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ABS > SURG CRIT CARE > Flashcards

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

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2
Q

mechanism of heparin

A

forms complex twith antithrombin to neutralize formed thrombin and factor Xa

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3
Q

What is antithrombin

A

serine protease inhibitor forms complexes with thrombin and factor Xa causing these enzymes to lose their procoagulant activity

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4
Q

What score on MMSE leads to cognitive impairment/risk factor for delirium

A

MMSE score <25

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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

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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

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7
Q

By what mechanism is steroid therapy causing hyperglycemia

A

decreased insulin production, decreased insulin secretion and increased gluconeogenesis

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8
Q

What rhythm should you avoid using synchronized CVN

A

v fib

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9
Q

Normal pCO2 rise without vent support

A

> or = 20 mm Hg

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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

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11
Q

Mixed venous oxygen saturation in septic shock is

A

Normal to elevated (lack of adequate tissue perfusion)

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12
Q

muscles responsible for inspiration

A

external intercostals

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13
Q

feared complication of rapid correction of severe hyponatremia

A

central pontine myelinolysis

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14
Q

ET tube for kids - how do you know what size

A

age/4 + 4
OR
size of child’s little finger

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15
Q

Which anesthestic has been shown to reduce post op pain and opioid consumption

A

precedex

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16
Q

PCWP in septic shock

A

low

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17
Q

PCWP in pericardial atamponade

A

high

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18
Q

CVP in pericardial tamponade

A

high

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19
Q

SVR in pericardial tamponade

A

high

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20
Q

CVP in cardiogenic shock

A

high

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21
Q

PCWP in cardiogenic shock

A

high

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22
Q

urine studies in HRS

A

absence of proteinuria microhematuria and low urine sodium

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23
Q

normal PCWP value

A

4-12 mm Hg

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24
Q

EKG changes with hypomag

A

widened QRS
eakted T waves –> falattened T waves
prolonged PR interval
Polymorphic v tach

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25
Q

IABP impact on afterload

A

Reduces it and improves myocardial perfusion therefore helping improve cardiac output

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26
Q

IV dose of epi for anaphylaxis

A

0.05 mg (1:10,0000)

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27
Q

IM dose of epinephrine for anaphylaxis

A

0.3 mg in 1:10000 concentration, can be repeated once after 5-15 min

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28
Q

dobutamine MOA

A

synthetic catecholamine
predominant affinity for beta adrenergic receptors (mild-moderate changes in HR)

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29
Q

Pacing mode to minimize interference during surgery

A

DOO
OO = asynchronous modes

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30
Q

Most reliable method to dx VAP

A

BAL

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31
Q

acute spinal cord injury - HR, BP and peripheral vascular resistance

A

all decreased

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32
Q

pressure control ventilation with increased I:E will have what impact on mean airway pressure

A

increase

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33
Q

narrow complex arrhythmia signifies origin of aberrant signal in what location

A

atria (SVT)

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34
Q

wide complex tachycardia signifies origin of signal in what location

A

ventricles

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35
Q

refeeding syndrome - what’s low?

A

phos, mag and K

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36
Q

Positive apnea test

A

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.

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37
Q

MCC cardiogenic shock after MI

A

left ventricular dysfunction

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38
Q

STOP BANG

A

BMI > 35
age > 50
male
HTN (>130/>80)
loud snoring

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39
Q

MCC ALF in US

A

acetaminophen toxicity

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40
Q

predictor of recovery from ALF

A

low grade encephalopathy

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41
Q

IJ relationship with SCM and carotid

A

deep to SCM
anterolateral to carotid

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42
Q

MC injured heart structure in penetrating trauma

A

right ventricle

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43
Q

which pressor can worsen bradycardia

A

phenylephrine
strong alpha, minimal beta
reflex bradycardia

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44
Q

miller blade and epiglottis

A

STRAIGHT and lifts it directly to provide glottic view

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45
Q

Macintosh blade and epiglottis

A

CURVED and it retracts the hyoepiglottic ligament to indirectly lift epiglottis

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46
Q

< ____ mL of blood in pleural space = chest tube not indicated

A

<300 mL

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47
Q

Flexible bronch in intubated pts increases

A

PaCO2 (decreases PaO2)

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48
Q

Duration of abx for VAP a/w Klebsiella

A

8 days

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49
Q

Propofol infusion syndrome

A

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.

