SURG CRIT CARE Flashcards
1
Q
when should bladder pressure be obtained
A
end expiration
also make sure transducer is zeroed at the midaxillary line
2
Q
mechanism of heparin
A
forms complex twith antithrombin to neutralize formed thrombin and factor Xa
3
Q
What is antithrombin
A
serine protease inhibitor forms complexes with thrombin and factor Xa causing these enzymes to lose their procoagulant activity
4
Q
What score on MMSE leads to cognitive impairment/risk factor for delirium
A
MMSE score <25
5
Q
Underdamping of arterial pressure occurs due to? What is this characterized by and what happens to pulse pressure
A
Long lengths of tubing
Augmetion of peak systolic pressure, blunting of diastolic pressure
Falsely elevated pulse pressure
6
Q
Overdamped system due to? what is the result and what happens to pulse pressure
A
Partial thrombus within catheter, air bubbles within tubing or transducer, kinking of catheter or tubing
Result is attenuation of peak systolic pressure and overestimation of diastolic pressure –> falsely reduced pulse pressure
7
Q
By what mechanism is steroid therapy causing hyperglycemia
A
decreased insulin production, decreased insulin secretion and increased gluconeogenesis
8
Q
What rhythm should you avoid using synchronized CVN
A
v fib
9
Q
Normal pCO2 rise without vent support
A
> or = 20 mm Hg
10
Q
Type 1 HRS
A
doubling of Cr within 2 weeks and Cr of at least 2.5 mg/dL
Urine sodium should be low and albumin shopuld not improve kidney function M
11
Q
Mixed venous oxygen saturation in septic shock is
A
Normal to elevated (lack of adequate tissue perfusion)
12
Q
muscles responsible for inspiration
A
external intercostals
13
Q
feared complication of rapid correction of severe hyponatremia
A
central pontine myelinolysis
14
Q
ET tube for kids - how do you know what size
A
age/4 + 4
OR
size of child’s little finger
15
Q
Which anesthestic has been shown to reduce post op pain and opioid consumption
A
precedex
16
Q
PCWP in septic shock
A
low
17
Q
PCWP in pericardial atamponade
A
high
18
Q
CVP in pericardial tamponade
A
high
19
Q
SVR in pericardial tamponade
A
high
20
Q
CVP in cardiogenic shock
A
high
21
Q
PCWP in cardiogenic shock
A
high
22
Q
urine studies in HRS
A
absence of proteinuria microhematuria and low urine sodium
23
Q
normal PCWP value
A
4-12 mm Hg
24
Q
EKG changes with hypomag
A
widened QRS
eakted T waves –> falattened T waves
prolonged PR interval
Polymorphic v tach
25
IABP impact on afterload
Reduces it and improves myocardial perfusion therefore helping improve cardiac output
26
IV dose of epi for anaphylaxis
0.05 mg (1:10,0000)
27
IM dose of epinephrine for anaphylaxis
0.3 mg in 1:10000 concentration, can be repeated once after 5-15 min
28
dobutamine MOA
synthetic catecholamine
predominant affinity for beta adrenergic receptors (mild-moderate changes in HR)
29
Pacing mode to minimize interference during surgery
DOO
OO = asynchronous modes
30
Most reliable method to dx VAP
BAL
31
acute spinal cord injury - HR, BP and peripheral vascular resistance
all decreased
32
pressure control ventilation with increased I:E will have what impact on mean airway pressure
increase
33
narrow complex arrhythmia signifies origin of aberrant signal in what location
atria (SVT)
34
wide complex tachycardia signifies origin of signal in what location
ventricles
35
refeeding syndrome - what's low?
phos, mag and K
36
Positive apnea test
arterial pCO2 60 mm Hg or rise in pCO2 at least 20 mm Hg over baseline
The theory behind the apnea test is that respiratory drive is based on PaCO₂ levels. An abnormally high level should trigger a respiratory effort in any patient capable of doing so. Ongoing apnea in the presence of hypercarbia indicates brain death. First, the patient is preoxygenated with 100% O₂ for 10 to 15 minutes. Next, the ventilator is adjusted to obtain a PaCO₂ as close as possible to 40 mm Hg. A baseline arterial blood gas is then drawn. The endotracheal tube is disconnected from the ventilator and a smaller nasal cannula tube is connected to 5 to 6 L/minute oxygen and inserted into the endotracheal tube. If spontaneous respirations, desaturation less than 85%, or hemodynamic instability occur, the apnea test is aborted. After 10 minutes, an arterial blood gas is drawn. A PaCO₂ greater than 60 mm Hg (or 20 mm Hg above baseline) is considered positive, and the patient is declared brain dead.
