Anaesthesiology/Intensive Treatment Prac. Exam Flashcards
(76 cards)
1
Q
Name 3 antibiotics for pseudomonas coverage (just the classes)
A
- Extended spectrum penicillin with B-lactamase inhibitors (Piperacilin-Tazobactam = antipseudo penicillin)
- Cephalosporins
- Fluoroquinolones
Additional from amboss:
- Carbapenems
- Aminoglycosides
- Monobactams
- Polymyxins
2
Q
What are 5 indications for dialysis?
A
AEIOU:
- Acidosis(certain ph or refractory to therapy)
- Electrolytes(K+ over 7)
- Intoxication,
- Overloaded with fluid,
- Uremia/uremic symptoms
3
Q
Child CPR/ALS difference from adults?
A
15:2 ratio.
From Amboss: · Children older than 1 year o 5 initial rescue breaths → CPR o Compression rate: 100-120/min o Compression-to-ventilation ratio: - § Medical professionals: 15:2 - § Lay rescuers: 30:2 o Further management should follow the guidelines for adults. · Defibrillation: monophasic and biphasic waveforms: 2–4 J/kg of body weight
4
Q
Symptomatic treatment of bradycardia, top 3 pharmacological agents.
A
- Atropine (he asked dose, 500mcg IV each time for max 3mg),
- isoprenaline,
- adrenaline,
- glycopyrrolate,
- dopamin.
5
Q
Ultrasound during CPR, you can investigate:
A
1 H, 3 Ts.
H
- Hypovolemia (collapsing IVC)
T
- Tamponade (Collapsed RV + fluid filled pericardium),
- PE (Enlarged RV and RA),
- PTX (Lack of lung sliding and B-lines).
6
Q
How many joules for infants/children with the defib?
A
4 J/KG
7
Q
Dose of Epinephrine and how do you give a patient in ICU?
A
Infusion, he was happy with 0.01-0.03 mcg/KG/min
8
Q
5 uses of end tidal CO2 during CPR? (capnography)
A
PQRST: Placement of ETT (endotracheal tube?),
Quality of compressions,
ROSC also know the values whats normal, what’s bad, and what is terminate-CPR bad.
Situation
Termination
9
Q
etCO2 ROSC values
A
> 24
- stop CC, look for ROSC
<24
- CC is effective
<20
- improve CC quality
=<10
- Poor prognosis
10
Q
3 indications for systemic thrombolysis?
A
I said PE, Ischemic stroke and early MI. He said MI is very rare and he wasn’t 100% happy
11
Q
Top nosocomial bacterias?
A
Pseudomonas, MRSA, Klebsiella, Acinetobacter
12
Q
3 symptoms of hypoglycemia:
A
CNS(agitation, coordination, sleepiness)
pale,
sweating,
tachycardia
13
Q
Basic difference between CRRT and IRRT? What do you use when?
A
CRRT= Continuous Renal Replacement Therapy, done over 24 hours, and is a slow type of
dialysis
IRRT= Intermittent Renal Replacement Therapy: performed for less than 24 hours in each 24
hour period, two to seven times per week
CRRT has better haemodynamic stability (BP control) and improved survival and greater
likelihood of renal recovery.
14
Q
Name 5 opioids commonly used?
A
Morphine, fentanyl, sufentanyl, Remifentanil, tramadol, codeine
15
Q
Name 3 non invasive airway measures?
A
Head chin tilt, eschmark, cpap bipap, oxygen, bag mask stuff.
16
Q
4 symptoms of shock:
A
MOF, Urine output<0,5ml/kg, loss of consciousness, confused, GI: absent bowel sounds
(adding)
Paleness
Cold-sweat
Cold skin (warm skin if distributive shock like sepsis/anaphylactic)
17
Q
Lethal triad:
A
Coagulopathy, Hypothermia, metabolic acidosis
18
Q
4 iv anesthetics
A
- Thiopental (= barbiturate 3-6mg/kg)
- Midazolam (= benzodiazepines 0.01-0.1 mg/kg)
- Propofol (2-4mg/kg) most popular
- Ketamine (1-5mg/kg)
19
Q
3 inotropes:
A
- Norepinephrine
- Epinephrine
- Dobutamine
- Dopamine
20
Q
Side affects of local anesthetics:
A
- Bradycardia and ventricular arrhythmias
- Hematoma → nerve compression→ neurological symptoms
- Infections
- Allergic reactions
- Spinal/epidural: Headache, bradycardia, hypotension…
21
Q
How do you diagnose airway at risk
A
Listening for snoring, gurgling, choking + paradoxical movement
22
Q
Criteria for empty stomach (how long do you need to fast):
A
Clear fluids (water, tea) = 2h Breast milk = 4h Nutritional drinks –cow milk – solid food = 6h
23
Q
First line treatment of tpx:
A
Provide respiratory support and treat dyspnea + immediate tube thoracostomy
24
Q
Caloric value of carbohydrates lipids protein and alcohol
A
- Carbohydrate (60-80% of nutrition): Glucose = 4,2Kcal/g ; Max glucose dose of
ICU patients 5mg/kg/min - Lipid (20-40% of nutrition): 9,1Kcal/g; lipid oxidation is limited, max dose = 1-1,5g/kg/day
- Protein: daily requirement in critical care =1,5-2 g/kg/day
- Alcohol: I guess 0 because the patient is in critical care ???