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50
Q

LMWH vs UFH for DVT ppx in TBI

A

LMWH causes lower VTE rate and mortality

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51
Q

Targeted temperature management after PCI

A

Current recommendations have a target of 33 to 36°C for at least 24 hours.

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52
Q

Strongest independent RF for stress ulcers

A

mechanical ventilation**
coagulopathy

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53
Q

neuromuscular blockade in severe ARDS

A

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.

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54
Q

What is pulsus paradoxus

A

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

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55
Q

Alcohol withdrawal sx when benzos are not doing the trick

A

Clonidine or precedex (alpha 2 agonists)

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56
Q

Fluid resuscitation in sepsis - first 3 hours

A

l. The new recommendations specify an initial crystalloid infusion of at least 30 mL/kg within the first 3 hours.

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57
Q

refractory monomorphic ventricular ectopy tx

A

amiodarone

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58
Q

first sign of class II hemorrhagic shock

A

narrowed pulse pressure

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59
Q

blood loss 750-1500, what class?

A

II

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60
Q

MOA responsible for vasodilatory effects of dobutamine

A

beta 2 agonist

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61
Q

milrinone MOA

A

phosphodiesterase inhibitor

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62
Q

Tx of hypertrophic obstructive cardiomyopathy

A

beta blockers and IVF

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63
Q

Contraindicated in hypertrophic obstructive cardiomyopathy

A

Positive inotropes, diuretics

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64
Q

respiratory quotient

A

ratio of CO2 PRODUCED to O2 CONSUMED

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65
Q

most fatalities due to refeeding syndrome are secondary to

A

cardiac complications

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66
Q

criteria for brain death exam

A

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)

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67
Q

which hormonal resuscitation therapy MOST helpful in organ donors considered brain dead

A

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

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68
Q

TRALI - temperature?

A

Fever, usually low grade

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69
Q

TACO - temperature?

A

Normothermic

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70
Q

TRALI - BLOOD PRESSURE?

A

HYPOTENSIVE OR NORMAL

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71
Q

TACO - BLOOD PRESSURE?

A

HTN OR NORMAL

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72
Q

CP OR PAOP - ELEVATED IN TRALI OR TACO?

A

TACO

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73
Q

TRALI OR TACO - WHICH HAS TRANSIENT WBC AND THROMBOCYTOPENIA?

A

TRALI

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74
Q

Age in TRALI vs TACO

A

Trali - any
TACO : very young and elderly

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75
Q

Blood products more common assoc with TRALI

A

plasma rich - such as FFP and platelet packs

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76
Q

Most transfusion related mortality in US is due to

A

TRALI

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77
Q

Duration of respiratory dysfunction in TRALI

A

<72 hrs in most cases

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78
Q

Half life of xarelto

A

9 to 13 hrs

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79
Q

Which sedative used for ETT pts is a/w lowest risk of delirium

A

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.

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80
Q

2 drugs known to cause adrenal suppression

A

etomidate
ketoconazole

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81
Q

initial crystalloid infusion recommended in sepsis guidelines

A

30 mL/kg within first 3 hours

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82
Q

Tx of monomorphic ventricular tachycardia with hypotension

A

Cardioversion

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83
Q

Tx of monomorphic ventricular ectopy

A

Amiodarone

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84
Q

New def of septic shock

A

persistent hypotension requiring pressor to maintain MAP >65 mm Hg and lactate of at least 2 mmol/L. despite volume resusc

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85
Q

qSOFA score

A

1 point each for
altered mentation
RR at least 22/min
SBP o 100 mm Hg or less

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86
Q

Relationship between serum Cr and GFR

A

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.

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87
Q

Normal SVR

A

700-1600 dynes/sec/cm

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88
Q

Normal pulm vasc resistance

A

20-130 dynes/sec/cm

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89
Q

MC pathogen assoc with VAP

A

Pseudomonas

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90
Q

hypovolemic shock - what is the response of the afferent arteriole and efferent arteriole?