37
MCC cardiogenic shock after MI
left ventricular dysfunction
38
STOP BANG
BMI > 35
age > 50
male
HTN (>130/>80)
loud snoring
39
MCC ALF in US
acetaminophen toxicity
40
predictor of recovery from ALF
low grade encephalopathy
41
IJ relationship with SCM and carotid
deep to SCM
anterolateral to carotid
42
MC injured heart structure in penetrating trauma
right ventricle
43
which pressor can worsen bradycardia
phenylephrine
strong alpha, minimal beta
reflex bradycardia
44
miller blade and epiglottis
STRAIGHT and lifts it directly to provide glottic view
45
Macintosh blade and epiglottis
CURVED and it retracts the hyoepiglottic ligament to indirectly lift epiglottis
46
< ____ mL of blood in pleural space = chest tube not indicated
<300 mL
47
Flexible bronch in intubated pts increases
PaCO2 (decreases PaO2)
48
Duration of abx for VAP a/w Klebsiella
8 days
49
Propofol infusion syndrome
Typically involves: unexplained metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, hyperlipidemia, arrhythmia, bradycardia, and rapid progression to cardiac failure. Propofol is also associated with the development of hypertriglyceridemia.
50
LMWH vs UFH for DVT ppx in TBI
LMWH causes lower VTE rate and mortality
51
Targeted temperature management after PCI
Current recommendations have a target of 33 to 36°C for at least 24 hours.
52
Strongest independent RF for stress ulcers
mechanical ventilation**
coagulopathy
53
neuromuscular blockade in severe ARDS
The use of neuromuscular blockade can improve oxygenation and decrease mortality in severe ARDS. A multicenter trial of 340 patients randomized patients to neuromuscular blockade with cisatracurium or placebo within 48 hours of diagnosis of ARDS. All patients saw an improvement in oxygenation, and the patients with severe ARDS had a decrease in 90-day mortality.
54
What is pulsus paradoxus
10 to 20 mm Hg decrease in systolic blood pressure during inspiration
Exaggerated normal
Negative intra pleural pressure causes increased RV filling ,dsiplacement of septum to left and decreased LV output
55
Alcohol withdrawal sx when benzos are not doing the trick
Clonidine or precedex (alpha 2 agonists)
56
Fluid resuscitation in sepsis - first 3 hours
l. The new recommendations specify an initial crystalloid infusion of at least 30 mL/kg within the first 3 hours.
57
refractory monomorphic ventricular ectopy tx
amiodarone
58
first sign of class II hemorrhagic shock
narrowed pulse pressure
59
blood loss 750-1500, what class?
II
60
MOA responsible for vasodilatory effects of dobutamine
beta 2 agonist
61
milrinone MOA
phosphodiesterase inhibitor
62
Tx of hypertrophic obstructive cardiomyopathy
beta blockers and IVF
63
Contraindicated in hypertrophic obstructive cardiomyopathy
Positive inotropes, diuretics
64
respiratory quotient
ratio of CO2 PRODUCED to O2 CONSUMED
65
most fatalities due to refeeding syndrome are secondary to
cardiac complications
66
criteria for brain death exam
normothermia for at least 6 hrs
loss of all brainstem reflexes
failed apnea test
if apnea test aborted must obtain confirmatory test (CTA, EEG, nuc med etc)
67
which hormonal resuscitation therapy MOST helpful in organ donors considered brain dead
vasopressin
80% of brain dead pts experience DI, following these pathophys changes due to exhaustion of ADH which is a/w hypovolemia, hyperosmolarity and hypernatremia
Vasopressin gtt often initiated in such situations to maintain vasopressor support, reduce diuresis and also withdraw potentially detrimental catecholamine support
68
TRALI - temperature?
Fever, usually low grade
69
TACO - temperature?
