Pulm/Crit Flashcards
Mean Arterial Pressure (MAP) formula
MAP = CO x SVR
Four Types of Shock
- Distributive (ex. Septic Shock, anaphylaxis)
- Hypovolemic (ex. Hemorrhagic Shock)
- Cardiogenic (ex. MI)
- Obstructive (ex. PE, tamponade)
Clinical features of Serotonin Syndrome
Hyperthermia, Tremor, Hyperreflexia, Clonus
Treatment of Serotonin Syndrome
Supportive treatment.
Benzodiazepines to help keep patient calm and to control BP and HR.
Only in very severe cases of agitation or hyperthermia do patients need to be deeply sedated, intubated, paralyzed, and sometimes treated with cyproheptadine
Do not physically restrain agitated patients as this can lead to worsened agitation and hyperthermia
Rigidity, hyporeflexia, hyperthermia, AMS days to weeks after Haldol
Neuroleptic Malignant Syndrome
Hyperthermia, Muscle Rigidity, Hemorrhage Without Hyperreflexia or clonus following inhaled anesthesia or neuromuscular blockade
Malignant Hyperthermia
Treat dyspnea in end stage Idiopathic Pulmonary Fibrosis
Morphine
Antidote for Cyanide Poisoning in smoke inhalation/ fire
Hydroxocobalamin
Second line is Sodium Thiosulfate
Sodium Nitrite is an antidote for CN but is contraindicated in smoke inhalation
Treat carbon monoxide poisoning
100% O2 and hyperbaric oxygen if carboxyhemoglobin level >25% or pregnant
Antidote for methemoglobinemia
Methylene Blue
Antidote for Cyanide poisoning without smoke inhalation
Sodium Nitrite
Define Complicated parapneumonic effusion
An effusion associated with a pneumonia that has a pH < 7.2 and glucose < 60
Define Empyema
A bacterial infection of the pleural space that results in frank pus on visual inspection of the pleural fluid or a positive Gram stain. A positive pleural fluid culture is not required for diagnosis as cultures are less sensitive than Gram stain in the detection of bacteria.
Adjunctive glucocorticoid therapy in patients with septic shock
ADRENAL Trial - In patients with septic shock who were undergoing mechanical ventilation, the administration of a continuous infusion of hydrocortisone did not result in lower mortality at 90 days than placebo
Mortality effect from Early Goal Directed Therapy vs. Usual Therapy in Septic Shock
A meta-analysis of individual patient data from three multicenter RCTs (ProCESS, ARISE, and ProMISe) showed early goal directed therapy was associated with similar 90-day mortality as usual care
Norepinephrine vs. Dopamine as 1st line vasopressor therapy in Shock
SOAP II Trial - the rate of death did not differ significantly between the group of patients treated with dopamine and the group treated with norepinephrine. This study raises serious concerns about the safety of dopamine therapy, since dopamine, as compared with norepinephrine, was associated with more arrhythmias and with an increased rate of death in the subgroup of patients with cardiogenic shock
Norepinephrine vs. Vasopressin in patients with Septic Shock
VASST Trial - Low-dose vasopressin did not reduce mortality rates as compared with norepinephrine among patients with septic shock who were treated with catecholamine vasopressors
Target MAP in septic shock
65 mmHg
Initial fluid resuscitation volume in septic shock
30 mL/kg of IV crystalloid fluid be given within the first 3 h (strong recommendation, low quality of evidence).
Methanol Toxicity (Source ex., Clinical Findings, Lab Findings)
Windshield wiper fluid, visual disturbances, Osmolol gap and High AG acidosis
Ethylene Glycol Toxicity (Source ex., Clinical Findings, Lab Findings)
Antifreeze/formation of oxalate crystals, which deposit in the lungs, heart, and kidney and produce organ dysfunction/Osmolol gap and high AG acidosis
Propylene Glycol Toxicity (Source ex., Clinical Findings, Lab Findings)
In parenteral medications, automotive antifreeze (marketed as a safer alterna- tive to ethylene glycol)/Hepatic and renal injury/Increased Osmolol gap alone - No AG
Isopropanol Toxicity (Source ex., Clinical Findings, Lab Findings)
Rubbing alcohol and hand sanitizer/decreased sensation and abdominal pain/ Increased Osmolol gap and ketonuria
Test for ethylene glycol toxicity
Wood’s lamp to detect urine fluorescence -
Detects fluorescein in antifreeze (ethylene glycol); false positives and false nega- tives occur frequently, which makes the test unreliable43
