Organ failure

Question 1

What possible causes when respiratory failure does not respond to therapy?

Answer 1

Untreated bacterial infection
Sputum retention
Pneumothorax
Inadequate bronchodilator therapy
Pulmonary oedema
Dysrhythmia
Inappropriate sedation
Wrong diagnosis

Question 2

What are indications to NIV?

Answer 2

pH 6,5 despite controlled oxygen therapy
RR >25
Breathlessness with accessory muscle use and paradox abdominal motion

Question 3

Contraindications to NIV?

Answer 3

Resp ac

Question 4

What are the physiological effects ob EPAP?

Answer 4

Keeping airway open
Increase alveolar ventilation
improves oxygenation
Increases FRC
Increases intrathoracic pressure --> reduce preload

Question 5

What are the physiological effects of IPAP?

Answer 5

Reduces effort of breathing
Improves tidal volume
Improves CO2 removal

Question 6

What is the mechanism of raised CO2 when giving O2 that is not losing the CO2 drive?

Answer 6

O2 –> loss of pulmonary constriction –> increase of ventilatory/perfusion mismatch –> increased respiratory rate –> increased ventilation of dead space

Question 7

What mechanisms can cause excessive fluid in lungs resulting in pulmonary oedema?

Answer 7

Increased hydrostatic pressure in lung capillaries (HF, neurogenic, fluid overload)
Decreased osmotic pressure (loss protein)
Capillary leakage (SIRS, ARDS, neurogenic)
Negative pressure in alveoli (inspiration against resistance)

Question 8

Stages of pulmonary oedema?

Answer 8

Pulmonary hypertension due to high pressures LA/LV
Reflectoric dyspnea
Overwhelmed lymphatic drainage
Alveolar fluid
Aggravated breathlessness and stress from patient
Increased afterload and HR
cumination in rapid onset of pulmonary oedema

Question 9

Why would preload need to be reduced in acute heart failure with pulmonary oedema?

Answer 9

Improve ventricular performance

Reduce pulmonary venes pressure

Question 10

How is fast heart rates non-beneficial in heart failure? When is this of significance?

Answer 10

Impairs diastolic filling. AF in conditions with impaired diastolic filling such as mitral stenosis.

Question 11

Where would you hear
A) Mitral stenosis?
B) Mitral regurgitation?

Answer 11

A) Apex (diastolic, just after systolic)

B) Apec (holosystolic)

Question 12

What are intrinsic renal mechanisms to cause acute renal failure? (4)

Answer 12

Glomerular (systemic disease)
Vascular disease (vasculitis, coagulopathy)
Acute tubular necrosis (ischemic)
Interstitial nephritis (drugs)

Question 13

När vid hyperkalem indicerat med
A) glukos-insulindropp?
B) Calcium-glukonat
C) Natriumbikarbonat?
Vilka ytterligare behandlingar att överväga?

Answer 13

A) K >6
B) K >6,5
C) K >7
Salbutamol, furosemid, resonium, hemodialys

Question 14

Why is early ultrasound of kidneys advicable in acute renal insufficiency?

Answer 14

Exclude postrenal obstruction

Number shape and size of kidneys of value in diagnostics.

Question 15

Which medications are known for causing renal damage?

Answer 15

NSAIDS
ACEi
Aminoglycosides
Kontrast

Question 16

What is important in evaluating possible infection in patient with liver disease?

Answer 16

Patients with liver failure ar relatively immunocompromised. Could llack pyrexia and leukocytosis.

Question 17

6 life-threatening features of liver failure?

Answer 17

Hypoxemia
Hypoglycemia
GI-bleeding
Coma
Hypovolemia
Multiple organ failure

Question 18

Never diagnose primary hyperventilation until ………………………………….. has been excluded.

Answer 18

Diabetic ketoacidosis.

Question 19

In which patients should acute adrenal insuficiency be suspected?

Answer 19

Unexplained hypotension
Mild hyponatremia
Earlier corticosterodi therapy
Pigmentation
Weight loss, vomiting, anorexia preceding

Question 20

What measures when suspected adreanal insufficiency?

Answer 20

drax s-cortisol and ACTH

Give Hydrocortison 100 mg iv