Normothermic
70
TRALI - BLOOD PRESSURE?
HYPOTENSIVE OR NORMAL
71
TACO - BLOOD PRESSURE?
HTN OR NORMAL
72
CP OR PAOP - ELEVATED IN TRALI OR TACO?
TACO
73
TRALI OR TACO - WHICH HAS TRANSIENT WBC AND THROMBOCYTOPENIA?
TRALI
74
Age in TRALI vs TACO
Trali - any
TACO : very young and elderly
75
Blood products more common assoc with TRALI
plasma rich - such as FFP and platelet packs
76
Most transfusion related mortality in US is due to
TRALI
77
Duration of respiratory dysfunction in TRALI
<72 hrs in most cases
78
Half life of xarelto
9 to 13 hrs
79
Which sedative used for ETT pts is a/w lowest risk of delirium
In 3 meta-analyses including only randomized controlled trials related to intensive care unit patients, dexmedetomidine was associated with a reduced incidence of delirium, intensive care unit length of stay, and mechanical ventilation duration, despite a significant heterogeneity among studies.
80
2 drugs known to cause adrenal suppression
etomidate
ketoconazole
81
initial crystalloid infusion recommended in sepsis guidelines
30 mL/kg within first 3 hours
82
Tx of monomorphic ventricular tachycardia with hypotension
Cardioversion
83
Tx of monomorphic ventricular ectopy
Amiodarone
84
New def of septic shock
persistent hypotension requiring pressor to maintain MAP >65 mm Hg and lactate of at least 2 mmol/L. despite volume resusc
85
qSOFA score
1 point each for
altered mentation
RR at least 22/min
SBP o 100 mm Hg or less
86
Relationship between serum Cr and GFR
In 3 meta-analyses including only randomized controlled trials related to intensive care unit patients, dexmedetomidine was associated with a reduced incidence of delirium, intensive care unit length of stay, and mechanical ventilation duration, despite a significant heterogeneity among studies.
87
Normal SVR
700-1600 dynes/sec/cm
88
Normal pulm vasc resistance
20-130 dynes/sec/cm
89
MC pathogen assoc with VAP
Pseudomonas
90
hypovolemic shock - what is the response of the afferent arteriole and efferent arteriole?
vasodilation of afferent arteriole
vasoconstriction of efferent arteriole
91
reason a tension pneumo is lethal/fatal
compression of vena cava
92
INR goal for aortic valve
2-3
93
INR goal for mitral valve
2.5-3.5
94
anticoagulation and bioprosthetic valves
do not require long term anticoag
utility of short term anti coag is controversial
95
bioprosthetic vs mechanical - which more likely for re operation?
bioprosthetic
96
autotnomic dysreflexia develops in individuasl with level of spinal cord injury at or above what vertebral level
T6
97
sx of autonomic dysreflexia
bradycardia and diaphoresis (heightened parasympathetic activity above the level of the injury)
HTN (unopposed sympathetic activity below the injury resulting in vasoconstriction)
98
internal mammary runs where and is a branch off what
either side of sternum (encountered during clamshell!!)
branch of subclavian a
99
branches of aortic arch
braciocephalic/innominate
left common carotid
left subclavian
100
brachiocephalic/innominate a gives rise to
right subclavian and right CCA
101
subclavian artery gives off what 3 branches
thyrocervical trunk
internal mamary artery
costocervical trunk
102
thyrocervical trunk gives off what 3 arteries
inferior thyroid artery
transverse cervical artery
suprascapular artery
103
effects of low dose dopamine
dopamine receptor stimulation and increased mesenteric blood flow
104
effects of moderate dose dopamine
beta 1 adrenergic stimulation and increases contractility
105
effect of high dose dopamine
alpha adrenergic effects and and can induce vasoconstriction
106
Oxygenation affected by what 3 things
FiO2
PEEP
MAP
107
Ventilation affected by what 2 things
RR
Tidal volume
108
Minute ventilation quation
RR x TV
109
Peak pressure - what does this reflect pressure of?
