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ANSTZ > the 10 commandments > Flashcards

the 10 commandments Flashcards

1
Q

Name 3 antibiotics for pseudomonas coverage (just the classes)

A
  • Extended spectrum penicillin with B-lactamase inhibitors (Piperacilin-Tazobactam = antipseudo penicillin)
  • Cephalosporins
  • Fluoroquinolones

Additional from amboss:
- Carbapenems
- Aminoglycosides
- Monobactams
- Polymyxins

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2
Q

What are 5 indications for dialysis?

A

AEIOU:
- Acidosis(<7.1 ph or refractory to therapy)
- Electrolytes(K+ over 6.5 mmol/l)
- Intoxication
- Overloaded with fluid,
- Uremia/uremic symptoms

-hypo/hypernatremia (<115, >160)
-AKI (>350 umol/l creat, >12hr anuria)

-hyperthermia(>39.5 )

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3
Q

Child CPR/ALS difference from adults?

A

15:2 ratio.

From Amboss:
· Children older than 1 year
o 5 initial rescue breaths → CPR
o Compression rate: 100-120/min
o Compression-to-ventilation ratio:
- § Medical professionals: 15:2
- § Lay rescuers: 30:2
o Further management should follow the guidelines for adults.
· Defibrillation: monophasic and biphasic waveforms: 2–4 J/kg of body weight

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4
Q

Symptomatic treatment of bradycardia, top 3 pharmacological agents.

A
  • Atropine (he asked dose, 500mcg IV each time for max 3mg)
  • dopamin
  • isoprenaline
  • adrenaline
  • glycopyrrolate
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5
Q

Ultrasound during CPR, you can investigate:

A

1 H, 3 Ts.

H
- Hypovolemia (collapsing IVC)

T
- Tamponade (Collapsed RV + fluid filled pericardium),
- PE (Enlarged RV and RA), collapsed left side
- PTX (Lack of lung sliding and B-lines).

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6
Q

How many joules for infants/children with the defib?

A

4 J/KG

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7
Q

Dose of Epinephrine and how do you give a patient in ICU?

A

Infusion, he was happy with 0.01- 0.03 mcg/KG/min

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8
Q

5 uses of end tidal CO2 during CPR? (capnography)

A

PQRST: Placement of airway device, ETT (endotracheal tube?),
Quality of compressions,
ROSC also know the values whats normal, what’s bad, and what is terminate-CPR bad.
Strategy : if <10 mmhg for long time> bad prognosis
Termination ( etCO3 >24, Rosc, spontaneous respiration)

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9
Q

etCO2 ROSC values

A

> 24
- stop ALS, check circulation ( ROSC)

20-24
- Chest Comp is effective

<20
- improve CC quality

=<10
- Poor prognosis

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10
Q

3 indications for systemic thrombolysis?

A

Early STEMI (< 12 hours) but rare

Early ischemic stroke (< 3 hours)

Massive pulmonary embolism

Acute peripheral arterial occlusion

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11
Q

Top nosocomial bacterias?

A

Klebsiella
Acinetobacter
MRSA
Pseudomonas

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12
Q

3 symptoms of hypoglycemia:

A

CNS(agitation, coordination, sleepiness)
pale,
sweating,
tachycardia

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13
Q

Basic difference between CRRT and IRRT? What do you use when?

A

CRRT= Continuous Renal Replacement Therapy, done over 24 hours, and is a slow type of dialysis

IRRT= Intermittent Renal Replacement
Therapy: performed for less than 24 hours in each 24 hour period,
two to seven times per week

CRRT has better
-haemodynamic stability (BP control)
- improved survival
- greater likelihood of renal recovery.

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14
Q

Name 5 opioids commonly used?

A

Morphine, fentanyl, sufentanyl, Remifentanil, tramadol, codeine

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15
Q

Name 3 non invasive airway measures?

