picu

Question 1

oxygen delivery (equation)

Answer 1

cardiac output x oxygen content

Question 2

cardiac output (equation)

Answer 2

HR x SV

Question 3

oxygen content (equation)

Answer 3

(1.34 x hgb x SpO2) + 0.003 x PaO2

Question 4

hypovolemic shock - what kind of problem?

Answer 4

preload

Question 5

hypovolemic shock symptoms

Answer 5

hypotension, tachycardia, dehydration, poor perfusion

Question 6

hypovolemic shock tx

Answer 6

fluids!

Question 7

cardiogenic shock - what kind of problem?

Answer 7

contractility

Question 8

cardiogenic shock symptoms

Answer 8

hypotension, tachycardia, tachypnea, lung crackles, hepatomegaly, cool expremities, depressed mental status, WORSENS with fluids

Question 9

SIRS criteria

Answer 9

temp (< 36 or > 38)
HR
RR
WBC (< 4 or > 12)

Question 10

SIRS: HR by age (neonate, infant, 1-5, 6-13, 12-18)

Answer 10

neonate < 100 or > 180
infant < 90 or > 180
1-5 yrs > 140
6-12 yrs > 130
13-18 yrs > 110

Question 11

SIRS: RR by age (neonate, infant, 1-5, 6-13, 12-18)

Answer 11

neonate > 50
infant > 34
1-5 yrs > 22
6-12 yrs > 18
13-18 yrs > 14

Question 12

monitoring shock

Answer 12

HR, BP, mental status, UOP, lactate, SVO2, pulses, perfusion

Question 13

SvO2

Answer 13

normal = 25 below arterial

• high = failure of energy usage
• low = excess oxygen demand, inadequate delivery

Question 14

brain death exam

Answer 14

loss of the following reflexes:
- pupils
- cornea
- bulbar musculature
- cough, gag, suck, root
- oculovestibular

apnea test: absence of respiratory effort with PaCO2 > 60 and > 20 above baseline i/s/o normal pH, PaCO2, BP, temp prior

Question 15

brain death definition

Answer 15

cessation of neuro function of brain due to known, irreversible cause. clincial dx.

Question 16

cerebral perfusion pressure

Answer 16

MAP - ICP

Question 17

neuroprotection goals:
- CO2
- glucose
- sats
- temp
- Na

Answer 17

• CO2: 35-40 (hypocarbia –> vasoconstriction)
• glucose: 80-180
• sats: > 92%
• temp: low normal`
• Na: > 140

Question 18

improving oxygenation on a vent

Answer 18

• FiO2
• MAP (PEEP and I time)

Question 19

improving ventilation on a vent

Answer 19

minute ventilation = RR x TV

Question 20

lung protection in ARDS

Answer 20

• low TV 4-6 mL/kg
• high PEEP 8-12
• allow hypercarbia (to pH > 7.25) and hypoxemia (sats > 88%)

Question 21

meds for status asthmaticus

Answer 21

• albuterol
• steroids
• magnesium
• IM epi
• terbutaline
• atrovent
• heliox
• aminophyline

Question 22

albuterol MOA + side effects

Answer 22

• B2 agonist
• tachycardia, tremor, agitation, hypoK

Question 23

terbutaline MOA + side effects

Answer 23

• B2 agonist
• tachycardia, tremor, agitation, hypoK, myocardial ischemia (get EKG prior)

Question 24

epinephrine MOA

Answer 24

• B2 agonist

Question 25

steroids MOA + side effects

Answer 25

• decrease inflammation and mucous production
• GI ppx, bradycardia

Question 26

atrovent MOA + side effects

Answer 26

• anticholingeric (inhibits cGMP)
• minimal evidence outside ED

Question 27

heliox MOA + side effects

Answer 27

• promotes laminar flow and decreases airway resistance
• cant use if requiring > 40% fiO2

Question 28

Mg MOA + side effects

Answer 28

• smooth muscle relaxation via calcium channel blocker
• hypotension

Question 29

aminophyline MOA + side effects

Answer 29

• unknown MOA of smooth muscle relaxation
• jitteriness, irritability, n/v

Question 30

complications of central line placement

Answer 30

bleeding, infection, clotting, arrhythmia, pneumo, arterial puncture

Question 31

ETT placement

Answer 31

breath sounds, chest rise, condensation in tube, ET CO2, CXR