large airways
110
In order to obtain plateau pressures you must do what
Inspiratory pause
This allows pressures to equilibrate and better reflects alveolar pressure
111
What if there is large differential between peak and plateau pressure
Large airway obstruction
Bronchospasm
112
What if peak and plateau pressures are both high
Alveolar lung disease (e.g., ARDS)
113
Must do what to check negative inspiratory force (NIF)
Expiratory pause
114
CMV/AC what two parameters are set
RR and volume
Every breath fully supported
115
PRoblems with CMV/AC mode
Volume is set regardless of pressure (can result in barotrauma)
hyperventilation if patient RR is high
116
Advantages of PS
limits barotrauma
117
Disadvantage of PS
Hypoventilation
118
In SIMV what two parameters are set
RR and volume
Spontaneous breaths above set rate are not fully supported
Delivered breaths are synchronized - typically more comfortable
119
Minimal vent settings for extubation
FiO2 50% or less
PEEP < 10
Rapid shallow RR/TV <100 (best predictor!)
NIF > 20 (good predictor of who will fail but >20 is poorly predictive of who will do well)
120
What two things can check for invasive candidiasis
mannan antigen and anti-mannan antibody
121
What assay for fungal infections
1,3 beta d glucan assay
122
Levo acts on what 2 receptors
alpha and some beta 1
123
Phenylephrine acts on what receptor
purely alpha
124
vasopressin acts on what receptor
V1
125
Epinephrine acts on what receptors
alpha and beta 1
126
PE - respiratory acidosis or alkalosis?
Alkalosis
127
Goal PTT in tx of PE
60-90
128
Indications for thrombolytics with PE (2)
Hemodynamic instability
Right heart strain on echo
129
CVP is surrogate for
end diastolic RV volume
130
PWP is surrogate for
end diastolic LV volume
131
CO equation
SV x HR
132
CVP/PWP in cardiogenic shock
High
133
Formula for oxygen delivery
CO x [Hb x O2 sat x 1.34 + (PaO2 x 0.003)]
134
Formula for oxygen consumption
CO x (arterial - venous O2 diff)
135
Formula for extraction ratio
O2 consumption/O2 delivery
136
What increases SvO2
increased shunting of blood or decreased oxygen extraction
Sepsis
Cirrhosis
Cyanide toxicity
Hyperbaric O2
Hypothermia
Paralysis
Coma
137
Reversal of coumadin besides PCC
FFP
Vitamin K
138
Partial reversal of factor Xa inhibitors
PCC
139
Nitrogen balance formula
Protein intake/6.25 - (urine nitorgen + 4)
140
Negative nitrogen balance indicates what state
catabolic
141
Positive nitrogen balance indicates what state
anabolic
142
Carbs should make up how much of your non protein cals
75%
143
Fats should make up how much of your non protein cals
25%
144
Two essential FAs
linoleic acid
Alpha linolenic acid
145
Rash, alopecia, vision changes
Zinc deficiency
146
Microcytic anemia, pancytopenia, osteopenia
Copper deficiency
147
Hyperacute rejection of transplanted organ mediated by
Antibodies
148
Acute rejection fo transplanted organ mediated by
T cells
149
Prolonged IV haldol doses for EtOH withdrawal followed by arrhythmia
Prolonged QT
150
Post op CABG pt with hypotension with CVP and wedge pressure of 20
Cardiac tamponade
151
MAP =
CO x SVR
152
Mild hypothermia
32-35
Passive ext rewarming
153
Moderate hypothermia
28-32
Active external rewarming
154
Severe hypothermia
<28
Active internal rewarming
155
EDV determined by
preload
distensibility of ventricle
156
ESV determined by
contractility
afterload
157
Atrial kick accounts for how much of LVEDV
20%
158
Anrep effect
automatic increase in contractility secondary to increased afterload
159
Bowditch effect
automatic increase in contractility secondary to increased HR
160
Normal O2 delivery to consumption ratio
4:1
CO increases to keep this ratio constant
O2 consumption is uusually supply independent
161
Causes of right shift of Oxygen Hgb dissocitation curve (O2 unloading)
Increased CO2
Increased temperature
Increased ATP production
Increased 2,3 - DPG production
Decreased pH
162
Normal SvO2
75% +/- 5%
163
Decreased SvO2
occurs with increased O2 extraction (malignant hyperthermia) or decreased O2 delivery (hypoxia, decreased CO, anemia)
164
Wedge pressure may be thrown off by (5)
pulmonary HTN
mitral stenosis
Mitral regurg
high PEEP
poor LV compliance
165
Sqan Ganz should be placed in which zone of lung
III
166
Hemopysis after flushing Swan Ganz - next step
increase PEEP (tamponade PA bleed), mainstem intubate no naffected side, can try to place Fogarty balloon down mainstem on affected side, may need thoracotomy and lobectomy