A

Head chin tilt,
eschmark,
cpap bipap,
oxygen,
bag mask

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16
Q

4 symptoms of shock:

A

MOF,
Urine output<0,5ml/kg,
loss of consciousness, confused,
GI: absent bowel sounds

(adding)
Paleness
Cold-sweat
Cold skin (warm skin if distributive shock like sepsis/anaphylactic)

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17
Q

Lethal triad:

A

Coagulopathy, Hypothermia, metabolic acidosis

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18
Q

4 iv anesthetics

A
  • Thiopental (= barbiturate 3-6mg/kg)
  • Midazolam (= benzodiazepines 0.01-0.1 mg/kg)
  • Propofol (2-4mg/kg) most popular
  • Ketamine (1-5mg/kg)
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19
Q

3 inotropes:

A
  • Norepinephrine
  • Epinephrine
  • Dobutamine
  • Dopamine
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20
Q

Side affects of local anesthetics:

A
  • Bradycardia and ventricular arrhythmias
  • Hematoma → nerve compression→ neurological symptoms
  • Infections
  • Allergic reactions
  • Spinal/epidural: Headache, bradycardia, hypotension…
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21
Q

How do you diagnose airway at risk

A

Listening for snoring, gurgling, choking + paradoxical movement

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22
Q

Criteria for empty stomach (how long do you need to fast):

A

Clear fluids (water, tea) = 2h
Breast milk = 4h
Nutritional drinks –cow milk – solid food = 6h

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23
Q

First line treatment of tpx:

A

Provide resp. support
Treat dyspnea
immediate tube thoracostomy

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24
Q

Caloric value of carbohydrates lipids protein and alcohol

A
  • Carbohydrate (60-80% of nutrition): Glucose = 4,2Kcal/g ;
    Max glucose dose of ICU patients 5mg/kg/min
  • Lipid (20-40% of nutrition): 9,1Kcal/g; lipid oxidation is limited, max dose = 1-1,5g/kg/day
  • Protein: daily requirement in critical care =1,5-2 g/kg/day
  • Alcohol: I guess 0 because the patient is in critical care ???
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25
Q

Formula of osmolality:

A

= 2[Na+] + [Glucose]/18 + [BUN]/2.8 (mg/dl)

In case: Osmolarity = 2Na + Glucose + Urea (mmol/L)

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26
Q

Shock definition:

A

Acute hemodynamic disorder (micro and macrocirculatory) independent of the cause, which
leads to insufficient oxygen supply and tissue hypoxia.

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27
Q

3 Application of ETCO2:

A

noninvasive technique which measures the partial pressure or maximal concentration of carbon
dioxide (CO2) at the end of an exhaled breath (N: 35-45 mmHg). Can be used to detect
metabolic acidosis (but ABG is the gold standard)

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28
Q

3 SUBLINGUAL antihypertensive drugs and their dose –

A

nitrates, ACEI, niflodipin.
Captopril = 25mg
Nifedipine = 10mg
Prozasin = 2mg

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29
Q

First choice of bradycardia treatment

A

Atropin

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30
Q

How to calculate PULMONARY MAP

A

= 1/3SBP + 2/3DBP

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31
Q

Atmospheric pressure in mmHg and mmH2O

A

760mmHg or 10332,276 mmH2O

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32
Q

5 reasons AMI can cause cardiogenic shock

A
  • Wall rupture (late phase)
  • Arrhythmia
  • Valvular dysfunction (e.g papillary muscle necrosis)
  • Decreased contractility (pump function)
  • Wall rupture → tamponade
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33
Q

3 complications with Central venous catheter

A

Infection
Rupture of Artery
pneumothorax

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34
Q

4H & 4T

A

H:Hypoxia
H: Hypovolemia
H: Hypo/HyperKalemia
H: Hypo/hyperthermia

T: toxins
T:tamponade
T: Tension PTX
T: Thrombosis

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35
Q

Gynecological emergencies in ICU

A

Placental abruption,
miscarriage,
ectopic pregnancy,
Acute PID,
Pelvic endometriosis…

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36
Q

Difference between dehydration and hypovolemia

A

Hypovolemia is a condition where the extracellular fluid volume is reduced and it results in
decreased tissue perfusion.
It can be produced by either salt and water loss.

Dehydration: Is when there is only water loss.

