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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
Lung compliance formula; what is normal lung compliance?
(Change in volume/Change in pressure)=TV/(plateau pressure-PEEP); normal compliance is 50-100
26
SIRS criteria
(1) Temp 38 (2) HR >90 (3) RR >20 (4) WBC >12,000 or <4,000 OR 10%bands
27
Acute lung injury: PaO2/FiO2
201-300; no evidence of increased left atrial pressure (wedge <18)
28
ARDS: PaO2/FiO2
<200
29
ARDS mortality; how does it change for each additional failing organ?
50% mortality; add 20%
30
What type of shock appear warm and pink?
septic, anaphylactic, neurogenic
31
What type of shock are cool and blue?
cardiogenic, hypovolemic, obstructive
32
Receptors acted on by levophed
alpha and beta, but alpha>beta so get more pressor action and less tachycardia
33
Goal BP when on levophed
titrate to keep map > 60
34
Should you titrate vasopressin?
No, keep dose constant at 0.04U/min
35
What vital sign abnormality should you avoid phenylephrine (neo)?
bradycardia; the strong alpha effects cause reflex bradycardia
36
What is a common side effect of dopamine?
arrhythmimas; B1>alpha
37
dobutamine receptors
B1 and B2-bronchodilates and vasodilates, chronotropy (increase cardiac output)
38
name the pressor of choice: - septic shock - neurogenic shock - cardiogenic shock - obstructive shock - anaphylactic shock
- septic shock; levophed - neurogenic shock: neo - cardiogenic shock: dobutamine, milrinone - obstructive shock: levophed - anaphylactic shock: epi
39
In suspected adrenal insufficiency, what drug can you give that will not interfere with cortisol stimulation test?
decadron (use 10mg)
40
When measuring wedge pressure with pulmonary artery catheter, do you measure during inspiration or expiration?
expiration
41
If you give Mg, when should you recheck levels?
at least not until next morning, peaks early and quickly falls again (if measure too early, will be falsely high)
42
Urine Na and osmolarity in pre-renal failure
Urine Na=low (500)
43
Urine Na and osmolarity in intrinsic renal failure
Urine Na=high, osmolarity=low (<400)
44
FeNa in prerenal and intrinsic
prerenal=1%
45
What drugs interfere with FeNa?
dopamine, diuretics, mannitol, saline
46
What are the MICU transfusion goals?
Hgb<21; if cardiac pt, Hgb10, PCV30
47
After giving how many units of blood do you have to give calcium gluconate and how much?
after 4 units; 1g for every 4 units
48
DVT ppx dosing
heparin 5000U q8h OR lovenox q day
49
What if pt needs SCDs but doesn't have legs/not available?
place on arms
50
Scenario: pt's platelets drop by 50% in last 5 days on MICU pt
consider HIT if on heparin; send HIT ab lab
51
1st thing to do in HIT?
stop the heparin and/or lovenox
52
What is the HIT treatment?
lepirudin, argatroban, bivaluridin-but ONLY if coagulopathic; tell nurses NOT to flush lines with heparin; do NOT give platelet transfusion
53
What patients do you want to avoid lepirudin in?
renal failure
54
How much does 1 unit of platelets raise PLT count?
10,000; Vandy uses single donor platelet units that are equivalent of 6-10 units
55
What is the indication for platelet transfusion (what plt count)?
5,000 without bleeding, 50,000 for invasive procedures
56
ICU delirium treatment
haldol
57
primary sedation used in VA MICU
fentanyl and versed

Adults (9 decks)

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