acute and critical care medicine

Question 1

what fluids are crystalloids

Answer 1

D5W
NS
LR
plasmalyte

Question 2

what fluids are colloids

Answer 2

albumin
dextran

Question 3

pros of crystalloids

Answer 3

less costly
fewer AE
does not sit in intravascular space

Question 4

when is albumin used

Answer 4

edema not for serum albumin

Question 5

hyponatremia state

Answer 5

<135
symptomatic when <120
3 diff state

Question 6

hypotonic hypovolemic

Answer 6

cause is diuretic and sodium wasting
tx is correct cause and add IV NS

Question 7

hypotonic hypervolemic hyponatremia

Answer 7

caused by fluid overload, cirrhosis, HF etc
tx is diuresis with fluid restriction

Question 8

hypotonic isovolemic hyponatremia

Answer 8

cause - SIADH syndrome of inappropriate antidiuretic hormone

Question 9

what is ODS

Answer 9

when treating hyponatremia aggressively it causes paralysis
should not be more than >12meq opver 24 hours
tx with stopping SIADH drugs , diuresis ore restricting fluids

Question 10

what are AVP

Answer 10

arginine vasopressin receptor antagonist
used for SIADH or hypervolemic hyponatremia

Question 11

tolvaptan

Answer 11

samsca
llimited to 30 days due to hepatoxic

Question 12

hypernatremia

Answer 12

Na> 145 meq
with water defecit and hypertonicity

Question 13

hypovolemic hypernatremia

Answer 13

caused by dehydration
tx with fluids

Question 14

hypervolemic hypernatremia

Answer 14

intake of hypertonic fluids
tx with diuresis

Question 15

isovolemic hypernatremia

Answer 15

caused by diabetes can decrease antidiuretic hormone
tx with desmopressin

Question 16

hypokalemia

Answer 16

K<3.5
manage underlying cause- metabolic alkalosis, diuresis, meds
tx with oral K

Question 17

what dose 1 drop of K below 3.5 mean

Answer 17

body defecit of 100-400 meq

Question 18

how to tx potassium

Answer 18

check phos first if more than 2.5 use oral supplements if less than 2.5 phos then add Kphos

Question 19

serum potassium instruction tx

Answer 19

<3.5 to 3.3 40 meq
3.0-3.2 60meq
2.6-2.9 80 meq
<2.6meq 100meq

Question 20

monitoring of K

Answer 20

if <3.2 recheck immediatley and am check
if more than 3.2 check am

Question 21

IV K recommendations

Answer 21

peripheral line max infusion rate 10meq/hr
max 10meq/100ml
IV push and undiluted can be fatal

Question 22

resistant K level through tx

Answer 22

check mg,
if both hypo tx mg first

Question 23

magnesium

Answer 23

hypo< 1.3
hyper is during renal insufficiency

Question 24

when is IV MG recommended

Answer 24

when MG <1 with symptoms
MGSO4
or without symptoms IV or IM

Question 25

when is MG oral recommende

Answer 25

when MG is between 1-1.5 MGO for 5 days

Question 26

phosphorus

Answer 26

hyper due to CKD Hypo is severe and symptomatic when <1 hypo can be caused by phospahte binding drugs alcohol intake and hyperparathyroidism

Question 27

when is IV phos recommended

Answer 27

<1

Question 28

VTE prophylaxis

Answer 28

for inpatient

Question 29

IVIG

Answer 29

warning for thrombosis HA, N/V/D for Myasthenia gravis, multiple sclerosis, GBS

Question 30

ICU meds that target SNS

Answer 30

vasopressors vasodilators ionotropes

Question 31

what are some vasopressors

Answer 31

dopamine epinephrine norep vasopressin ** all should be through central line

Question 32

MOA of dopamine

Answer 32

low dose- D1 agonist 1-4 medium dose- Beta 1 agonist high dose- alpha 1 agonist 10-20mcg/kg/min can cause vesicant, arrythmia, tachycardia, necrosis,

Question 33

MOA of epinephrine

Answer 33

A1 B1 B2 agonist arrythmia, tachy, hyperglycemia

Question 34

MOA Norep

Answer 34

A1>B1

Question 35

phenylephrine MOA

Answer 35

A1

Question 36

vasopressin

Answer 36

AVP vasopressin receptor agonist

Question 37

how to treat extravastion caused by Alpha agonists

Answer 37

phentolamine

Question 38

what are vasodilators used in ICU

Answer 38

nitroglycerin nitroprusside (nitropress)

Question 39

ionotrpoes in icu

Answer 39

dobutamine B1 PDE3 inhibitor milrinone

Question 40

types of shocks

Answer 40

Hypovolemic distributive cardiofenic obstructive

Question 41

how to tx hypovolemic shock

Answer 41

fluid resuscitation with crystalloids for hypo shock not with hemorrhage vasopressors will not work without effective intravascular volume

Question 42

distributive

Answer 42

when there is low SVR septic anaphylactic and neurologic are ex of distributive

Question 43

septic shock

Answer 43

SOFA >2 alterered mental status SBP<100 RR>22

Question 44

what are some contra indications of nitro

Answer 44

PDe5 inhibitors HA Tachycardia SBP <90

Question 45

high dose nitro is for

Answer 45

arterial vasodilation

Question 46

target MAP for treating shock

Answer 46

>65 MAP= (2XDBP)+ SBP /3

Question 47

most common causes of ICU infections

Answer 47

Mechanical ventilation- psudomonas foley catheter

Question 48

how to maintain MAP

Answer 48

vasoconstrictors and crystalloid fluids

Question 49

cardiogeneic shock

Answer 49

HF with worsening symptoms

Question 50

how to tx

Answer 50

avoid NSAIDS avoid BB if Hypotension

Question 51

cardiogenic shock with volume overload

Answer 51

IV diuretics vasodilators

Question 52

cardiogenic shock with hypoperfusion

Answer 52

inotropes vasopressors

Question 53

cardiogenic shock with volume overload and hypoperfusion

Answer 53

combination of IV diuretics vasodilators inotropes vasopressors

Question 54

tx hypoperfusion if Bp is adequate

Answer 54

ionotrope with vasodilator if not add vaso constrictors

Question 55

what are some non benzo sedation

Answer 55

prpofol dexmedetomidine (precedex) preferred

Question 56

RASS scale

Answer 56

richmond agitation and sedation scale

Question 57

stress ulcers

Answer 57

H2raas and PPIs

Question 58

when is a risk for stress ulcer

Answer 58

mechanical ventilation >48 hours coagulopathy sepsis TIA major burns AKI high dose steroids

Question 59

anesthtics

Answer 59

local- lidocaine inhaled - desflurane secoflurane inj- bupivacaine ropivacaine

Question 60

neuromuscular blocking agents

Answer 60

causes paralysis succinylcholine- depolarizing cistra"curium" - non depolarizing

Question 61

hat is a depolizing NMBA good for

Answer 61

short acting `