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37
Q

Respiratory failure classes

A

Type I - hypoxemic failure
Type II - hypercapnic failure
Type III - post-operative failure
Type IV - CV-associated failure (shock-ass hypoperfusion)

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38
Q

Type 1 respiratory failure values

A

decreased arterial oxygen = PaO2 < 60 mmHg

(SaO2 < 90%,
PaCO2 decreased/normal,
pH increased/normal).

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39
Q

Type 2 respiratory failure values

A

increased arterial carbon dioxide = PaCO2 > 50 mmHg or pH < 7.3 (respiratory acidosis).

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40
Q

Anaphylactic shock symptoms (give the answer in ABCDE order)

A

A: Wheezing (bronchoconstriction)
B: dyspnea
C: Hypotension, Skin: hives, itching, urticaria, Angioedema
D: dizziness, fainting
E: nausea, vomiting

41
Q

Define septic shock

A

Is a type of distributive shock caused by an excessive inflammatory response to disseminated infection,

which leads to extravasation from the vascular space and loss of intravascular volume.

42
Q

3 indications of central vein

A
  • Dialysis
  • ICU
  • Longer hospital stay
  • Fluids
43
Q

What is 60-40-20 rule

A

Total body water = 60% of body weight
Intracellular fluid = 40% of body weight
Extracellular fluid= 20% of body weight

44
Q

Antidotes for opiates, benzodiazepine and non depolarizing muscle relaxant

A
  • Opiates= Naloxone
  • BZ= Flumazenile
  • Non depolarizing muscle= Neostigmine (cholinestherase ihibitors)
45
Q

3 ways to measure cardiac output

A
  • Doppler ultrasound
  • Pulse pressure methods
  • Impedance cardiography
  • MRI
  • Calculate = SV x HR

swan ganz catheter
arterial line

46
Q

Puncture in ribs

A
  • midaxillary line: 4-5 intercostal space

or

  • mid clavicular: 2 intercostal space
    (just above the third rib)
    for needle decompression (faster)
47
Q

Parameters in mechanical ventilation

A

*Mode:
- Assisted control
- Intermittent mandatory ventilation
- pressure ventilation which is CPAP and BiPAP
- volume ventilation
* FiO2,
* Tidal volume and respiratory rate which will change the alveolar ventilation and positive end expiratory pressure which is the PEEP
* Flow

48
Q

Horowitz index

A

ratio of partial pressure of oxygen in blood (PaO2), in millimeters of mercury, and the fraction of
oxygen in the inhaled air (FIO2) — the PaO2/FiO2 ratio.

→ used to assess the lung function in patients, especially those under ventilators.

49
Q

Treatment protocol for tachycardia

A
  • Beta Blockers,
  • vagal maneuvers,
  • cardioversion electrical or chemical
  • ICD,
  • PM,
  • ablation
50
Q

Hyperkalemia : ECG

A
  • Peaked T waves on prechordial leads
  • PR prolongation
    -wide QRS
  • p wave flattening
51
Q

Treatment for hyperkalemia?

A

Mention 5:

  • Insulin-glucose
  • Ca-gluconate I.V,
  • Haemodialysis
  • B-agonist (activates Na/K pump moving K into cells)
  • NaHCO3- (alkalosis drives K into cell)
52
Q

Indications for HCO3-:

A
  • CPR when severe acidosis pH<7,1
  • strong suspicion of metabolic acidosis,
  • Correct hyperkalaemia (K+ + HCO3+), pH < 7,1
53
Q

Correction of symptomatic bradycardia:

A

Atropine 0,5mg —> 3mg (0,5 every bolus)

54
Q

Layers for spinal anesthesia

A

Injection site:
Injection usually performed below L2 to avoid damage to the spinal cord
Needle inserted into subarachnoid space between the arachnoid and pia mater

Layers the needle goes through:
Skin
Subcutaneous fat
Supraspinal ligament
Interspinal ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Subarachnoid space

55
Q

Epidural anesthesia layers

A

Can be used for acute pancreatitis → Increased blood flow to the pancreas for healing.
No parasympathetic fibers in epidural anesthesis

Injection site:
May be performed at any vertebral level (cervical, thoracic and lumbar spine)
Needle inserted into the epidural space between the ligamentum flavum and dura mater

56
Q

HCO3- dosage for DKA

A

50mmol

57
Q

3 symptoms of upper GI bleeding:

A
  • Hematemesis
  • Melena (digested blood)
  • Drop of BP, lightheadedness
58
Q

EtCO2 normal value?