A

vasodilation of afferent arteriole
vasoconstriction of efferent arteriole

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91
Q

reason a tension pneumo is lethal/fatal

A

compression of vena cava

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92
Q

INR goal for aortic valve

A

2-3

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93
Q

INR goal for mitral valve

A

2.5-3.5

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94
Q

anticoagulation and bioprosthetic valves

A

do not require long term anticoag
utility of short term anti coag is controversial

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95
Q

bioprosthetic vs mechanical - which more likely for re operation?

A

bioprosthetic

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96
Q

autotnomic dysreflexia develops in individuasl with level of spinal cord injury at or above what vertebral level

A

T6

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97
Q

sx of autonomic dysreflexia

A

bradycardia and diaphoresis (heightened parasympathetic activity above the level of the injury)
HTN (unopposed sympathetic activity below the injury resulting in vasoconstriction)

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98
Q

internal mammary runs where and is a branch off what

A

either side of sternum (encountered during clamshell!!)
branch of subclavian a

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99
Q

branches of aortic arch

A

braciocephalic/innominate
left common carotid
left subclavian

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100
Q

brachiocephalic/innominate a gives rise to

A

right subclavian and right CCA

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101
Q

subclavian artery gives off what 3 branches

A

thyrocervical trunk
internal mamary artery
costocervical trunk

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102
Q

thyrocervical trunk gives off what 3 arteries

A

inferior thyroid artery
transverse cervical artery
suprascapular artery

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103
Q

effects of low dose dopamine

A

dopamine receptor stimulation and increased mesenteric blood flow

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104
Q

effects of moderate dose dopamine

A

beta 1 adrenergic stimulation and increases contractility

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105
Q

effect of high dose dopamine

A

alpha adrenergic effects and and can induce vasoconstriction

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106
Q

Oxygenation affected by what 3 things

A

FiO2
PEEP
MAP

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107
Q

Ventilation affected by what 2 things

A

RR
Tidal volume

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108
Q

Minute ventilation quation

A

RR x TV

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109
Q

Peak pressure - what does this reflect pressure of?

A

large airways

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110
Q

In order to obtain plateau pressures you must do what

A

Inspiratory pause
This allows pressures to equilibrate and better reflects alveolar pressure

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111
Q

What if there is large differential between peak and plateau pressure

A

Large airway obstruction
Bronchospasm

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112
Q

What if peak and plateau pressures are both high

A

Alveolar lung disease (e.g., ARDS)

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113
Q

Must do what to check negative inspiratory force (NIF)

A

Expiratory pause

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114
Q

CMV/AC what two parameters are set

A

RR and volume
Every breath fully supported

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115
Q

PRoblems with CMV/AC mode

A

Volume is set regardless of pressure (can result in barotrauma)
hyperventilation if patient RR is high

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116
Q

Advantages of PS

A

limits barotrauma

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117
Q

Disadvantage of PS

A

Hypoventilation

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118
Q

In SIMV what two parameters are set

A

RR and volume
Spontaneous breaths above set rate are not fully supported
Delivered breaths are synchronized - typically more comfortable

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119
Q

Minimal vent settings for extubation

A

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)

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120
Q

What two things can check for invasive candidiasis

A

mannan antigen and anti-mannan antibody

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121
Q

What assay for fungal infections

A

1,3 beta d glucan assay

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122
Q

Levo acts on what 2 receptors

A

alpha and some beta 1

123
Q

Phenylephrine acts on what receptor

A

purely alpha

124
Q

vasopressin acts on what receptor

A

V1

125
Q

Epinephrine acts on what receptors

A

alpha and beta 1

126
Q

PE - respiratory acidosis or alkalosis?

