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MICU Flashcards

1
Q

Hypotension after etomidate

A

adrenal insufficiency

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2
Q

Vent settings for ALI

A

low tidal volume (6cc/kg) with relatively high PEEP

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3
Q

Vent settings in asthma/COPD

A

lower RR

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4
Q

Most common vent mode in ICU

A

assist control (AC)/volume control

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5
Q

What do you set on AC mode? What if the patient takes extra breaths?

A

Set RR, FiO2, TV, PEEP; if pt takes extra breath they will be delivered the TV you have set; if they take less breaths than set, they will still get what is set

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6
Q

What is the key difference between SIMV and AC?

A

it patient breathes over vent on SIMV, they only get a tidal volume based on their own effot; in AC, they will get a full tidal volume that is preset

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7
Q

What is pressure support mode and when is it used?

A

Often used as weaning mode; patient initiates all of their own breaths and sets their own TV

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8
Q

What pressure support is needed just to overcome resistance of ETT?

A

5

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9
Q

What is pressure control mode and when is it often used?

A

used to control inspiratory pressure (set by you); RR, FiO2 also set; TV varies to keep pressure from gettting too high; ;used for stiff lungs

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10
Q

What is PRVC?

A

pressure regulated volume control-you set tidal volume and presure; ventilator will change flow rate in order to acheive preset TV without exceeding set pressure

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11
Q

What is the difference btwn spontaneous breathing and CPAP?

A

CPAP has PEEP

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12
Q

What is added with BIPAP?

A

pressure support (also has PEEP); pressure cycled-peak inspiratory pressure is constant

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13
Q

How can BIPAP and CPAP be bad if too much oxygen given for too long?

A

causes removal of nitrogen from alveoli, leading to atelectasis; happens with only 50% FiO2 in 4hr

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14
Q

What is inspiratory sensitivity?

A

the effort pt makes to deliver breath (0.5-1cm H20)

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15
Q

What is plateau?

A

pause after inspiration to improve gas excahnge; usually set at 0. If needed, set at 0.5sec

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16
Q

How does PEEP help?

A

improves gas exchange by recruiting alveoli and reduces O2 toxicity

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17
Q

When should PEEP be avoided?

A

pulmonary hypertension

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18
Q

Desaturation on vent-possible problems mneumonic

A

DOPE-displacement, obstruction, PTX, equipment failure

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19
Q

Steps to increase PaO2/O2 sats:

A

(1) increase FiO2 (2) increase PEEP by 3-5 (3) increase TV

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20
Q

How to adjust vent to change high PCO2?

A

increase RR or TV (try to keep peak airway pressures <40-50)

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21
Q

Extubation criteria: FiO2, minute ventilation, RSBi/Tobin index, PEEP, pressure support, NIF

A
  • FiO2<12
  • RSBI or Tobin index: RR^2/minute ventilation, goal less than 100
  • PEEP at 5, PS at 5
  • minimal secretions
  • mental status: can follow commands
  • patient on on pressors (only true in VU MICU)
  • NIF: -20 or more
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22
Q

Minute Ventilation formula

A

MV=RR X TV

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23
Q

How does pH on VBG compare to pH on ABG?

A

0.03 + VBG pH = ABG pH

assuming pt not hypotensive

24
Q

How does pCO2 on VBG compare to pCO2 on ABG?

A

5 + VBG CO2=ABG CO2?

25
Q

Lung compliance formula; what is normal lung compliance?

A

(Change in volume/Change in pressure)=TV/(plateau pressure-PEEP); normal compliance is 50-100

26
Q

SIRS criteria

A

(1) Temp 38
(2) HR >90
(3) RR >20
(4) WBC >12,000 or <4,000 OR 10%bands

27
Q

Acute lung injury: PaO2/FiO2

A

201-300; no evidence of increased left atrial pressure (wedge <18)

28
Q

ARDS: PaO2/FiO2

A

<200

29
Q

ARDS mortality; how does it change for each additional failing organ?

A

50% mortality; add 20%

30
Q

What type of shock appear warm and pink?

A

septic, anaphylactic, neurogenic

31
Q

What type of shock are cool and blue?

A

cardiogenic, hypovolemic, obstructive

32
Q

Receptors acted on by levophed

A

alpha and beta, but alpha>beta so get more pressor action and less tachycardia

33
Q

Goal BP when on levophed

A

titrate to keep map > 60

34
Q

Should you titrate vasopressin?

A

No, keep dose constant at 0.04U/min

35
Q

What vital sign abnormality should you avoid phenylephrine (neo)?

A

bradycardia; the strong alpha effects cause reflex bradycardia

36
Q

What is a common side effect of dopamine?

A

arrhythmimas; B1>alpha

37
Q

dobutamine receptors

A

B1 and B2-bronchodilates and vasodilates, chronotropy (increase cardiac output)

38
Q

name the pressor of choice:

  • septic shock
  • neurogenic shock
  • cardiogenic shock
  • obstructive shock
  • anaphylactic shock
A
  • septic shock; levophed
  • neurogenic shock: neo
  • cardiogenic shock: dobutamine, milrinone
  • obstructive shock: levophed
  • anaphylactic shock: epi
39
Q

In suspected adrenal insufficiency, what drug can you give that will not interfere with cortisol stimulation test?

A

decadron (use 10mg)

40
Q

When measuring wedge pressure with pulmonary artery catheter, do you measure during inspiration or expiration?

A

expiration

41
Q

If you give Mg, when should you recheck levels?

A

at least not until next morning, peaks early and quickly falls again (if measure too early, will be falsely high)

42
Q

Urine Na and osmolarity in pre-renal failure

A

Urine Na=low (500)

43
Q

Urine Na and osmolarity in intrinsic renal failure

A

Urine Na=high, osmolarity=low (<400)

44
Q

FeNa in prerenal and intrinsic

A

prerenal=1%

45
Q

What drugs interfere with FeNa?

A

dopamine, diuretics, mannitol, saline

46
Q

What are the MICU transfusion goals?

A

Hgb<21; if cardiac pt, Hgb10, PCV30

47
Q

After giving how many units of blood do you have to give calcium gluconate and how much?

A

after 4 units; 1g for every 4 units

48
Q

DVT ppx dosing

A

heparin 5000U q8h OR lovenox q day

49
Q

What if pt needs SCDs but doesn’t have legs/not available?

A

place on arms

50
Q

Scenario: pt’s platelets drop by 50% in last 5 days on MICU pt

A

consider HIT if on heparin; send HIT ab lab

51
Q

1st thing to do in HIT?

A

stop the heparin and/or lovenox

52
Q

What is the HIT treatment?

A

lepirudin, argatroban, bivaluridin-but ONLY if coagulopathic; tell nurses NOT to flush lines with heparin; do NOT give platelet transfusion

53
Q

What patients do you want to avoid lepirudin in?

A

renal failure

54
Q

How much does 1 unit of platelets raise PLT count?

A

10,000; Vandy uses single donor platelet units that are equivalent of 6-10 units

55
Q

What is the indication for platelet transfusion (what plt count)?

A

5,000 without bleeding, 50,000 for invasive procedures

56
Q

ICU delirium treatment

A

haldol

57
Q

primary sedation used in VA MICU

A

fentanyl and versed

Adults (9 decks)

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