A

35-45

59
Q

Reversible causes of cardiac arrest: Hypoxia signs and treatment

A

Signs
- colour of skin

Treatment
- Ventilation with suppl. O2

60
Q

Reversible causes of cardiac arrest: Hypovolaemia signs and treatment

A

Signs:
- Pale skin
- History
- DRE
- US findings (collapsed IVC)

Treatment:
- Volume therapy +/- transfusion (Hb <7 is transfusion indication)

61
Q

Reversible causes of cardiac arrest: Hypo- / hyperkalaemia signs and treatment

A

Signs:
- Identified by ABG/lab

Correction:
- hypokalemia - Mg++ and K+
- hyperkalenia - Calcium-gluconate IV

62
Q

Reversible causes of cardiac arrest: Hypo/hyperthermia signs and treatment

A

Signs
- Core temperature

Treatment
- Active warming / cooling
- Treat underlying issue

63
Q

Reversible causes of cardiac arrest: Thrombosis signs and treatment

A

Signs:
- Chest pain
- Difference in lower limbs
- US findings

Treatment
- ACS: PCI
- PE: Fibrinolysis

64
Q

Reversible causes of cardiac arrest: Tension ptx signs and treatment

A

Signs:
- dyspnea
- assymetric chest
- US pleural sliding sign

Treatment:
- Decompression

65
Q

Reversible causes of cardiac arrest: Tamponade signs and treatment

A

Signs:
- US
-> RV collapse in diastole
-> RA collapse in systole
-> Pericardial effusion

Treatment:
- Pericardiac puncture

66
Q

Reversible causes of cardiac arrest: Toxins signs and treatment

A

Signs:
- history, medical documents, enviroment

Treatment:
- Elimination
- Antidotes

67
Q

ABCDE: A

A
  • Patent airway
  • Airway in-danger?
  • Secretions
  • Foreign object
  • Snoring
  • Obstructed airway
    (paradoxical breathing)
68
Q

ABCDE: B

A
  • Rate (normal 12-20)
  • Work of breathing (accessory muscles)?
  • Symmetry of chest movement and sounds?
  • SaO2 % (normal > 94%)
69
Q

ABCDE: C (5p’s)

A
  • Pulse
  • P-QRS-T (rhythm)
  • Electrical activity present on ECG?
  • Frequency
  • Narrow/wide QRS?
  • Regular/irregular rhythm?
  • P waves present?
  • P waves followed by QRS complexes?
  • Pressure
  • Perfusion (peripheral circulation) - CRT
  • Preload
  • JVP
  • Lung crackles
70
Q

ABCDE: D

A
  • Mental status
  • AVPU scale (alert, voice, pain,
    unresponsive)
  • Glasgow coma scale (GCS) < 9
  • Symmetry
  • Pain localizing
  • Pupils
    -lateralizing signs
  • Blood sugar
71
Q

ABCDE: E

A

ƒ ‘RUSH’ exam - Rapid US in shock

ƒ Bleeding source?

ƒ Injury?

ƒ Temperature

ƒ ABG
DRE

ƒ Drugs

ƒ Toxicities

ƒ Further anamnesis

72
Q

Shockable and non-shockable rhythms

A

Shockable
- VF, pulseless VT

Non-shockable
- PEA, asystole

73
Q

Shockable rhythms - drug protocol

A

First dose

  • Adrenaline 1mg after 3rd shock
  • Amiodarone 300mg after 3rd shock

Additional doses

  • Adrenaline 1mg every 2nd shock (2-5min)
  • Amiodarone 150 mg after 5th shock
74
Q

Non-shockable rhythm - drug protocol

A

Adrenaline 1mg as soon as IV access

Additional adrenaline 1mg every 2nd cycle (3-5min)

