Organ System Dysfunction

Question 1

King’s College criteria for acute liver failure due to acetaminophen overdose

Answer 1

pH < 7.3
grade III or IV encephalopathy
PT > 100 sec
Serum creat > 3.4
INR > 1.5

Question 2

Tx of Hepatorenal syndrome

Answer 2

Tx: expand intravascular fluid volume with albumin, decreasing peripheral vasodilation w/ admin of vasopressors (midodrine/vasopressin)

Question 3

Delirium and antiemetics

Answer 3

metoclopramide (raglan) and promethazine (phenergan) are dopaminergic agonists which don’t allow daily naps

Question 4

SOFA score

Answer 4

identifies high-risk pts for mortality with infection in ICU

PaO2, FiO2, PLT, GCS, Bili, Creatinine, MAP/Admin of pressers

Question 5

qSOFA score

Answer 5

ID high-risk pts for in-hospital mortality outside of ICU

RR>22, AMS (GCS <15), Syst BP <100

Question 6

Uremic platelet dysfunction

Answer 6

Common in ICU pts, chronic kidney disease

Defect in PLT aggregation. Uremia affects activity of vWF & PLT surface proteins, increase endothelial factors that inhibit platelet activity

Tx: desmopressin -> increases secretion of F8 & vWF -> increases PLT aggregation. improves bleeding w/in 1 hr, lasts up to 4-8 h. HD also helps uremic PLT dysfunction. chronic dz tx w/ conjugated estrogen

Question 7

Classification of hypothermia

Answer 7

Mild: 32-35C (90-95F). Confused, shivering. Tx: passive external warming (remove wet clothes, increase room temp, blankets)

Mod: 28-32 (82-90). Agitated, shivering stops. Tx: active external rewarming (heating packs, warming bath, hair hugger)

Severe: <28 (<82). Comatose. Tx: active internal rewarming (ECMO, CP bypass, thoracic/peritoneal lavage)

Question 8

Primary hypothermia

Answer 8

Due to environmental exposure to cold temp and body’s natural heat-generating ability is overwhelmed

Question 9

Secondary hypothermia

Answer 9

When illness or substance abuse impairs body’s ability to regular temp

Question 10

Hemodynamic changes seen with Pneumoperitoneum during laparoscopic surgery

Answer 10

Decreased venous return
Decreased cardiac output
Increased heart rate
Increased myocardial O2 demand
Increases systemic vascular resistance (2/2 vasoconstrictive effect of hypercapnia)

Question 11

Hemodynamic changes during Induction of anesthesia

Answer 11

SVR decreases
MAP decreases
CO decreases

Question 12

Hemodynamic changes during abdominal desufflation

Answer 12

SVR decreases
MAP decreases
CO/CI increases

Question 13

ARDS

Answer 13

acute injury to lung

1st phase: protein-rich fluid moves into alveolar spaces. leukocytes proliferate, intrinsic injury to lung
2nd phase: fibroproliferative, associated w/ fibrosis and collagen formation, stiff noncompliant lung, reversible over time
3rd phase: resolution, remodeling and clearing of pulmonary edema

PaO2/FiO2 <200 w/ PEEP >5

Question 14

Shifts in O2-Hg dissociation curve

Answer 14

Right shift -> Hg less affinity for O2 -> release of O2 to tissues: increased 2,3-DPG, high temp, high partial pressure CO2, decreased pH

Left shift: Increased pH, decreased temp/PCO2/2,3-DPG