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Therapeutics III > ARDs, CNS, Trauma - Block 4 > Flashcards

ARDs, CNS, Trauma - Block 4 Flashcards

1
Q

What is ARDs

A

Inflammatory pulmonary edema -> severe hypoxemia

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1
Q

What is PEEP?

A

Posititve end expiratory pressure: amount of presure left in the alvoli after expiration

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2
Q

What is the pathology of ARDs??

A

Imbalance between ventilation x perfusion -> MODs -> deoxygenated blood

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3
Q

What are the primary ARDs?

A
  1. Aspiration
  2. Pulmonary contusion
  3. Pneumonia
  4. Drowning
  5. Toxic inhalation
  6. Burns
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4
Q

What are causes of secondary ARDs?

A
  1. Sepsis
  2. Hypovolemic shock
  3. Acute pancreatitis
  4. Trauma
  5. TRALI
  6. DIC
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5
Q

What is a strong recommendation to treat ARDs?

A
  1. Mechanical ventilation
  2. Prone positioning for more than 12 h/d in severe ARDs
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6
Q

What are conditional tx for ARDs?

A
  1. CS
  2. NMB in early severe
  3. Higher PEEP without lung recruitment maneuvers for mod-severe
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7
Q

What are treatments that should not be used in ARDs?

A
  1. High frequency oscillation ventilation
  2. Prolonged lung recruitment maneuvers in mod-severe
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8
Q

When are CS used in ARDs?

A

Septic shock or pneumonia
* Increase hyperglycemia and GI bleeding

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9
Q

What are the benefits of using NMBAs for ARDs?

A
  1. Decreased mortality and ventilation
  2. Reduction of ventilation injuries
  3. Reduced O2 consumption
  4. Reduced inflammation
  5. Reduced alveolar fluid
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10
Q

What are the concerns of using NMBAs?

A
  1. Deep sedation
  2. ICU-acquired weakness
  3. Unclear long term outcomes
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11
Q

What is the difference between primary and secondary traumatic brain injury?

A

Primary: external transfer of kinetic energy to various structural components of the brain -> contact, acceleration/develeration

Secondary: imbalnaces in cerebral o2 delivery (CDO2) and cerebral metabolic rate of o2 (CMRO2) consumption -> ischemia -> cell death

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12
Q

What are sx of TBI?

A
  1. Posttraumatic amnesia
  2. DZ
  3. Severe HA
  4. N/V
  5. Limb weakness
  6. Parestheisa
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13
Q

What are the signs of TBI?

A
  1. CSF otorrhea or rhinorrhea
  2. SZ
  3. Unreactive pupils
  4. Rapid mental deterioration
  5. Alterations in vital signs
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14
Q

How do we assess TBI mental status?

A

Gasgow Coma Scale

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15
Q

What are we assessing in GCS?

A

Level of consciousness:
1. Eye opening
2. Motor response
3. Verbal response

Scoring:
3 to 8 = severe brain injury
9 to 12 = moderate brain injury
13 to 15 = mild or minor brain injury

16
Q

What are diagnostic test we use for TBI?

A

Labs:
1. ABG (pH, pCO2, HCO3)
2. Alcohol levels
3. Urine tox
4. CMP (LFT, BMP)

CT Scan:
1. Mass lesion
2. Midline shift
3. Compressed ventricles

17
Q

Tx goals for TBI?

A

Short term:
1. Perfusion/airway -> balace cerebral O2
2. Prevention of complications
3. Prevention of secondary injuries

Long term:
1. Reduction of morbidity and mortality
2. Functional status

18
Q

What are recommendations for TBI?

A
  1. Decompressive craniectomy
  2. Hyperosmolar tx (hypertonic saline 3%, 23.4%; mannitol)
  3. CSF drainage
  4. Nutrition
  5. DVT prophylaxis
  6. Sz prophylaxis
19
Q

What is the intitial tx for TBI?

A
20
Q

How is ICP managed?

A
21
Q

What do you give if patient is refractory to mannitol or hypertonic saline?

A

Phenobarbitol

22
Q

What are the components of CAB?

A

COmpression, airway, rescue breaths

23
Q

Directions for proper compressions?

A
  1. 100-120 compressions/minute
  2. Depth of 2-2.4 inches
  3. Allow chest recoil after each compression
24
Q

Factors that can effect airway?

A
  1. Foreign body airway obstrction
  2. Advanced airway
  3. Drug induced respiratry depression
25
Q

What are rescue breaths?

A
  1. Assist in maintaining oxygenation and eliminating CO2
  2. 30 compressions to 2 breaths or 1 breath every 6 seconds (10 breaths/minute)
26
Q

What are the characterisitcs of normal heart rate and rhythm?

A
  1. Normal PQRST deflections and intervals
  2. Rate: 60-100 at rest
27
Q

What constitutes bradycardia?

A

HR: <50 bpm

28
Q

What are infusions that induce bradycardia?

A

Non-DHP, beta blockers

29
Q

What drugs that can reverse bradycarda?

A

CCB and beta blocker: glucogon
1. Atrpine
2. Dopamine
3. Epinehrine

30
Q

How do we treat tachycardia in ALS?

A
  1. Adenosine
  2. Cardioversion

ANtiarrhytmic:
1. Pocainamide
2. Amiodarone
3. Sotalol

31
Q

How do we treat cardiac arrest?

A
32
Q

How is adenosine given?

A

Left arm:
1. Rapid push
2. Rapid flush
3. Arm elevation

  • Due to short half-life
33
Q

What is V fib?

A

Disorganized

34
Q

WHat is pVT features?

A

Pulseless
Sawtooth

35
Q

What is asystole?

A

Therapeutics III (40 decks)

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