Test 2 - ICU Care Flashcards
CAAHEP
commission on accreditation of allied health education programs
CAAHEP quote
The anesthesiologist who is responsible for the AA is available to prescribe and direct particular therapeutic interventions in the operating room and INTENSIVE CARE SETTING
iron lung
works by negative pressure
ICU combines 5 specialties
anesthesiology, internal medicine, pediactrics, surgery, emergency medicine
Medicare billing code
99291 and 99292
ICU Clinical condition criterion
summary: high likeliness of death, requires preparedness of MD to intervene urgently
ICU Treatment Criterion
crit care req direct mamagement by MD, interventions frequently required that without can result in death/deterioration
CMS category for Aas
Non-Physician providers (NPPs)
NPPs and billing
able to bill under medicare part B for services otherwised billed as physician care
ICU Skill set
technical, cognitive, admin, ethical
Airway management tools
bronchoscopy, glidescope, surgical airway
PA catheters measure 4 things
LVEDV (preload) PA pressure, mixed venous saturation, cardiac output
Do PA catheters really change anything?
no
Was the 2 hour PA cath explanation a waste of time?
yes
Acute Respiratory Distress Syndrome (network)
network to test agents, devices, or mgmt strategies to improve care of pts with ARDS
ARDS mechanical ventilation strategies
Low Vt with plat press < 30cmH2O. Keep O2 sat 88-95
Liberation vs Weaning
weaning is a misnomer. We ‘liberate’ upon doing a series of tests (getting them to breathe) to see if they’re capable of taking them off the vent completely
Use of Nitric Oxide & Helium
He is a lower density gas used in cases of an obstructed upper airway. N2O has some analgesic effects
ECMO, ECLS
Life support: for cardiac and pulmonary systems in patients who cannot support their functions. Extra Corporeal membrane oxygenation.
VAD
Ventricular Assisted Device, pump that helps the heart
Ultrasound - artery vs vein
Vein compresses, artery does not.
ICU - Radiology
Stuff we’ve learned before. Radiodensities. more dense=white, densities are ADDITIVE
Radiology PA, AP
Posterior to anterior, anterior to posterior.. Direction the xray is being taken
Setup of x-ray
Xray, YOU, Device to collect ‘shadow’
1 cause of death in ICU
death. funny, but he said infection.
Surviving Sepsis
the earlier you treat it, there’s an exponentially higher chance of helping that patient.
SIRS
Systemic inflammatory response syndrome
Sepsis interventions
draw cultures, start antibiotics, measure lactate, give fluids, measure CVP and ScVO2
Kidney measurement of recover
Good benchmark in determining the systemic health improvement or deterioration. “can’t out think a kidney.”
50% of dying that year
109 years old.
Which day in the ICU stay carries the highest risk of death for a patient
Day 0
Easiest and most difficult cases
5e hardest (going to die), most difficult (elective)
4 principles of medical ethic
do no harm, do good, autonomy, social justice
swan ganz
v wedge pressure: catheter inserted until “wedges” into a pulmonary artery, no blood flow distal to this point. Pulmonary occlusion pressure is equivalent to left atrial pressure = ventricular end diastolic pressure (when mitral valve open and aortic pressure closed) =LVEDP= preload
best feature of swan ganz?
mixed venous blood sample for blood gas
ultrasound guided line placement
central, arterial, dialysis. NOT subclavian
cardiopulmonary bypass
circulation but no pulse
swan ganz
right heart catheterization. insertion: thick line 50 cm, thin line 10 cm
pulmonary artery pressure is?
diastolic pressure
myocardial length just before contraction
preload
thermal dilution
cardiac output calculated using the area under the curve of the temperature/time curve
ventilation mode
“proning”. facilitates ventilation
can change the density of airway gas
helium, lower density, moves faster: useful for airway edema