25
Formula of osmolality:
= 2[Na+] +[Glucose]/18 +[BUN]/2.8
In case: Osmolarity = 2Na + Glucose + Urea (mmol/L)
26
Shock definition:
Acute hemodynamic disorder (micro and macrocirculatory) independent of the cause, which
leads to insufficient oxygen supply and tissue hypoxia.
27
3 Application of ETCO2:
noninvasive technique which measures the partial pressure or maximal concentration of carbon
dioxide (CO2) at the end of an exhaled breath (N: 35-45 mmHg). Can be used to detect
metabolic acidosis (but ABG is the gold standard)
28
3 SUBLINGUAL antihypertensive drugs and their dose –
nitrates, ACEI, niflodipin.
Captopril = 25mg
Nifedipine = 10mg
Prozasin = 2mg
29
First choice of bradycardia treatment
Atropin
30
How to calculate PULMONARY MAP
= 1/3SBP + 2/3DBP
31
Atmospheric pressure in mmHg and mmH2O
760mmHg or 10332,276 mmH2O
32
5 reasons AMI can cause cardiogenic shock
- Wall rupture (late phase)
- Arrhythmia
- Valvular dysfunction (e.g papillary muscle necrosis)
- Decreased contractility
- Wall rupture → tamponade
33
3 complications with Central venous catheter
Infection
Rupture of Artery
pneumothorax
34
4H & 4T
H:Hypoxia
H: Hypovolemia
H: Hypo/HyperKalemia
H: Hypo/hyperthermia
T: toxins
T:tamponade
T: Tension PTX
T: Thrombosis
35
Gynecological emergencies in ICU
Placental abruption, miscarriage, ectopic pregnancy, Acute PID, Pelvic endometriosis…
36
Difference between dehydration and hypovolemia
Hypovolemia is a condition where the extracellular fluid volume is reduced and it results in
decreased tissue perfusion. It can be produced by either salt and water loss.
Dehydration: Is when there is only water loss.
37
Respiratory failure classes
Type I - hypoxemic failure
Type II - hypercapnic failure
Type III - post-operative failure
Type IV - CV-associated failure
38
Type 1 respiratory failure values
decreased arterial oxygen = PaO2 < 60 mmHg
(SaO2 < 90%, PaCO2 decreased/normal, pH increased/normal).
39
Type 2 respiratory failure values
increased arterial carbon dioxide = PaCO2 > 50 mmHg or pH < 7.3 (respiratory acidosis).
40
Anaphylactic shock symptoms (give the answer in ABCDE order)
```
A: Wheezing (bronchoconstriction)
B: dyspnea
C: Hypotension, Skin: hives, itching, urticaria, Angioedema
D: dizziness, fainting
E: nausea, vomiting
```
41
Define septic shock
Is a type of distributive shock caused by an excessive inflammatory response to disseminated
infection, which leads to extravasation from the vascular space and loss of intravascular
volume.
42
3 indications of central vein
- Fluids,
- Dialysis
- Longer hospital stay
- ICU
43
What is 60-40-20 rule
Total body water = 60% of body weight
Intracellular fluid = 40% of body weight
Extracellular fluid= 20% of body weight
44
Antidotes for opiates, benzodiazepine and non depolarizing muscle relaxant
- Opiates= Naloxone
- BZ= Flumazenile
- Non depolarizing muscle= Neostigmine (cholinestherase ihibitors)
45
3 ways to measure cardiac output
- Doppler ultrasound
- Pulse pressure methods
- Impedance cardiography
- MRI
- Calculate = SV x HR
46
Puncture in ribs
- 4-5 intercostal space midaxillary line, or
| - in the 2 intercostal space for needle decompression (faster)
47
Parameters in mechanical ventilation
Mode (Assisted control),
Intermediate mandatory ventilation or pressure support which is CPAP and BiPAP,
FiO2,
Tidal volume and respiratory rate which will change the alveolar ventilation and positive end expiratory pressure which is the PEEP
48
Horowitz index
ratio of partial pressure of oxygen in blood (PaO2), in millimeters of mercury, and the fraction of
oxygen in the inhaled air (FIO2) — the PaO2/FiO2 ratio.
→ used to assess the lung function in patients, especially those under ventilators.
49
Treatment protocol for tachycardia
- Beta Blockers,
- vagal maneuvers,
- cardioversion electrical or chemical
- ICD,
- PM,
- ablation
50
Hyperkalemia : ECG
- Peaked T waves on prechordial leads
- Shortened QT interval
- ST-segment depression
51
Treatment for hyperkalemia?