A

Alkalosis

127
Q

Goal PTT in tx of PE

A

60-90

128
Q

Indications for thrombolytics with PE (2)

A

Hemodynamic instability
Right heart strain on echo

129
Q

CVP is surrogate for

A

end diastolic RV volume

130
Q

PWP is surrogate for

A

end diastolic LV volume

131
Q

CO equation

A

SV x HR

132
Q

CVP/PWP in cardiogenic shock

A

High

133
Q

Formula for oxygen delivery

A

CO x [Hb x O2 sat x 1.34 + (PaO2 x 0.003)]

134
Q

Formula for oxygen consumption

A

CO x (arterial - venous O2 diff)

135
Q

Formula for extraction ratio

A

O2 consumption/O2 delivery

136
Q

What increases SvO2

A

increased shunting of blood or decreased oxygen extraction
Sepsis
Cirrhosis
Cyanide toxicity
Hyperbaric O2
Hypothermia
Paralysis
Coma

137
Q

Reversal of coumadin besides PCC

A

FFP
Vitamin K

138
Q

Partial reversal of factor Xa inhibitors

A

PCC

139
Q

Nitrogen balance formula

A

Protein intake/6.25 - (urine nitorgen + 4)

140
Q

Negative nitrogen balance indicates what state

A

catabolic

141
Q

Positive nitrogen balance indicates what state

A

anabolic

142
Q

Carbs should make up how much of your non protein cals

A

75%

143
Q

Fats should make up how much of your non protein cals

A

25%

144
Q

Two essential FAs

A

linoleic acid
Alpha linolenic acid

145
Q

Rash, alopecia, vision changes

A

Zinc deficiency

146
Q

Microcytic anemia, pancytopenia, osteopenia

A

Copper deficiency

147
Q

Hyperacute rejection of transplanted organ mediated by

A

Antibodies

148
Q

Acute rejection fo transplanted organ mediated by

A

T cells

149
Q

Prolonged IV haldol doses for EtOH withdrawal followed by arrhythmia

A

Prolonged QT

150
Q

Post op CABG pt with hypotension with CVP and wedge pressure of 20

A

Cardiac tamponade

151
Q

MAP =

A

CO x SVR

152
Q

Mild hypothermia

A

32-35
Passive ext rewarming

153
Q

Moderate hypothermia

A

28-32
Active external rewarming

154
Q

Severe hypothermia

A

<28
Active internal rewarming

155
Q

EDV determined by

A

preload
distensibility of ventricle

156
Q

ESV determined by

A

contractility
afterload

157
Q

Atrial kick accounts for how much of LVEDV

A

20%

158
Q

Anrep effect

A

automatic increase in contractility secondary to increased afterload

159
Q

Bowditch effect

A

automatic increase in contractility secondary to increased HR

160
Q

Normal O2 delivery to consumption ratio

A

4:1
CO increases to keep this ratio constant
O2 consumption is uusually supply independent

161
Q

Causes of right shift of Oxygen Hgb dissocitation curve (O2 unloading)

A

Increased CO2
Increased temperature
Increased ATP production
Increased 2,3 - DPG production
Decreased pH

162
Q

Normal SvO2

A

75% +/- 5%

163
Q

Decreased SvO2

A

occurs with increased O2 extraction (malignant hyperthermia) or decreased O2 delivery (hypoxia, decreased CO, anemia)

164
Q

Wedge pressure may be thrown off by (5)

A

pulmonary HTN
mitral stenosis
Mitral regurg
high PEEP
poor LV compliance

165
Q

Sqan Ganz should be placed in which zone of lung

A

III

166
Q

Hemopysis after flushing Swan Ganz - next step

A

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
Q

Absolute contraindication to Swan Ganz

A

right sided mechanical valve

168
Q

Relative contraindications to swan ganz

A

previous pneumonectomy
left bundle branch block
recent pacemaker
right sided endocarditis

169
Q

PVR can only be measured using

A

Swan Ganz

170
Q

Primary determinants of myocardial oxygen consumption (2 things)

A

ventricular wall tenson increased (#1) and HR

171
Q

What explaisn difference in PO2 in LV vs pulmonary capillaries

A

unsaturated bronchial blood empties into pulm veins therefore LV blood is 5 mm Hg lower than pulm capillaries

172
Q

Alveolar arterial gradient - normal non ventilated pt

A

10-15 mm Hg

173
Q

Blood with lowest venous saturation

A

coronary sinus blood (30%)

