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*Surgery > Surgical Critical Care > Flashcards

Surgical Critical Care Flashcards

1
Q

examples of conditions that need surgical critical care

A 
trauma
burns
severe pancreatitis
rupture aneurysms
cholangitis
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2
Q

what are some post op complications that can cause someone to be in the surgical ICU

A

renal failure
PE
myocardial infarction
sepsis

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3
Q

evaluation of the critically ill or injured patient

A

ABC
obtain history (AMPLE)
rapid primary survey and tx or correct problems
perform a secondary survey

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4
Q

what are some resuscitation fluids

A

crystalloid (NS, LC)
colloids (Hespan, Albumin)
blood products

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5
Q

typically into radial artery, get pulse by pulse BPs, can draw ABGs right from it

A

Arterial pressure monitoring

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6
Q

Measures cardiac output, mixed venous oxygen saturation, systemic venous resistance and most importantly, pulmonary artery diastolic pressure (PADP) and PAWP

A

Pulmonary Artery catheter

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7
Q

what are the pressures from teh pulmonary artery catheter used to estimate?

A

Left ventricular filling pressure and help guide fluid and vasoactive drug administration

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8
Q

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in inflammation which leads to generalized cellular hypoxia

A

Shock

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9
Q

caused by a problem with heart rate or stroke volume

A

low cardiac output

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10
Q

caused by a problem with heart rate or stroke volume

A

low blood pressure

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11
Q

hypovolemia with direct soft tissue injury and bone fractures

A

traumatic shock

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12
Q

compression of the heart or great veins

A

compressive cardiogenic shock

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13
Q

loss of autonomic control of the vasculature

A

neurogenic shock

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14
Q

intravascular volume depletion through hemorrhage or loss of plasma volume (3rd spacing, burns or GI losses)

A

Hypovolemic shocks

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15
Q

tx for hypovolemic shock

A

replace fluids
2-3 L crystalloid over 10-30 minutes
blood products if needed
stop volume loss

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16
Q

over what percent blood volume loss does your HR increase

A

15%

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17
Q

when does the BP start to drop with hemorrhagic shock

A

30-40%

1500-2000 mL

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18
Q

is BP reliable for blood loss?

A

No

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19
Q

what is the most reliable thing for blood loss

A

urine output (decrease)

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20
Q

tx for traumatic shock

A

volume and pressors

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21
Q

type of shock caused by Failure of the heart as an effective pump

A

intrinsic cardiogenic shock

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22
Q

causes of intrinsic cardiogenic shock

A

MI or arrhythmias are the most common

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23
Q

how do you tx cardiogenic shock

A

treat MI or underyling disorder
judicial use of fluids
ionotropes

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24
Q

signs of cardiogenic shock

A

edema- LE
crackles/ rales
JVD

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25
Q

compressive causes of cardiogenic shock

A

pericardial tamponade
tension pneumothorax (PTX)
mediastinal hematoma
positive pressure from mechanical ventilation

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26
Q

Causes of a tension PTX

A

known trauma or central line, cardiac cath vs. spontaneous

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27
Q

tx for Tension PTX

A

needle compression and tube thoracostomy

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28
Q

Tx for pericardial tamponade

A

pericardicentesis

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29
Q

beck’s triad

A

JVD
muffled heart sounds
pulsus paradoxus/ HPOTN

30
Q

type of shock with ↓ CVP, ↓ SVR), ↑ CO, , fever, tachypnea, tachycardia, HPOTN, end-organ dysfunction

A

Septic shock - hyper dynamic “warm”

31
Q

tx for septic shock

A

broad spectrum abx
heavy fluid resuscitation (doe this before operation)
ionotropes, vasopressors
debride, drain, operate as needed

32
Q

causes of neurogenic shock

A

neurologic injury
spinal anesthesia
tachy w/ HPOTN and warm, well perfused extremities

33
Q

with a high C-spine injuries what may the HR be?

A

bradycardia

34
Q

Tx for neurogenic shock

A

extremely large voluem resucitation

vasoactive agents

35
Q

shock most Most often from chronic use of high dose corticosteroids, causing adrenal suppression.

