ICU

Question 1

Three step pattern to treat shock?

Answer 1

1 IV fluids (bonus to CVP of 10)
2 inotropes/mechanical
3 vasopressors

Question 2

What are the Indications for mechanical tx vs inotropes in shock?

Answer 2

Positive JVD, S3, cool extremities, pulm crackles

Question 3

What CVP should one obtain before staring pressors?

Answer 3

12

Question 4

Complications of pressors via peripheral IV?

Answer 4

Peripheral limb ischemia, ONLY ok as temp bridge to CV cath

Question 5

Effects of norepi?

Answer 5

+++ A1, ++ B1, but significant arrhythmias

Question 6

Phenylepi effects?

Answer 6

+++ A1, can use in place of norepi if arrhythmias occur

Question 7

Epi effects?

Answer 7

+++ B1 then +++ A1, ++ B2 (dec svr with lower dose, inc svr with higher dose)

Question 8

What makes effects of dopamine unique?

Answer 8

Highly dose dependent

Question 9

Low dose dopa effects?

Answer 9

++ D1 = renal bed vasodilation

Question 10

Medium dose dopamine effects?

Answer 10

5-10: + A1, ++ B1, ++ D1

Question 11

High dose dopa effects?

Answer 11

10-20: ++ A1, ++ B1, ++ D1

Question 12

Dobutamine effects?

Answer 12

+++ B1, ++ B2 - good for HTN

Question 13

Which pressors are initially used to treat septic shock?

Answer 13

Norepi, then phenylepi if arrhythmias develop

Question 14

Pressors to treat cardiogenic shock in patients with low or high BP?

Answer 14

Low - dopamine (B1 and A1)

High - dobutamine (B1 and B2)

Question 15

What two characteristics define shock?

Answer 15

Hypotension (

Question 16

What are standard TV’s determined by?

Answer 16

normal - 8 cc/kg ideal BW
pulm path - 6 cc/kg ideal BW
(vol req don’t change with added adipose)

Question 17

What is vent RR usually set at?

Answer 17

12-18 per min

Question 18

What is FiO2?

Answer 18

fractional inspired oxygen = how much O2 is delivered with each breath

Question 19

What determines FiO2 on nasal cannula?

Answer 19

each L of nasal cannula can inc FiO2 by an add’l 3 percent (0.03) up until about 6 liters (effect plateaus)

this results in theoretical max of 40%, 0.4 FiO2 via nasal cannula

Facemask can have 100% FiO2 (good seal; normally ~ 70%)

Question 20

What is FiO2 of room air?

Answer 20

21%, 0.21

Question 21

What is the ideal max of FiO2 to prevent ox tox?

Question 22

How is PEEP normally set?

Answer 22

measured in cm H2O and kept as low as possible to prevent barotrauma (5-15 cm H2O)

Question 23

What is pressure support? What is it normally set at?

Answer 23

assistance during inspiration to negate increased airway resistance of ET tube (10 cm H2O)

Question 24

Vent settings in a normal person?

Answer 24

TV - 8 cc/kg IBW
RR 12-18
FiO2 - 100% to 40%
PEEP 5 to 15
PS 10

Question 25

What are standard TV’s determined by?

Answer 25

normal - 8 cc/kg ideal BW
pulm path - 6 cc/kg ideal BW
(vol req don’t change with added adipose)

Question 26

What is vent RR usually set at?

Answer 26

12-18 per min

Question 27

What is FiO2?

Answer 27

fractional inspired oxygen = how much O2 is delivered with each breath

Question 28

What determines FiO2 on nasal cannula?

Answer 28

each L of nasal cannula can inc FiO2 by an add’l 3 percent (0.03) up until about 6 liters (effect plateaus)

this results in theoretical max of 40%, 0.4 FiO2 via nasal cannula

Facemask can have 100% FiO2 (good seal; normally ~ 70%)

Question 29

What is FiO2 of room air?

Answer 29

21%, 0.21

Question 30

What is the ideal max of FiO2 to prevent ox tox?

Question 31

How is PEEP normally set?

Answer 31

measured in cm H2O and kept as low as possible to prevent barotrauma (5-15 cm H2O)

Question 32

What is pressure support? What is it normally set at?

Answer 32

assistance during inspiration to negate increased airway resistance of ET tube (10 cm H2O)

Question 33

Vent settings in a normal person?

Answer 33

TV - 8 cc/kg IBW
RR 12-18
FiO2 - 100% to 40%

Question 34

Normal pO2 and pCO2?

Answer 34

100-80, 40

Question 35

What is MV? How does it affect pCO2?

Answer 35

minute vent = TV x RR; inc MV and gas exchange, dec pCO2; dec MV and gas exchange, inc pCO2

Question 36

What vent parameters pertain to oxygenation?

Answer 36

FiO2 - increases ox gradient

PEEP - helps ‘recruit’ more alveoli and improve gas exchange

Question 37

SO - ventilation is TV and RR

Answer 37

oxygenation is FiO2 and PEEP

Question 38

What are the two modes of ventilation?

Answer 38

volume OR pressure (compliance = change in volume/change in pressure)

Question 39

What is vent control/assist control mode and when is it used?

Answer 39

vent delivers set TV and RR (no PS); in patients that just crashed and got intubated/unstable

Question 40

What is a problem with vent control?

Answer 40

any spontaneous breathing triggers delivery of full TV so pt can overbreathe the preset RR –> hyperventilation

Question 41

What is SIMV mode? When is it used?

Answer 41

synchronized intermittent mandatory ventilation (with PS); once a patient is ‘stable’

Question 42

What is different about SIMV? Downfall?

Answer 42

if a patient overbreathes the RR, the vent does not assist in the extra breaths (besides the PS); NO EVIDENCE that it works better than any other mode in improving pt by ‘exercising lungs’

Question 43

What is PRVC mode?

Answer 43

Pressure regulated volume control - attempts to deliver set TV as lowest possible pressure (set a MAX pressure threshold an vent adjusts breath-by-breath to minimize airway pressures)

Question 44

What is PS mode? When is it used?

Answer 44

Pressure support - VERY DIFFERENT; used when pt has improved and extubation is being considered (you provide assistance to overcome resistance of tube + O2)

Question 45

PS settings and requirements?

Answer 45

You set FiO2, PEEP, and PS (10); similar to BiPAP; mode req that pt is AWAKE and spontaneously breathing

Question 46

What services prefer PRVC vs. SIMV?

Answer 46

internal med vs. surgery