Mention 5:
- Insulin-glucose
- Ca-gluconate I.V,
- Haemodialysis
- B-agonist (activates Na/K pump moving K into cells)
- NaHCO3- (if metabolic acidosis)
52
Indications for HCO3-:
- CPR when severe acidosis pH<7,1
- strong suspicion of metabolic acidosis,
- Correct hyperkalaemia (K+ + HCO3+), pH < 7,1
53
Correction of symptomatic bradycardia:
Atropine 0,5mg —> 3mg (0,5 every bolus)
54
Layers for spinal anesthesia
Injection site:
Injection usually performed below L2 to avoid damage to the spinal cord
Needle inserted into subarachnoid space between the arachnoid and pia mater
```
Layers the needle goes through:
Skin
Subcutaneous fat
Supraspinal ligament
Interspinal ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
Subarachnoid space
```
55
Epidural anesthesia layers
Can be used for acute pancreatitis → Increased blood flow to the pancreas for healing.
No parasympathetic fibers in epidural anesthesis
Injection site:
May be performed at any vertebral level (cervical, thoracic and lumbar spine)
Needle inserted into the epidural space between the ligamentum flavum and dura mater
56
HCO3- dosage for DKA
50mmol
57
3 symptoms of upper GI bleeding:
- Hematemesis
- Melena (digested blood)
- Drop of BP, lightheadedness
58
EtCO2 normal value?
35-45
59
Reversible causes of cardiac arrest: Hypoxia signs and treatment
Signs
- colour of skin
Treatment
- Ventilation with suppl. O2
60
Reversible causes of cardiac arrest: Hypovolaemia signs and treatment
Signs:
- Pale skin
- History
- DRE
- US findings (collapsed IVC)
Treatment:
- Volume therapy +/- transfusion (Hb <7 is transfusion indication)
61
Reversible causes of cardiac arrest: Hypo- / hyperkalaemia signs and treatment
Signs:
- Identified by ABG/lab
Correction:
- hypokalemia - Mg++ and K+
- hyperkalenia - Calcium-gluconate IV
62
Reversible causes of cardiac arrest: Hypo/hyperthermia signs and treatment
Signs
- Core temperature
Treatment
- Active warming / cooling
- Treat underlying issue
63
Reversible causes of cardiac arrest: Thrombosis signs and treatment
Signs:
- Chest pain
- Difference in lower limbs
- US findings
Treatment
- ACS: PCI
- PE: Fibrinolysis
64
Reversible causes of cardiac arrest: Tension ptx signs and treatment
Signs:
- dyspnea
- assymetric chest
- US pleural sliding sign
Treatment:
- Decompression
65
Reversible causes of cardiac arrest: Tamponade signs and treatment
Signs:
- US
- > RV collapse in diastole
- > RA collapse in systole
- > Pericardial effusion
Treatment:
- Pericardiac puncture
66
Reversible causes of cardiac arrest: Toxins signs and treatment
Signs:
- history, medical documents, enviroment
Treatment:
- Elimination
- Antidotes
67
ABCDE: A
- Patent airway
- Airway in-danger?
- Secretions
- Foreign object
- Snoring
- Obstructed airway
(paradoxical breathing)
68
ABCDE: B
- Rate (normal 12-20)
- Work of breathing (accessory muscles)?
- Symmetry of chest movement and sounds?
- SaO2 % (normal > 94%)
69
ABCDE: C (5p's)
* Pulse
* P-QRS-T (rhythm)
- Electrical activity present on ECG?
- Frequency
- Narrow/wide QRS?
- Regular/irregular rhythm?
- P waves present?
- P waves followed by QRS complexes?
* Pressure
* Perfusion (peripheral circulation) - CRT
* Preload
- JVP
- Lung crackles
70
ABCDE: D
* Mental status
- AVPU scale (alert, voice, pain,
unresponsive)
- Glasgow coma scale (GCS) < 9
* Symmetry
- Pain localizing
- Pupils
* Blood sugar
71
ABCDE: E
'RUSH' exam - Rapid US in shock
Bleeding source?
Injury?
Temperature
ABG
Drugs
Toxicities
Further anamnesis
72
Shockable and non-shockable rhythms
Shockable
- VF, pulseless VT
Non-shockable
- PEA, asystole
73
Shockable rhythms - drug protocol
First dose
- Adrenaline 1mg after 3rd shock
- Amiodarone 300mg after 3rd shock
Additional doses
- Adrenaline 1mg every 2nd shock (2-5min)
- Amiodarone 150 mg after 5th shock
74
Non-shockable rhythm - drug protocol
Adrenaline 1mg as soon as IV access
Additional adrenaline 1mg every 2nd cycle (3-5min)
75
PE - US signs
Collapsed left ventricle
Grossly enlarged right ventricle
76
US signs - hypovolemia
Collapsed left ventricle
Collapsed right ventricle
Collapsed IVC