A

hypoadrenal shock

36
Q

diagnosis for hypoadrenal shock

A

shock not responding to tx

hyperthermia, dramatic HPOTN

37
Q

tx for hypoadrenal shock

A

volume resuscitiation
pressors
stress dose corticosteroids- hydrocortisone 100 mg q6-8 hours

38
Q

vasopressors

A

norepinephrine (stimulates alpha-1, mild beta)
dopamine (Beta 1, alpha 1) - dose dependent
epinephrine
phenylephrine

39
Q

vasopressor that stimulate beta 1 in low doses and alpha 1 in medium doses

A

dopamine

40
Q

strong alpha 1 agonist, increases PVR, has myocardial depression

A

phenylephrine

41
Q

is the systemic inflammatory response of either infectious or non-infectious origin to a wide variety of severe clinical insults manifested

A

Systemic inflammatory response syndrome (SIRS)

42
Q

criteria for SIRS

A
  1. Temp >38
  2. HR >90 bpm
  3. Resp rate >20
  4. WBC >12,000 or 10% bands
43
Q

what may SIRS turn into if not treated

A

Multiple Organ-system Dysfunction syndrome (MODS)

44
Q

failure of 2 or more of the six vital organ systems

Cardiovascular, respiratory, nervous, renal, liver, host defense

A

MODS (multi organ system dysfunction)

45
Q

risk factors for MODS

A

shock
SIRS
massive blood transfusions

46
Q

Tx for MODS

A

supportive and correction of underlying disorder

47
Q

Diffuse pulmonary parenchymal injury associated with noncardiogenic pulmonary edema and resulting in severe respiratory distress and hypoxemic respiratory failure.

A

ARDS- adult respiratory distress syndrome

48
Q

pathological hallmark of ARDS

A

pathologic hallmark is diffuse alveolar damage

DAD

49
Q

What id diffuse alveolar damage (DAD)?

A

loss of integrity of the alveolar capillary barrier and transduction fo protein-rich fluid across the barrier
pulmonary edema
hypoxemia from intrapulmonary shunting

50
Q

what will ARDS look like on chest x-ray

A

B/L puffy infiltrates

51
Q

what will PAWP be w/ ARDS

A

normal or low

52
Q

Causes of ARDS

A 
infection
systemic sepsis
shock
aspiration 
trauma (pulmonary contusions, fat embolism)
bypass
massive blood transfusions
53
Q

tx for ARDS

A

tx underlying condition

supportive with agressive ventilator management

54
Q

what do you want to be high with ARDS tx

A

PEEPS (positive end expiratory pressure)

and a low tidal volume (decrease injury of lung)

55
Q

signs of pulmonary failure

A

RR>36, labored ventilation, use of accessory muscles and tachycardia

56
Q

what is failure of oxygenation

A

PAO2 50%

57
Q

what is failure of ventilation

A

PACO2 >45-

58
Q

what is assist control

A

sets the same tidal volume for all breaths (whether patient initiated or machine inititaed)

59
Q

with normal lungs what should the tidal volume be?

A

8 mL/kg (TV)

PEEP-3

60
Q

with ARDS what should you set at?

A

TV- 6 mL/kg

PEEP of 4-15

61
Q

what should you check after initial vent settings?

A

ABG

62
Q

what affect pCO2

A

tidal volume

RR

63
Q

what affect O2

A

FIO2

PEEP

64
Q

what improves survival in burn and trauma patients

A

early feedings

65
Q

surgical critical care patients may develop what?

A

transient insulin resistance

66
Q

most common cause of renal failure w/ critically ill patients

A

inadequate volume repletion

67
Q

diagnosis of renal failure

A

rising creatinine

68
Q

what is FENa

A

Fractional excretion of sodium

69
Q

what is a normal FENa

A

<1-2%

70
Q

what FENa would indicate prerenal?

A

<1% FENa

71
Q

what FENa would indicate a renal cause

A

> 2-3%

*Surgery (5 decks)

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