NBRC ARDS, CAD, Neuro Flashcards
Hypoxemic respiratory failure can be defined as a PaO2 less than ___ or a PF ratio less than ___.
PaO2 less than 50-60
PF ratio less than 300
What is the most common cause of hypoxemic respiratory failure?
VQ mismatching
If a patient’s FVC (Forced Vital Capacity) is less than ___, then they are in hypercapnic respiratory failure.
Less than 10 mg/kg
If a patient’s MIP (Maximal Inspiratory Pressure) is less than ___, then they are in hypercapnic respiratory failure.
-20 cm H2O
(Remember they are inhaling. That’s why that number is expressed as -20, not 20. It’s not actually a negative number. It just indicates that they’re inhaling, not exhaling.)
If someone’s NIF is -25, then, then -16, then -5, is their NIF getting better or getting worse?
It’s getting worse.
In the ATS/ERS Criteria, a PF ratio less than 300 is ___.
A PF ratio less than 200 is ___.
Less than 300: Acute lung injury
Less than 200: ARDS
What phase of ARDS is characterized by the development of lung injury and fibrosis?
Proliferative phase (2nd phase)
What is the second phase of ARDS?
How long does it last?
The Proliferative Phase
7-21 days
What phase of ARDS is characterized by advanced fibrosis?
Fibrotic phase (3rd Phase)
You should give this class of drug to ARDS patients because of the inflammation involved in this syndrome.
Corticosteroids.
What is the first phase of ARDS?
How long does it last?
Exudative phase
1-7 days
What are the three I’s of a myocardial infarction?
Ischemia, then
Injury, then
Infarction.
When treating an MI patient, you can give anti-ischemic therapy, including nitroglycerin, morphine, ___, and ___. (It’s not oxygen or aspirin)
Beta-blockers, diltiazem
These drugs are platelet inhibitors. Aspirin, ___, ___, and ___. They’re given to MI patients.
Clopidogrel (Plavix)
Prasugrel (Effient)
or Ticagrelor (Brilinta)
These are platelet inhibitors.
What is the third phase of ARDS?
How long does it last?
Fibrotic phase
Most patients recover in 3-4 weeks.
When treating an MI, these drugs are good anticoagulants: Heparin, ___, and ___.
Fondaparinux (Arixtra) and Bivalirudin (Angiomax or Angiox)
Patients who are brain dead will often have this urinary finding.
Increased urine output (Diabetes insipidus)
What are the 3 prerequisites for apnea testing?
What do you do before you start apnea testing?
Normal BP, temp, and CO2.
Hyper-oxygenate to obtain PaO2 greater than 200.
How do you do an apnea test? (x4)
- Disconnect patient from ventiator.
- Observe closely for breathing effort
- Obtain an ABG after 8 minutes
- Reconnect pt to the ventilator.
During an apnea test, when should you re-connect the patient to the ventilator?
- Systolic BP goes below 90
- Pt desaturates
- Cardiac arrythmias occur
During an apnea test, you get an ABG and look at the PaCO2. What would indicate that it’s a positive test? (x2)
PaCO2 greater than 60 or 20 above baseline.
How do you confirm diagnosis of brain death?
Cerebral Perfusion Scan. (Not EEG!)
What is a normal Cerebral Perfusion Pressure?
Maintain CPP within what range?
A critical CPP is ___.
Normal is 60-100.
Maintain within 50-70.
Critical is 20-40
There are two contraindications of ICP monitor insertion. One of them is ___, which is indicated by ___. The other is the presence of ___, especially ___.
Low platelet count
APTT two times normal
Immunosupressive therapy (esp. steroids)
Brain dead patient with harvestable organs:
Keep BP above ___.
90
Brain dead patient with harvestable organs:
Keep mean arterial pressure between ___.
60-85
Brain dead patient with harvestable organs: Keep CVP between ___ and ___.
4 and 10
What phase of ARDS will you see alveolar edema and leukocytic inflammation?
Exudative (1st phase)
Brain dead patient with harvestable organs: Urine output should be between ___ and ___.
100-200 per hour
What phase of ARDS will you see hyaline membranes develop?
Exudative (1st phase)
What phase of ARDS is characterized by persistent dyspnea and hypoxemia?
Proliferative phase (2nd phase)
What phase of ARDS is characterized by prolonged mechanical ventilation and/or supplemental O2 therapy?
Fibrotic Phase (3rd phase)
Brain dead patient with harvestable organs: SpO2 should stay above ___.
95%
Brain dead patient with harvestable organs: Hematocrit should be above ___.
30%
Brain dead patient with harvestable organs: Temp should be between ___ and ___.
36.5 and 37.5
or
97.7 and 99.5
Brain dead patient with harvestable organs: Glucose should remain at this range:
120-180 mg/dl
How do you calculate CPP?
Cerebral Perfusion Pressure = Mean arterial pressure - ICP
To reduce ICP, you should sedate the patient to prevent movement. What two drug classes should be used?
Narcotics and benzodiazepines
What drug is used to decrease ICP?
Mannitol
When should you consider surgery to treat ICP?
Large but focal hemorrhage
Obstructive hydrocephalus
Tumors
How is a ischemic stroke treated? x2
Tissue plasminogen activator (Within 4.5 hrs)
Aspirin
How is a cardioembolic stroke treated?
CT scan to see if there is hemorrhaging.
Low molecular weight heparin
Warfarin
How do you treat TIA’s?
What are two alternatives to this drug?
Aspirin
If patient is aspirin sensitive, give ticlopidine or clopidogrel
What PaCO2 constitutes hypercapnic acute respiratory failure?
PaCO2 greater than 50 torr and not due to metabolic alkalosis.
