Trauma/SICU Flashcards
Burn percent rules
concerning compartment P cutoff?
what is delta P?
30mmhg
diastolic - comp P (<30 is bad)
Decubitus Ulcer staging
Stage I: Superficial injury with intact skin, characterized by nonblanching erythema (in darker-skinned patients, the injury may simply appear darker without blanching), with possible tenderness
Stage II: Partial-thickness injury, with loss of dermis presenting as a shallow ulceration with a red or pink wound bed or intact blister or bullae
Stage III: (see above)
Stage IV: Full-thickness skin loss with exposed muscle, tendon, and bone, which is often accompanied by undermining and tunneling
Most important first step for snake bite
local wound care
Pancreas injury Grading and treatments
I - Drain
II - Drain
III- STaple
Iv - Panc J
V - Whipple
What is an acceptable pH when trying to prevent ARDS in burn patients?
7.2
Venous connection for hemorrhoids in Cirrhosis
Umbilical vein connects with these 2
IMV and SH connects with pudendal and inf hem
L portal and epigastric — cap medusae
How is ascites created from portal htn
increased splanchnic arterial inflow from dilation leading to increased hydrostatic P in lymph
Side effects of the burn medications:
Ag Sulf
Ag Nit
Mafenide acetate
Neutropenia
methemoglobinemia and low electrolytes
Metabolic acidosis
Distance rule of thumb for choice of repair in vessel laceration
2cm without tension — primary anastomosis
otherwise contralateral vein with interpostition
Pt with pain in anatomical snuffbox after fall. Neg XR. Next step and overall tx
CT or repeat radiographs in 2 weels
immobilization
Which pathways go with PTT v PT/INR respectively
Intrinsic
extrinsic
What is SvO2?
What is a normal %?
What is expected in each type of shock?
venous oxygen saturation
75% and up
All decreased except for distributive which decrease
First line afib med in icu
What consideration must be taken and what is the alternatve
BB
amio
What is the new med for alcohol withdrawal syndrome — proven benefit
barbs
less vent days
Go to fungal coverage med for sick perfed gastric ulcers
benefit
micafungin(echinocandin)
mortality
type 1 2 and 3 NSTI bugs
who gets what
1 - multi, T1DM/immun comp/alcohol/renal — fourniers and ludwig
2- GA strep pyogenes —TSS
3 - c perfringings — IV drugs and surgery
tx for mucor
ampho b
hepatorenal syndrome mech
3 part treatment
portal htn leads to splanchnic dilation and overal poor systemic art flow, poor renal perfusion
levo, octreotide, vol expansion
West prospective findings on CT clearance
Who can we not clear
98.5% sensitivity for CT
3 had FN and central cord , presented with motor changes
new thoughts on TPN causing more infection, trials?
what is a overall benefit?
no difference according to CALORIES and NUTRIREA
dec hypoglycemia
New recs for lovenox dosing
overall anti thrombotic ppx for patients
lovenox and SCDs
necrotizing pneumonia is usually due to what bug
associated toxin
staph
panton-valentine leukocidin
recommendation for oxygen support post intubation for moderate risk patients
HFNC
Preferred regional rib block on anticoag?
paravertebral
mech of heparin
if main substrate is deficient in patient
antithrombin binding and enhancement
add ffp
common infection after liver transplant in first 4 weeks
after?
bacterial
viral(cMV)
got to colon prep
high volume poly glycol
NG tube syndrome?
posterior cricoarytenoid ulcer vocal cord paralysis
oral vs j tube determinants for esophagectomy
pref oral but if frail, immun comp, poor conduit then j tube
BIS measures …..
level of concsiousness
5 detriments of hypothermia periop
increased blood loss and transfusion requirements,
cardiac morbidity,
surgical site infection,
increased hospital length of stay.
increases the effects of paralytics during surgery.
Dg of HIT, also has CKD, tx choice
argatroban
3 effects of hyperbarics physio
Safe alternative to epidrual anesth
On Q pump
how long can whole blood be stored
4 weeks
frost bite grading
recs for grade 3 and 4 tx
thrombolytics
conventional vs contingency vs crisis level descriptions for icu capacity
greatest risk with whole blood
taco
in disaster situation, which interventions are deemed too time consuming/costly
whole blood transfusion, intubation
when talking about teg for trauma what specific alternative phrase is there
viscoelastic testing
rattlesnake treatment?
crofab
target CPP
50
cell mediated killing CD
the other
assigned mhc classees?
8
4
8-1
4-2
what ig goes across placenta?
through milk?
G
A
what ig is suppressed by splenectomy
M
4 ‘other’ long term risks following splenectomy
DVT, PE, pneumonia, meningitis
uremias effect on immune system
depresses both
SEs:
steroids
tac
cyclosporine
mycophenolate
sirolimus
wounds and adrenals
nephro, neuro
seizures, arrythmias
pancytopenia, GIB
wounds
supplement for wound healing in steroid users
vit a
mechs:
infliximab
adalimumab
rituximab
TNFI
TNFI
B cell antag
transplant viruses and their treatments
CMV - gang
EBV, post lymphoproliferative dis – red immmun suppression
what is the only muscle recurrent laryngeal does not innervate
cricothyroid
greatest RF for pancreatitis post valve replacemt
prolong pump time
Gram neg bacteremia abx duration
7 days -
fastest cooling technique
arctic sun
new sepsis end goals
ANDROMEDA — cap refill and LA for resus end goals
uop not as hot now
urinary insulin-like growth factor-binding protein (IGFBP-7) and tissue inhibitor of metalloproteinase (TIMP-2).
what are they good for
early aki detection
intitial labs for aki
how are these read
fena
FEna - <1 is prerenal
FEur- < 35% is prerenal
When is the earliest we can start TPN in ICU?
late group benefits?
Thoughts on energy dense formulas
8 days
significantly reduced infectious complications (22.8% vs 26.2%, p = .008), cholestasis, duration of mechanical ventilation, duration of renal replacement therapy, and healthcare costs.
na dawg
COVID trach timing
21 days from dg
onyl thing to do for NOMI
operative?
papaverine
no mortality benefit
straight leg raise method
what is the pathophys behind this
change expected if hypoV
autotransfusion of 500ml
more than 10% change in CO
new ppi recs in icu
famotidine?
enteral feeding?
shock
coag
liver
dialysis
vent
tbi
not good enough
only a small trial so far
SMART trial rec
ALWAYS LR
new c diff test
tcdB gene perirectal swab
When to consider operation for extraperitoneal bladder injury
open book pelvis needing dissection, penetrating, neck of bladder, bony fragments or FBs, persistent hematuria