174
Q

blood with highest venous saturation

A

renal vv (80%)

175
Q

Lyte issues in adrenal insufficiency

A

HyperK
Hypoglycemia

176
Q

Whch steroid does not interfere with corticotropin stim test

A

dexamethasone

177
Q

1x steroid potency (2)

A

cortisone, hydrocortisone

178
Q

5x steroid potency (3)

A

prednisone
prednisolone
methylprednisolone

179
Q

30x steroid potency

A

dexamethasone

180
Q

tx of neurogenic shock

A

volume first
then phenyl

181
Q

initial alteration in hemorrhagic shock

A

increased diastolic pressure

182
Q

cause of hypotension i ncardiac tamponade

A

decreased ventricular filling due to fluid in pericardial sac around heart

183
Q

first sign of cardiac tamponade

A

echo showing impaired diastolic filling of right atrium initially

184
Q

CVP in adrenal insufficiency

A

decreased usually

185
Q

adrenal insufficiency shock parameters most similar to

A

neurogenic (head or SC injury)

186
Q

early gram negative sepsis - insulin and glucose

A

decreased insulin, increased glucose due to impaired utilization

187
Q

late gram negative sepsis - insulin and glucose

A

increased insulin, increased glucose secondary to insulin resistance

188
Q

sustained neurohormonal response to hypovolemia

A

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
Q

what stain can help dx fat embolism

A

sudan red stain may show fat in sputum and urine

190
Q

intubated pts with PE may show what 2 signs

A

decreased ETCO2 and hypotension

191
Q

IABP inflates on

A

T wave (diastole)

192
Q

IABP deflates on

A

P wave (systole) immediately after aortic valve closure

193
Q

Where does the tip of IABP catheter go

A

just distal to left subclavian (1-2 cm below top of arch)

194
Q

IABP has waht impact on blood pressure

A

improves diastolic BP which improves diastolic coronary perfusion

195
Q

absolute contraindications to IABP

A

aortic dissection
severe aortoiliac disease
aortic regurgitation

196
Q

relative contraindications to IABP

A

vascular grafts
aortic aneurysms

197
Q

alpha 2 receptors act on

A

venous smooth muscle constriction

198
Q

beta 2 receptors have what 3 effects

A

relaxes bronchial smooth muscle
relaxes vascular smooth muscle
increases renin

199
Q

initial rate of dobutamine

A

3 microg per kg per min

200
Q

low dose epi acts on

A

beta 1 and beta 2 which increases contractiliy and vasodilation (can decrease BP at low doses)

201
Q

High dose epi acts on

A

alpha 1 and alpha 2 (Vasoconstriction) which can increase cardiac ectopic pacer activity and myocardial oxygen demand

202
Q

isoproterenol MOA

A

beta 1 and beta 2, increased hr and contracitility, vasodilates

203
Q

side effects of isoproterenol

A

extremely arrhythmogenic, icnreased heart metabolic demand (rarely used) and may actually decrease BP

204
Q

V2 receptors (intrarenal) act where

A

water reabsorption at collecting ducts

205
Q

V2 receptors (extra renal) act where

A

mediate release of factor VIII and vWF

206
Q

Nipride if given at doses >3 mics per kg per min for 72 hours can lead to

A

cyanide toxicity
check thiocyanate levels and signs iof metabolic acidosis

207
Q

tx for cyanide toxicity

A

amyl nitrite then sodium nitrite, hydroxycobalamin

208
Q

high pulmonary compliacne means

A

lungs easy to ventilate (severe COPD)

209
Q

decreased pulm compliance

A

ARDS, fibrotic lung diseases, reperfusion injury, pulmonary edema, atelectasis

210
Q

Aging causes what pulm parameter to increase

A

FRC

211
Q

Aging causes what impact on FEV1 and vital capacity

A

decreases them

212
Q

Excessive PEEP complications

A

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
Q

TLC equals

A

FVC + RV
lung volume after max inspiration

214
Q

RV accounts for how much of TLC

A

20%

215
Q

FRC =

A

lung volume aftern ormal exhalation
ERV + RV

216
Q

FEV1 in restrictive lung disesase

A

normal or increased

217
Q

FVC in obstructive lung disease

A

Normal or decreased

218
Q

Why does COPD increase work of breathing

A

prolonged expiratory phase

219
Q

what is dead space

A

part of lung that is ventilated but not perfused

220
Q

MCC increased dead space (high Vq ratio)

