Surgical critical care Review

Question 1

What is the paralytic agent of choice in the ICU

Answer 1

• cisatracurium

Question 2

How is cisatracurium metabolized by the body?

Answer 2

• hoffman metabolism
• ester hydrolysis
• i.e. does not need renal or liver function

Question 3

indications for stress ulcer prophylaxis in ICU patients

Answer 3

• mechanical ventilation greater than 48 hours and no tube feeds
• INR > 1.5
• platelets < 50
• TBI
• Spinal cord injury

Question 4

What should you be careful with when using vasopressin as a second line agent?

Answer 4

• can cause hypotension secondary to decreased cardiac output, as a result of decreased stroke volume
• can precipitate ischemia in coronary artery disease (be careful with older patients)

Question 5

Main effect of epinephrine use?

Answer 5

increases heart rate

Question 6

side effects of epinephrine use in SICU

Answer 6

• can lead to tachyarrhythmias
• can lead to ischemia (increased cardiac demand)

Question 7

main effect of dobutamine

Answer 7

increases heart rate and myocardial contractility

Question 8

Target receptors for Norepinephrine

Answer 8

alpha 1 > beta 1

Question 9

target receptors of vasopressin

Answer 9

V1a

Question 10

target receptors of epinephrine

Answer 10

alpha 1, beta 1, beta 2

beta > alpha

Question 11

target receptors of dobutamine

Answer 11

beta 1, beta 2

Question 12

when do hepatic glycogen stores run out

Answer 12

within 24 hours of being made NPO

Question 13

primary precursor of hepatic gluconeogensis

Answer 13

Alanine

Question 14

which narcotic do you use in patient’s with renal insufficiency?

Answer 14

Hydromorphone (Dilaudid)

Question 15

what the main physiological issue in ARDS?

Answer 15

• protein rich fluid saturates the alveoli causing poor oxygenation

Question 16

first line pressor for cardio-genic shock?

Answer 16

dobutamine

Question 17

drugs that can cause cyanide toxicity?

Answer 17

• Nitroprusside
• thicyanate

Question 18

antidote for cyanide toxicity

Answer 18

• amyl nitrite
• sodium nitrite
• hydroxocobalamin

Question 19

respiratory quotient of <0.7

Answer 19

patient is starving (underfed)

Question 20

respiratory quotient of 0.7

Answer 20

pure fat utilization

Question 21

respiratory quotient of 0.8

Answer 21

pure protein utilization

Question 22

respiratory quotient between 0.8-0.9

Answer 22

mixed substrate utilization (desired)

Question 23

respiratory quotient of 1.0

Answer 23

pure carbohydrate utilization

Question 24

respiratory quotient > 1.0

Answer 24

overfeeding

Question 25

high peak pressures with normal plateau pressures on ventilator…what is the issue and how do you treat

Answer 25

high bronchial resistance, treat with bronchodilators (albuterol)

Question 26

high peak and plateau pressures on ventilator…what is the issue

Answer 26

pulmonary compliance issue (eg ARDS, pneumothorax, abdominal compartment syndrome)

Question 27

in the critical care setting, what is the most accurate way to assess malnutrition

Answer 27

history and physical

Question 28

organ that uses the most energy during stress

Answer 28

heart