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Critical Care > Test 5 > Flashcards

Test 5 Flashcards

1
Q

What are causes of cirrhosis of the liver? (8)

A
  • Alcoholic liver dz
  • NAFLD (fatty liver)
  • Autoimmune
  • Hepatitis
  • Primary biliary cirrhosis
  • Drug induced
  • Wilson’s Dz
  • Chronic R sided HF
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2
Q

Which type of Hepatitis is closely associated with development of cancer?

A

Hep C

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3
Q

Name 6 complications of altered liver function:

A
  • Low albumin
  • Low protein
  • Low potassium
  • High bilirubin
  • High ammonia
  • Coagulopathies
  • H2O retention
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4
Q

What is the most common cause of encephalopathy? (hepatic or otherwise)

A

High ammonia levels

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5
Q

What are 2 medications used to lower ammonia levels/Tx encephalopathy?

A

Lactulose

Neomycin

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6
Q

Asterixis is AKA _____ and is caused from _____

A

Liver flap; encepalopathy (high ammonia)

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7
Q

Liver failure patients are hypo or hypervolemic?

A

Hypovolemic despite being edematous–due to third spacing

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8
Q

What role do the kidneys play in liver failure?

A

Hypovolemia causes the kidneys to be under-perfused which can cause AKI.
Kidneys excrete bilirubin.

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9
Q

What blood products/Tx might a liver failure pt. receive?

A
  • PRBCs
  • FFP
  • Plts
  • Volume rep. w/ Colloids
  • Vit K
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10
Q

What fluid/electrolyte imbalances would you see in LF patients?

A
  • Hypokalemia
  • Decreased UOP
  • IV volume depletion
  • Hypoalbuminemia
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11
Q

Explain the TIPS procedure:

A

Stent placed (acts as an artificial vessel) to bypass the portal system in liver

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12
Q

When chronic paracentesises are no longer tolerated, what intervention can be done?

A

A LeVeen shunt can be placed- shunt is placed under the skin that routes the ascitic fluid from the peritoneum (more permanent drainage system)

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13
Q

What causes abdominal compartment syndrome?

A

High pressures that result in decreased perfusion to the abdominal cavity (sustained intra abdominal pressure of >20 mmHg with new organ dysfunction or failure)

Sustained IAP = MAP-IAP

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14
Q

Define fulminant hepatic failure and what is the major cause?

A

Liver failure which occurs in less than 6 months; hepatotoxic meds (acetaminophen)

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15
Q

Which medications are contraindicated in fulminant LF but are indicated in normal LF?

A

Lactulose, neomycin

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16
Q

Name some non-candidate risk factors for liver transplant:

A
  • Uncontrolled bacterial sepsis
  • Major organ failure
  • Portal vein thrombosis
  • Current alcohol/drug use
  • Extrahepatic malignancy
17
Q

What role does bicarb play in the liver?

A

It provides pH balance for the acids that come from the stomach

18
Q

What are two common clinical manifestations that result from pancreatitis?

A

ARDS and hypocalcemia

19
Q

What entails “pancreatic rest”?

A

NPO, NG tube suctioning

20
Q

What analgesic medication is contraindicated in pancreatitis?

A

Morphine which causes sphincter spasms which worsens the problem

21
Q

Name and explain the three zones of injury in burns:

A
  • Zone of coagulation- center (site of greatest damage)
  • Zone of stasis- surrounding (impaired circulation)
  • Zone of hyperemia- peripheral (vasodilation and increased blood flow)
22
Q

Name and describe the burn classifications:

A

Minor: <15%
Moderate: 15-25% partial thickness, <10% full thickness
Severe: >25% partial, >10% full thickness

23
Q

What might you watch for in a lightning strike pt.? Related to urine

A

Myoglobinuria

24
Q

Define the phases of burn injuries:

A

Emergent- resuscitative phase (0-72 hours)
Acute (weeks/months UNTIL WOUND CLOSURE)
Rehabilitative (years–>lifetime)

25
Q

What issues do you watch for during the emergent burn phase?

A

Airway management
Burn shock/fluids
Pain management

26
Q

What issues do you watch for during the emergent burn phase? (3)

A

Airway management
Burn shock/fluids
Pain management

27
Q

How will carbonmonoxide poisoning present?

A

Good O2 sats but hypoxic

28
Q

What is the consensus formula for burn fluid calc and how fast is the fluid delivered?

A

2mL LR x weight in kg x TBSA = 24 hour post burn total
1/2 mL in first 8 hours
Remaining over the remaining 16 hours

29
Q

What are the 6 P’s of compartment syndrome?

A 
Pain
Pallor
Paresthesia
Pulseless
Paralysis
Poikliothermia (temp unmanageable)

Critical Care (6 decks)

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