A

excessive PEEP (capillary compression)

221
Q

3 causes of increased dead space

A

decreased CO (capillary collapse)
PE
pulmonary HTN

222
Q

Increased dead space increases CO2 or O2

A

PCO2

223
Q

MCC of increased shunt (low V/Q ratio)

A

atelectasis (alveolar hypoventilation)

224
Q

3 causes of increased shunt

A

atelectasis
mucus plug
ARDs

225
Q

Keep plateau pressures

A

30

226
Q

Mendelsons syndrome

A

chemical pneumonitis from aspiration of gastric secretions

227
Q

most frequent site of aspiration

A

superior segment of RLL

228
Q

atelectasis is mediated by what

A

alveolar macrophages which release IL-1 (acts at hypothalamus)

229
Q

Name 4 things that cause pulmonary vasodilation

A

PGE1
Prostacyclin
inhaled NO
sildenafil

230
Q

Name 5 things that cause pulmonary vasoconstriction

A

hypoxia #1
acidosis
histamine
serotonin
TXA2

231
Q

MCC post op renal failure

A

hypotension intra op

232
Q

What % of nephrons need to be damaged before renal dysfunction occurs

A

70%

233
Q

renin is released in response to

A

decreased pressure sensed by JGA or increased Na concentrations sensed by macula densa
Beta adrenergic stimulation and hyperK also cause release

234
Q

Where is angiotensinogen synthesized

A

liver

235
Q

what converts angiotensinogen to angiotensin I

A

renin

236
Q

adrenal cortex releases what in response to angiotensin II

A

aldosterone

237
Q

where does aldosterone act

A

distal convoluted tubule to reabsorb water by upregulating NA/K ATPase on membrane (Na reabsorbed, K secreted)

238
Q

How does ANP act on collecting ducts

A

inhibits Na and water resorption

239
Q

ADH released by

A

posterior pituitary gland when osmolality is high

240
Q

which limb of kidney controls GFR

A

efferent limb

241
Q

how do NSAIDs cause renal damage

A

inhibit prostaglandin synthesis resulting in renal arteriole vasoconstriction

242
Q

SIRS mediated by what two cytokines

A

IL1 and TNF alpha

243
Q

Most potent stimulus for SIRs

A

endotoxin (LPS - lipid A)

244
Q

Lipid A is a very potent stimulator of

A

TNF release

245
Q

Can still have what reflexes with brain death

A

deep tendon

246
Q

Negative test for apnea occurs if

A

BP drops <90 mm Hg
pt desats <85% on pulse ox
spontaneous breathing occurs

247
Q

CO causes what shift on hemoglobin/oxygen curve

A

left shift

248
Q

carboxyhemoglobin in smokers

A

20%

249
Q

name some things that can cause methemoglobinemia

A

nitirtes such as hurricaine spray, fertilizers, nitrites bind hemoglobin

250
Q

methemobloinemia will shift dissociation curve where

A

left

251
Q

most impt mediator of reperfusion injury

A

PMNs

252
Q

site specific complication of radial a line

A

peripheral neuropathy

253
Q

site specific complicatio nof brachial a line

A

median nerve damage

254
Q

site specific complication of axillary a line

A

brachial plexopathy

255
Q

waveform characteristics indication PA catheter is in RV

A

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
Q

a wave on PA cath represents

A

atrial contraction

257
Q

c wave on PA cath

A

closing of tricuspid valve and ventricular systole

258
Q

x descent on PA cath

A

atrial filling

259
Q

normal ICP

A

7-15 mm Hg

260
Q

y descent on PA cath

A

opening of tricuspid valve and passive atrial emptying

261
Q

pulmonary artery waveform on PA cath

A

characterized by dicrotic notch, which represents closure of pulmonary valve. otherwise relatively similar to TV pressure tracing