167
Absolute contraindication to Swan Ganz
right sided mechanical valve
168
Relative contraindications to swan ganz
previous pneumonectomy
left bundle branch block
recent pacemaker
right sided endocarditis
169
PVR can only be measured using
Swan Ganz
170
Primary determinants of myocardial oxygen consumption (2 things)
ventricular wall tenson increased (#1) and HR
171
What explaisn difference in PO2 in LV vs pulmonary capillaries
unsaturated bronchial blood empties into pulm veins therefore LV blood is 5 mm Hg lower than pulm capillaries
172
Alveolar arterial gradient - normal non ventilated pt
10-15 mm Hg
173
Blood with lowest venous saturation
coronary sinus blood (30%)
174
blood with highest venous saturation
renal vv (80%)
175
Lyte issues in adrenal insufficiency
HyperK
Hypoglycemia
176
Whch steroid does not interfere with corticotropin stim test
dexamethasone
177
1x steroid potency (2)
cortisone, hydrocortisone
178
5x steroid potency (3)
prednisone
prednisolone
methylprednisolone
179
30x steroid potency
dexamethasone
180
tx of neurogenic shock
volume first
then phenyl
181
initial alteration in hemorrhagic shock
increased diastolic pressure
182
cause of hypotension i ncardiac tamponade
decreased ventricular filling due to fluid in pericardial sac around heart
183
first sign of cardiac tamponade
echo showing impaired diastolic filling of right atrium initially
184
CVP in adrenal insufficiency
decreased usually
185
adrenal insufficiency shock parameters most similar to
neurogenic (head or SC injury)
186
early gram negative sepsis - insulin and glucose
decreased insulin, increased glucose due to impaired utilization
187
late gram negative sepsis - insulin and glucose
increased insulin, increased glucose secondary to insulin resistance
188
sustained neurohormonal response to hypovolemia
renin (from kidney - RAS activated resulting in vasoconstriction and water resorption), ADH from pituitary allowing reabsorption of water, and ACTH release from pituitary to increase cortisol
189
what stain can help dx fat embolism
sudan red stain may show fat in sputum and urine
190
intubated pts with PE may show what 2 signs
decreased ETCO2 and hypotension
191
IABP inflates on
T wave (diastole)
192
IABP deflates on
P wave (systole) immediately after aortic valve closure
193
Where does the tip of IABP catheter go
just distal to left subclavian (1-2 cm below top of arch)
194
IABP has waht impact on blood pressure
improves diastolic BP which improves diastolic coronary perfusion
195
absolute contraindications to IABP
aortic dissection
severe aortoiliac disease
aortic regurgitation
196
relative contraindications to IABP
vascular grafts
aortic aneurysms
197
alpha 2 receptors act on
venous smooth muscle constriction
198
beta 2 receptors have what 3 effects
relaxes bronchial smooth muscle
relaxes vascular smooth muscle
increases renin
199
initial rate of dobutamine
3 microg per kg per min
200
low dose epi acts on
beta 1 and beta 2 which increases contractiliy and vasodilation (can decrease BP at low doses)
201
High dose epi acts on
alpha 1 and alpha 2 (Vasoconstriction) which can increase cardiac ectopic pacer activity and myocardial oxygen demand
202
isoproterenol MOA
beta 1 and beta 2, increased hr and contracitility, vasodilates
203
side effects of isoproterenol
extremely arrhythmogenic, icnreased heart metabolic demand (rarely used) and may actually decrease BP
204
V2 receptors (intrarenal) act where
water reabsorption at collecting ducts
205
V2 receptors (extra renal) act where
mediate release of factor VIII and vWF
206
Nipride if given at doses >3 mics per kg per min for 72 hours can lead to
cyanide toxicity
check thiocyanate levels and signs iof metabolic acidosis
207
tx for cyanide toxicity
amyl nitrite then sodium nitrite, hydroxycobalamin
208
high pulmonary compliacne means
lungs easy to ventilate (severe COPD)
209
decreased pulm compliance
ARDS, fibrotic lung diseases, reperfusion injury, pulmonary edema, atelectasis
210
Aging causes what pulm parameter to increase
FRC
211
Aging causes what impact on FEV1 and vital capacity
decreases them
212
Excessive PEEP complications
decreased right arrial filling (main reason for decreased CO)
decreased BP
Decreased renal blood flow (increased renin)
decreased UOP
Increased wedge pressure
Increased PVR
