressively depeer and faster then decrease and apnea

109
Q

treatment for hypoxic respiratory failure

A

FiO2 & PEEP

110
Q

treatmetn for hypercarbic respiratory failure

A

increase pPlat then increase rate
double minute ventilation

111
Q

Vt setting for weight

A

over 8ml/kg of IBW for Vt settings can cause VILI

112
Q

normal Vt

A

4-8 ml/lg IBW

113
Q

PIP

A

not over 35
- amount if resistence to overcome the ventilator circiut, appliances, the ETT, main airways

114
Q

waveform on ventilator

A
115
Q

pPLAT

A

under 30
-pressure applied to the small airways and alveoli
- represents teh static end inspirationry recoil pressure of hte respiratory system, lung, and chest wall

116
Q

when do you measure pPLAT

A

durng inspiratory pause (i-hold)

117
Q

Assist-control

A

trigger for deliver of bretht by either pt or elapsed time
-0 preferred mode for pt with respiratory distress
FULL Vt regardless of respiratory effort of drive

118
Q

how much of a Vt do you get per breath on Assist control

A

trigger for breath is either pt or elapsed time
- gets full Vt regardless of respiratory effort or drive

119
Q

prblem of auto-peep

A
  • predispose to barotrauma & hemodynamic compromises
  • increases teh effort to trigger the ventilator and WOB
  • diminshes the efficiency of hte force generated by respiratory muscles
120
Q

SIMV

A

if pt fails to breathe, the ventilator will provide the breathe
can breathe in between preset intervals

121
Q

purpose of pressure support ventilation

A

Vt, rate
- must have consistent ventilation effort
0 decreases overall WOB

122
Q

patient-ventilator dyssynchrony indication

A

inadequate pain and sedation. resp demands not being met
curare cleft per ETCO2 waveform

123
Q

curare cleft

A

ETCO2 shows curare cleft
inadequate pain/sedation
fighting the vent

124
Q

problem of patient-ventilator dyssynchrony

A

increased WOB, HR, BP, ICP, oxygen demand

125
Q

treat patient-ventilator dyssynchrony

A

manage auto-peep
adjust rate to match pt demand
adjust sensitivity
suchtion
pain/sedation rx
adjust minute ventilation (F x Vt)

126
Q

ventilator setting to check if acute respiratory deterioration is noted

A

DOPE
PIP first (decrease/increase/no change)
then plateau pressure

127
Q

ventilator shows decreased PIP

A

air leak
hypERVENT
HYPOventilation

128
Q

ventilator shows increased PIP

A

chec to see if there is a change or no change in pPLAT

129
Q

ventilator shows no change in PIP

A

PE
extrathoracic process

130
Q

acute respiratory deterioration
shows increased PIP
but no change in pPLAT

A

airway obstruction

131
Q

acute respiratory deterioration
shows incrased PPLAT
and increased pPLAT

A

decreased compliance is the cause

132
Q

calculate VQ

A

alveolar ventilation / CO

133
Q

low V/Q

A

shunting (alveoli is perfused but not ventilated)
ET tube in mainstem bronchus

134
Q

high VQ

A

deadspace: aveoli ventilation but not perfused (cardiac arrest)

135
Q

normal V/Q

A

around 0.8
alveoli is perfused and ventilated
(low V/Q is shunting. alveoli perfused not ventilated)
high is deadapace: alveoli ventilated, not perfused

136
Q

problem of lwo V/Q

A

ventilation is not keeping pace with perfusion
-r. failure, ARDS< pneummonia
-low PaO2
high PaCO2

137
Q

problem of asthma

A

problem is breathing out
r. acidosis b/c hypercarbic r. failure

138
Q

CXR of asthma

A

flattened diaphragm
chest cavity overexpanded b/c air traping

139
Q

ventilation for asthma

A

increase I:E to 1:4
zero peep
consider bipap

140
Q

rx for asthma

A

bronchoD
steroids
epi
magnesium
IVF
ketamine

141
Q

CXR of COPD

A

flat diaphragm

chest cavity overexpanded b/c air trapping

142
Q

COPD exacerbation intubatin

A

increase i:E to 1:4 to facilitate CO2 offloading
zero peep

143
Q

thing to consider abotu I:E ratuis

A

uncomfortable & need deep sedation
longer E increases CO2 clearnence but can cause risk fo atelectasis

144
Q

what happens in ARDS

A

diffuse alveolar injury
- incrased permeability of hte alveoliar-capillary barrier so influx of fluid in the alveolar space
= hypoxemia and p. HTN

145
Q

CXR of ARDS

A

ground glass
patchy infiltrates
bilateral diffuse infiltrates

146
Q

Swan-Ganz results of ARDS

A

PAWP is over 18 b/c the right heat is pumping against increased resistence inteh lung vasculature

147
Q

treat ARDS

A

increase Peep and FIO2
Vt low at 4ml/kg
increase F to ensure adequate minute volume

148
Q

intervention if IABP has condensation

A

place pump on standby,
disconnect at safety chamber/extension tubing,
pump for 30 seconds iwth tubing/chamber faced downward to expel droplets,
set pump back on standby,
reconnect/refill/resume

149
Q

intervention if IABP has a consol malfunction

A

manually inflate/deflate balloon with 20-50ml luerlock syyronge q 5-15 minutes|-use at least 15ml lessfill gas or air (this is not counterpulsation- inflation can occur at systole
- replace IABP asap

critical care 1 (14 decks)

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