262
Q

rapid pressure increase and decrease on PA cath

A

normal pulmonary artery waveform

263
Q

small pressure increases and decreases on pa cath

A

normal wedged pulm a waveform

264
Q

a c wave followed by an x descent on PA cath

A

normal RA waveform

265
Q

diff in urine between CSW and SIADH

A

CSW will have high Na levels (higher than intake) and net sodium balance will be negative

266
Q

diff in fluid response between CSW and SIADH

A

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
Q

polyuria - present in CSW or SIADH?

A

CSW

268
Q

volume status in CSW and DI

A

hypovolemic

269
Q

volume status in SIADH

A

normal or hypervolemic

270
Q

tx of hyponatremia in sIADH

A

demeclocycline

271
Q

location of femoral vein

A

junction of medial and middle 1/3 of inguinal ligament 2 cm breadths below the inguinal ligament

272
Q

normal ICP

A

7-15 mm Hg

273
Q

most efficienct site of GI calcium absorption

A

duodenum and proxiaml jejunum

274
Q

oxygen extraction is highest where

A

coronary circulation and brain tissue

275
Q

average oxygen extraction ratio

A

0.3

276
Q

with hypovolemia what happens to oxygen extraction

A

higher

277
Q

as oxygen consumtpion increases what happens to the extraction ratio

A

increases

278
Q

indications for IABP

A

systolic pressure <90 or CI <2.2, cardiogenic shock, low cardiac output

279
Q

shift to the right on O2 hgb curve has effect of ___ affinity of Hgb for oxygen

A

decreased

280
Q

main reason for refeeding syndrome phenomenon

A

insulin

281
Q

most myocardial perfusion occurs during?

A

diastole when subendocardial coronary vessels are open and under lower pressure

282
Q

when asking pt to make a fist fingers 1-3 extend

A

proximal median nerve injury

283
Q

when asking pt to extend fingers/at rest they are unable to extend 1-3

A

distal median nerve injury

284
Q

when asking pt to make a fist they are unable to flex fingers 4-5

A

proximal ulnear nerve injury

285
Q

when asking pt to extend fingers/at rest they are unable to extend 4-5

A

distal ulnar nerve injury

286
Q

wrist drop with inability to abduct thumb or extend MCP joints

A

radial nerve

287
Q

which two major colic vessels can be ligated with minimal impunity

A

celiac and IMA

288
Q

pancreatic fistula definition

A

drain amylase >3 times ULN + some type of clinical implication (like signs of infection etc or persistent drainage after 3 weeks)

289
Q

blood supply of omentum

A

omental branches given off by left and right gastroepiploic arteries

290
Q

urethral injury diagnosed by RUG

A

suprapubic cath or attempt primary realignment with a cystoscope and wire antegrade or retrograde

291
Q

PAOP and CVP in hypovolemic shock

A

decreased

292
Q

anatomic landmark for paracentesis

A

3 cm medial and 3 cm superior to left ASIS

293
Q

Base deficit warranting damage control

A

> 15

294
Q

Elemental formulas

A

Include 16-25% of calories as proteins
Elemental formulas supply free AA instead of proteins therefore they are mre easily absorbed

295
Q

Indications for elemental formula

A

short bowel syndrome
EOE
milk protein allergy

296
Q

vasodilatory effect of dobutamine

A

beta 2 receptor stimulation (at higher doses has vasodilatory effect. at lower doses it stimulates beta 1 to increase contractility)

297
Q

Opens eyes to pain

A

E 2

298
Q

Incoherent words/sentences (GCS)

A

V 3

299
Q

Withdraws from pain (GCS)

A

M 4

300
Q

Localized to pain (GCS)

A

M 5

301
Q

Follows commands (GCS)

A

M 6

302
Q

Decorticate (GCS)

A

Clenched fists, legs straight out (M3)

303
Q

MC complication of hepatic trauma

A

biliary fistula

304
Q

ptx is fatal becasue

A

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.

ABS (23 decks)

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