Trauma/Critical Care/Infection Flashcards
According to the results of prospective, randomized, controlled trials, which of the following best describes the effect of therapeutic hypothermia in patients with severe traumatic brain injury?
Despite a large number of studies, there remains no high-quality evidence that hypothermia is beneficial in the treatment of patients with severe traumatic brain injury.
While hypothermia may be associated with a decreased release of excitatory neurotransmitters (which, along with reducing cerebral metabolic rate, may explain its mechanism of action), there is insufficient evidence to show that therapeutic hypothermia improves mortality or long-term functional outcomes.
The main risks associated with therapeutic hypothermia include increased risk of infectious complications, coagulation abnormalities, myocardial ischemia, and atrial fibrillation.
What is the preferred reversal agent for tPA?
The reversal agent of choice for tPA associated hemorrhages is cryoprecipitate which contains fibrinogen, which is depleted by tPA. If Cryoprecipitate is unavailable, fresh frozen plasma and tranexamic acid can be considered
What is the most frequent complication associated with Single fraction or hypofractionated stereotactic radiation therapy to spinal metastases/
Vertebral body fracture
The pathology seen in the silver-stained histologic specimen from the caudate nucleus shown was most likely caused by which of the following processes?
Aspergillus fumigatus is a fungus with septate hyphae that branch at a V-shaped (i.e. acute) 45 degree angle in a dichotomous fashion. Aspergillosis most commonly occurs in the settings of chronic corticosteroid use or other immunosuppressed states. Hemorrhagic abscesses are typical due to invasion of blood vessel walls, and secondary stroke leading to focal deficits.
What are the ECG changes observed in patients with severe hyperkalemia?
peaked T waves, shortened QT interval, and ST-segment depression
Which of the following structures is most responsible for control of extensor posturing?
The medullary reticulospinal tract is under cortical control and maintains balance between extensor and flexor tone.
The vestibulospinal and pontine reticular spinal tracts maintain extensor tone whereas the rubrospinal tract maintains flexor tone.
Injury to the midbrain below the level of the red nucleus injures both the rubrospinal tract which facilitates flexor tone and damages the medullary reticulospinal tract which inhibits the vestibulospinal and pontine reticular spinal tracts.
This leaves extensor tone unopposed.
Propofol infusion syndrome is most often associated with which conditions?
Propofol infusion syndrome manifests as acute refractory bradycardia leading to asystole, in the setting of one or more of the following: metabolic acidosis, rhabdomyolysis, hyperlipidemia, and enlarged of fatty liver.
type of inclusion bodies in viral infections:
intranuclear: HSV1 (cowdry type A), CMV, SSPE
intracytoplasmic: rabies, CMV
Brain herniation changes:
Kernohan’s notch (the contralateral cerebral peduncle is compressed against the incisura with ipsilateral weakness producing a false localizing sign), posterior cerebral artery (PCA) stroke, Duret hemorrhages of the midbrain and pons (by arteriole stretching), cranial nerve (CN) III palsy, and hydrocephalus (by compression of the cerebral aqueduct).
Which anesthetics decrease cerebral blood flow?
Thiopental, etomidate, and fentanyl
Which anesthetics increase cerebral blood flow?
Nitrous oxide, isoflurane, ketamine, enflurane, and halothane (Nike Halo)
What causes INO? which location has preserved convergence?
lesion to MLF
posterior INO is caused by pontine lesion and has preserved convergence
anterior INO is caused by a midbrain lesion and has decreased convergence
Which nuclei is associated with extensor posturing?
lateral vestibular nuclei (Dieters)
inhibited by purkinje cells of the anterior lobe of cerebellum
extensor posturing also occurs because of loss of input from the rubrospinal tract
What are increased in serum with lasix? what decreases in urine?
increases serum GUL: glucose, uric acid, and lipids
decreases K, Ca, Mg, Cl, platelets, and granulocytes
can lead to hypochloremic alkalosis.
What effect does PEEP have on the lungs?
PEEP increases the dead space by collapsing pulmonary capillaries and to a lesser extent by decreasing cardiac output. It can cause barotrauma. Its main benefit is recruiting collapsed alveoli, thus decreasing the shunt effect