213
TLC equals
FVC + RV
lung volume after max inspiration
214
RV accounts for how much of TLC
20%
215
FRC =
lung volume aftern ormal exhalation
ERV + RV
216
FEV1 in restrictive lung disesase
normal or increased
217
FVC in obstructive lung disease
Normal or decreased
218
Why does COPD increase work of breathing
prolonged expiratory phase
219
what is dead space
part of lung that is ventilated but not perfused
220
MCC increased dead space (high Vq ratio)
excessive PEEP (capillary compression)
221
3 causes of increased dead space
decreased CO (capillary collapse)
PE
pulmonary HTN
222
Increased dead space increases CO2 or O2
PCO2
223
MCC of increased shunt (low V/Q ratio)
atelectasis (alveolar hypoventilation)
224
3 causes of increased shunt
atelectasis
mucus plug
ARDs
225
Keep plateau pressures
30
226
Mendelsons syndrome
chemical pneumonitis from aspiration of gastric secretions
227
most frequent site of aspiration
superior segment of RLL
228
atelectasis is mediated by what
alveolar macrophages which release IL-1 (acts at hypothalamus)
229
Name 4 things that cause pulmonary vasodilation
PGE1
Prostacyclin
inhaled NO
sildenafil
230
Name 5 things that cause pulmonary vasoconstriction
hypoxia #1
acidosis
histamine
serotonin
TXA2
231
MCC post op renal failure
hypotension intra op
232
What % of nephrons need to be damaged before renal dysfunction occurs
70%
233
renin is released in response to
decreased pressure sensed by JGA or increased Na concentrations sensed by macula densa
Beta adrenergic stimulation and hyperK also cause release
234
Where is angiotensinogen synthesized
liver
235
what converts angiotensinogen to angiotensin I
renin
236
adrenal cortex releases what in response to angiotensin II
aldosterone
237
where does aldosterone act
distal convoluted tubule to reabsorb water by upregulating NA/K ATPase on membrane (Na reabsorbed, K secreted)
238
How does ANP act on collecting ducts
inhibits Na and water resorption
239
ADH released by
posterior pituitary gland when osmolality is high
240
which limb of kidney controls GFR
efferent limb
241
how do NSAIDs cause renal damage
inhibit prostaglandin synthesis resulting in renal arteriole vasoconstriction
242
SIRS mediated by what two cytokines
IL1 and TNF alpha
243
Most potent stimulus for SIRs
endotoxin (LPS - lipid A)
244
Lipid A is a very potent stimulator of
TNF release
245
Can still have what reflexes with brain death
deep tendon
246
Negative test for apnea occurs if
BP drops <90 mm Hg
pt desats <85% on pulse ox
spontaneous breathing occurs
247
CO causes what shift on hemoglobin/oxygen curve
left shift
248
carboxyhemoglobin in smokers
20%
249
name some things that can cause methemoglobinemia
nitirtes such as hurricaine spray, fertilizers, nitrites bind hemoglobin
250
methemobloinemia will shift dissociation curve where
left
251
most impt mediator of reperfusion injury
PMNs
252
site specific complication of radial a line
peripheral neuropathy
253
site specific complicatio nof brachial a line
median nerve damage
254
site specific complication of axillary a line
brachial plexopathy
255
waveform characteristics indication PA catheter is in RV
sharp rise in pressure follwoed by rapid decrease in pressure with a gradual increase in pressure between waves, coinciding with QRS complex on EKG
256
a wave on PA cath represents
atrial contraction
257
c wave on PA cath
closing of tricuspid valve and ventricular systole
258
x descent on PA cath
atrial filling
259
normal ICP
7-15 mm Hg
260
y descent on PA cath
opening of tricuspid valve and passive atrial emptying
261
pulmonary artery waveform on PA cath
characterized by dicrotic notch, which represents closure of pulmonary valve. otherwise relatively similar to TV pressure tracing
262
rapid pressure increase and decrease on PA cath
normal pulmonary artery waveform
263
small pressure increases and decreases on pa cath
normal wedged pulm a waveform
264
a c wave followed by an x descent on PA cath
normal RA waveform
265
diff in urine between CSW and SIADH
CSW will have high Na levels (higher than intake) and net sodium balance will be negative
266
diff in fluid response between CSW and SIADH
The treatment of choice for SIADH is free water restriction when increased fluid intake will worsen the hyponatremia. In contrast, CSW is a volume-depleted and sodium-wasting state requiring fluid replacement with isotonic solutions.