75
Q

PE - US signs

A

Collapsed left ventricle

Grossly enlarged right ventricle

76
Q

US signs - hypovolemia

A

Collapsed left ventricle

Collapsed right ventricle

Collapsed IVC

77
Q

Indications of ICU
and circumstances of admission:

A

• Indication:
1. severe life-threatening illnesses and injuries, which
2. require constant, close monitoring and support from specialist equipment
3. and medications in order to ensure normal bodily functions

• circumstances of admission:
-surgery,
-trauma
-severe illness

78
Q

ICU limitation

A

• ICU beds are a very expensive
• and limited resource:
– specialised monitoring equipment
– a high degree of medical expertise
– constant access to highly trained nurses

• reserved for those patients with
1. reversible medical conditions +
2. who have a reasonable prospect and physiological reserve for substantial recovery

79
Q

Invasive arterial pressure
monitoring
•
Indications:

A

– hemodinamics instability
– vasoactive therapy (both hypo and hypertension)
– Surgery of a high risk patient (perioperative monitoring)

80
Q

Invasive arterial pressure advantages

A

Advantages:
– Continuous pressure measurement
– Accurate
– both the wave and the values can be seen

81
Q

relative Contraindications of Epidural
Anesthesia

A

RELATIVE:
1. Hypovolemia/ shock-state
2. Severe cardiovasular disease
3. Lack of Informed consent

82
Q

absolute Contraindications of Epidural
Anesthesia

A
  1. Haemophilia and/or coagulation disturbances
    – Aquired/iatrogenic
    – Hereditary
    – Consequence of diseases (eg. DIC)
  2. Inflammation/wound on skin
83
Q

IV Anti-HTN drugs?
(3)

A

Labetalol
Metoprolol
Nicradipine
Hydralazin

fenoldopam (D1 agonist)
Nitroprusside (release NO)
diazoxide (K ch opener)

84
Q

Muscle paralysis agents?
(3 examples)

A

Succinylcholine
AtraCURIum
RoCUROnium

85
Q

Inhalation anesthetics?
(4 examples)

A

Halothane (most potent)- hepatotoxic
Isoflurane
Sevoflurane (most common, rapid onset & recovery)
Desflurane (least potent)

nitrous oxide

  1. induction (pediatric)
  2. maintenance
    sedation

lower MAC ; more potent

86
Q

NSAID side effects?
(3)

A

blurred vision
dizziness
nausea
vomiting
gastric ulcer

87
Q

MAP equation

A

MAP = [SBP + (2*DBP)]/3

88
Q

Which organs affected MOF and symptoms?

SOFA

A

Respiration: PaO2
Coagulation: PLT count
Liver: Bilirubin
Cardiovascular: MAP
CNS: Glasgow Coma Score
Renal: Creatinine, Urine output

SOFA > 2 ; organ dysfunction

89
Q

Causes of delirium?

A

Advanced age
Pre-op cognitive disorder
Severe general status
Preop anemia
Preop hypoalbuminemia
BZD: midazolam
Chronic alcohol consumption

90
Q

ASA Scoring?

A

General risk assessment

91
Q

normal Lactate?

A

0.5 to 1.5 mmol/L

92
Q

Causes of cardiogenic shock?

A

Pump function decrease
Valvular disorder
Arrhythmia
Intracardiac shunt

93
Q

placement of intraosseous IV

A

tibia
humerus - 45 angle

94
Q

Metabolic acidosis symptoms

A

increased sympathetic activity
Kussmal respiration
Hyperkalemia
Hyperventilation
Emesis

95
Q

Invasive ventilation

A
  1. ETT
  2. Tracheostomy
  3. oropharyngeal
  4. supraglottic air device
96
Q

O2 carrying capacity of blood

A

100 ml blood contains 15g Hb
which can bind 20.1 ml of O2

1gram Hb: 1.34 ml O2

97
Q

How much oxygen can 1g Hb carry

A

1g Hb : 1.34 ml O2

98
Q

Vessel placement CVL

A

IJV
Subclavian v
femoral vein

ANSTZ (7 decks)

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