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Pulmonology/Critical Care > Pulm/Crit > Flashcards

Pulm/Crit Flashcards

1
Q

Mean Arterial Pressure (MAP) formula

A

MAP = CO x SVR

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2
Q

Four Types of Shock

A
  1. Distributive (ex. Septic Shock, anaphylaxis)
  2. Hypovolemic (ex. Hemorrhagic Shock)
  3. Cardiogenic (ex. MI)
  4. Obstructive (ex. PE, tamponade)
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3
Q

Clinical features of Serotonin Syndrome

A

Hyperthermia, Tremor, Hyperreflexia, Clonus

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4
Q

Treatment of Serotonin Syndrome

A

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

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5
Q

Rigidity, hyporeflexia, hyperthermia, AMS days to weeks after Haldol

A

Neuroleptic Malignant Syndrome

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6
Q

Hyperthermia, Muscle Rigidity, Hemorrhage Without Hyperreflexia or clonus following inhaled anesthesia or neuromuscular blockade

A

Malignant Hyperthermia

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7
Q

Treat dyspnea in end stage Idiopathic Pulmonary Fibrosis

A

Morphine

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8
Q

Antidote for Cyanide Poisoning in smoke inhalation/ fire

A

Hydroxocobalamin

Second line is Sodium Thiosulfate

Sodium Nitrite is an antidote for CN but is contraindicated in smoke inhalation

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9
Q

Treat carbon monoxide poisoning

A

100% O2 and hyperbaric oxygen if carboxyhemoglobin level >25% or pregnant

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10
Q

Antidote for methemoglobinemia

A

Methylene Blue

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11
Q

Antidote for Cyanide poisoning without smoke inhalation

A

Sodium Nitrite

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12
Q

Define Complicated parapneumonic effusion

A

An effusion associated with a pneumonia that has a pH < 7.2 and glucose < 60

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13
Q

Define Empyema

A

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.

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14
Q

Adjunctive glucocorticoid therapy in patients with septic shock

A

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

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15
Q

Mortality effect from Early Goal Directed Therapy vs. Usual Therapy in Septic Shock

A

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

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16
Q

Norepinephrine vs. Dopamine as 1st line vasopressor therapy in Shock

A

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

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17
Q

Norepinephrine vs. Vasopressin in patients with Septic Shock

A

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

18
Q

Target MAP in septic shock

A

65 mmHg

19
Q

Initial fluid resuscitation volume in septic shock

A

30 mL/kg of IV crystalloid fluid be given within the first 3 h (strong recommendation, low quality of evidence).

20
Q

Methanol Toxicity (Source ex., Clinical Findings, Lab Findings)

A

Windshield wiper fluid, visual disturbances, Osmolol gap and High AG acidosis

21
Q

Ethylene Glycol Toxicity (Source ex., Clinical Findings, Lab Findings)

A

Antifreeze/formation of oxalate crystals, which deposit in the lungs, heart, and kidney and produce organ dysfunction/Osmolol gap and high AG acidosis

22
Q

Propylene Glycol Toxicity (Source ex., Clinical Findings, Lab Findings)

A

In parenteral medications, automotive antifreeze (marketed as a safer alterna- tive to ethylene glycol)/Hepatic and renal injury/Increased Osmolol gap alone - No AG

23
Q

Isopropanol Toxicity (Source ex., Clinical Findings, Lab Findings)

A

Rubbing alcohol and hand sanitizer/decreased sensation and abdominal pain/ Increased Osmolol gap and ketonuria

24
Q

Test for ethylene glycol toxicity

A

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

25
Q

Fomepizole is used to treat…

An alternative is?

A

Methanol and Ethylene Glycol toxicity.

Fomepizole is an inhibitor of alcohol dehydrogenase, the enzyme that breaks down toxic alcohols to their toxic metabolites

An alternative is IV or PO ethanol

26
Q

Blurred vision indicates ___ poisoning

A

Methanol

27
Q

Oxalate crystals in urine and AKI indicates ___ poisoning

A

Ethylene glycol

28
Q

Acetonemia or ketonuria indicates ___ poisoning

A

Isopropanol

29
Q

Osmolol Gap Formula

A

serum osmolol gap - calculated osmolol gap

Calculated osmolol gap (2*Na + G/18 + BUN/2.8)

30
Q

Treat Isopropanol Toxicity

A

Supportive

31
Q

Treatment for Propylene Glycol Toxicity

A

Dialysis if lactic acidosis, otherwise discontinue offending drug and supportive

32
Q

Causes of Hypoxemia

A
  1. Low FIO2
  2. Hypoventilation
  3. Shunt
  4. V/Q mismatch
  5. Oxygen diffusion limitation
33
Q

Normal A-a gradient formula

A

4 + (Age/4)

34
Q

PAO2 formula (to be used in A-a gradient)

A

PAO2 = 150 mmHg – [PaCO2 / 0.8])

35
Q

Causes of Hypercarbia

A
  1. Increased Dead Space

2. Decreased Minute Ventilation

36
Q

The FLORALI trial showed that…

A

high-flow nasal cannula can reduce 90-day mortality in patients with non-hypercapnic, acute hypoxemic respiratory failure

37
Q

Cardiogenic pulmonary edema noninvasive ventilation strategy in acute hypoxemic respiratory failure

A

BiPAP

38
Q

COPD noninvasive ventilation strategy in acute hypercapnic respiratory failure

A

BiPAP

39
Q

CPAP/BiPAP are contraindicated in patients with…

A
  1. AMS
  2. Aspiration risk
  3. ARDS
40
Q

Treat Nonexertional Heat Stroke

A

Patients with nonexertional heat stroke should be treated with evaporative cooling (sprayed water and fans) to lower their core temperature to a safe level.

Heat Stroke - T 104F + encephalopathy

41
Q

Treat Hypertensive Emergency without a compelling condition (aortic dissection, preeclampsia, eclampsia)

A

SBP should be reduced by no more than 25% within the first hour; then, if stable, to 160 mm Hg within the next 2 to 6 hours; and then cautiously to normal during the following 24 to 48 hours. Options include nicardipine, nitroprusside, and fenoldopam

42
Q

Lofgren Syndrome

A

Bilateral Hilar lymphadenopathy, erythema nodosum, migrating polyarthralgia, fever

Presentation of sarcoidosis that does not require biopsy to prove

Pulmonology/Critical Care (1 decks)

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