267
polyuria - present in CSW or SIADH?
CSW
268
volume status in CSW and DI
hypovolemic
269
volume status in SIADH
normal or hypervolemic
270
tx of hyponatremia in sIADH
demeclocycline
271
location of femoral vein
junction of medial and middle 1/3 of inguinal ligament 2 cm breadths below the inguinal ligament
272
normal ICP
7-15 mm Hg
273
most efficienct site of GI calcium absorption
duodenum and proxiaml jejunum
274
oxygen extraction is highest where
coronary circulation and brain tissue
275
average oxygen extraction ratio
0.3
276
with hypovolemia what happens to oxygen extraction
higher
277
as oxygen consumtpion increases what happens to the extraction ratio
increases
278
indications for IABP
systolic pressure <90 or CI <2.2, cardiogenic shock, low cardiac output
279
shift to the right on O2 hgb curve has effect of ___ affinity of Hgb for oxygen
decreased
280
main reason for refeeding syndrome phenomenon
insulin
281
most myocardial perfusion occurs during?
diastole when subendocardial coronary vessels are open and under lower pressure
282
when asking pt to make a fist fingers 1-3 extend
proximal median nerve injury
283
when asking pt to extend fingers/at rest they are unable to extend 1-3
distal median nerve injury
284
when asking pt to make a fist they are unable to flex fingers 4-5
proximal ulnear nerve injury
285
when asking pt to extend fingers/at rest they are unable to extend 4-5
distal ulnar nerve injury
286
wrist drop with inability to abduct thumb or extend MCP joints
radial nerve
287
which two major colic vessels can be ligated with minimal impunity
celiac and IMA
288
pancreatic fistula definition
drain amylase >3 times ULN + some type of clinical implication (like signs of infection etc or persistent drainage after 3 weeks)
289
blood supply of omentum
omental branches given off by left and right gastroepiploic arteries
290
urethral injury diagnosed by RUG
suprapubic cath or attempt primary realignment with a cystoscope and wire antegrade or retrograde
291
PAOP and CVP in hypovolemic shock
decreased
292
anatomic landmark for paracentesis
3 cm medial and 3 cm superior to left ASIS
293
Base deficit warranting damage control
>15
294
Elemental formulas
Include 16-25% of calories as proteins
Elemental formulas supply free AA instead of proteins therefore they are mre easily absorbed
295
Indications for elemental formula
short bowel syndrome
EOE
milk protein allergy
296
vasodilatory effect of dobutamine
beta 2 receptor stimulation (at higher doses has vasodilatory effect. at lower doses it stimulates beta 1 to increase contractility)
297
Opens eyes to pain
E 2
298
Incoherent words/sentences (GCS)
V 3
299
Withdraws from pain (GCS)
M 4
300
Localized to pain (GCS)
M 5
301
Follows commands (GCS)
M 6
302
Decorticate (GCS)
Clenched fists, legs straight out (M3)
303
MC complication of hepatic trauma
biliary fistula
304
ptx is fatal becasue
compression of ivc
as more air enters pleural space the rpessure increases and collapses lung on injured side. less air exchanged for perfusion. pressure begins to compress heart shifting mediastinum toward uninjured lung. compression of ivc reduces cardiac blood flow to the herart and decreases co.
