Critical Care

Question 1

ARDS treatment

Answer 1

Lung protective ventilation (low tidal vol)
Permissive hypercapnia ok to achieve low TV if no intracranial process
Prone position and neuromuscular blockade improve outcomes.
VV ecmo considered
Tolerate paO2 as low as 55, paco2 as high as 65, ph as low as 7.15
Plateua pressures less than 30

Question 2

Postoperative mediastinis cause

Answer 2

MSSA (45%)
MRSA (16%)
Gram meh bacilli (17%)
Coat negative staph (13%)
Strep (5%)

Start w broad spectrum covering ‘MRSA then peel back

Question 3

Correcting increased PVR post op

Answer 3

If hypoxic, hypercarbic or acidotic, correct these first.
Nitric good option if above all normal
Dobutamine increases RV conteactility and pulm vasoldilates but also peripherally dilates so avoid if hypotension

Question 4

Dobutamine

Answer 4

Increases RV contractility
Drops PVR
Drops SVR (so avoid if hypotension)

Question 5

ARDS severity

Answer 5

P/F ratio
<100 severe
100-200 moderate
>300 normal

Question 6

Reverse INR in emergent setting

Answer 6

PCC with vitamin K preferred
FFP if PCC not available