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IPT: CC > Block 2 > Flashcards

Block 2 Flashcards

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1
Q

BP = what two parameters?

A

CO x SVR

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2
Q

SVR is determined by what?

A

Radius of resistance vessels

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3
Q

Cardiac = what two parameters?

A

SV x HR

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4
Q

CO
SVR
SV
HR

Which one is directly influenced by preload, contractility, and afterload?

A

SV

SVR is proportional to Afterload

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5
Q

Increase of (preload/contractility/afterload) increases SV

A

All except afterload

Increased afterload decreases SV

Increased afterload will INCREASE SVR though

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6
Q

Cardiac output adjusted for body weight is known as..?

A

Cardiac Index

= CO/BSA

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7
Q

What is preload? Afterload?

A

Preload = pressure/volume in ventricles as they fill up

Afterload = the pressure the left ventricles have to overcome for blood to flow, resistance to blood flow

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8
Q

How do fluids and vasopressors affect preload/afterload?

A

Fluids will increase preload (diuretics will decrease it)

Anything that causes vasoconstriction (like vasopressors) will increase afterload (so vasodilation will decrease it)

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9
Q

Increased preload = Increased end diastolic volume = Increased contractility except in what patients?

A

Heart Failure, stroke volume hardly changes

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10
Q

What are the 4 types of shock?

A

Hypovolemic
Cardiogenic
Obstructive
Distributive

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11
Q

Distributive
Hypovolemic
Cardiogenic
Obstructive

Which one has vasodilation?

A

Distributive

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12
Q

Distributive
Hypovolemic
Cardiogenic
Obstructive

Which one has vasoconstriction?

A

Hypovolemic (arterial side usually)

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13
Q

Distributive
Hypovolemic
Cardiogenic
Obstructive

Which one has a formation of a pericardial tamponade?

A

Obstruction

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14
Q

Distributive
Hypovolemic
Cardiogenic
Obstructive

Which one is seen in patients with possible edema?

A

Cardiogenic

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15
Q

Distributive
Hypovolemic
Cardiogenic
Obstructive

Which one is caused by ventricular failure?

A

Cardiogenic

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16
Q

CVP
PCWP
CO
SVR

How does hypovolemic shock affect these values?

A

Low fluid, therefore CVP and PCWP decreased

CO is down as a result, but SVR will compensate (vasoconstriction) and increase

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17
Q

CVP
PCWP
CO
SVR

How does cardiogenic shock affect these values?

A

Fluid status is usually increased, so CVP and PCWP are increased.

CO is still down as a result and SVR will compensate by increasing

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18
Q

CVP
PCWP
CO
SVR

How does obstructive (pericardium tamponade) shock affect these values?

A

Same as cardiogenic but different from PE obstructive shock

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19
Q

CVP
PCWP
CO
SVR

How does obstructive (systolic contraction/PE) shock affect these values?

A

Pretty much the same as obstructive and cardiogenic, but PCWP may decrease or be normal

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20
Q

CVP
PCWP
CO
SVR

How does distributive shock affect these values?

A

No treatment = everything decreased

With treatment = everything increased except SVR

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21
Q

Immediate goals of:

MAP
CI

A

MAP > 65

CI >2.2

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22
Q

Immediate goals of:

Hgb
O2 sat
Lactate

A

Hgb > 7

O2 sat >92%

Lactate < 2

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23
Q

Osmolarity equation?

A

2xNa + (BUN/2.8) + (Glucose/18)

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24
Q

Compared to NS, what does LR have?

A

Less sodium

Potassium
Calcium

Less chloride

Lactate

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25
Compared to NS, what does plasmalyte-A or Normosol-R have?
Less sodium (but more than LR) Potassium (higher than LR) Less chloride (even less than LR) Magnesium Acetate Gluconate
26
How does administering albumin help with fluids?
Draws fluids from extravascular/intracellular space to intravascular space
27
What did the SAFE trial say?
ICU patients, fluid resuscitation with albumin vs NS No difference in 28-day mortality Subgroup analysis with traumatic brain injury had a higher mortality with albumin (but wasn't the focus of the trial) Use crystalloids (NS) for initial resuscitation vs colloids) Another study (CRISTAL) showed the same results except they did it with more crystalloids and colloids
28
What have studies shown about using more balanced crystalloids (LR, plasma-lyte) vs NS?
No mortality differences, but less AKI in LR, plasma-lyte groups
29
Activation of alpha 1 and 2 in the vascular smooth muscle/CNS cause vaso(constriction/dilation)
Alpha 1 = constriction Alpha 2 = dilation in CNS, constriction in vascular space
30
Activation of beta 1 and 2 in the vascular smooth muscle cause vaso(constriction/dilation)
Beta 1 = increased chronotropy (cardiac muscle) Beta 2 = dilation
31
Activation of dopamine and phosphodiesterase in the vascular smooth muscle cause vaso(constriction/dilation)
Dopamine = constriction Phosphodiesterase = dilation
32
Activation of vasopressin 1 and 2 in the vascular smooth muscle cause vaso(constriction/dilation)
1 = constriction 2 = increases blood volume (water retention in kidneys)
33
Activation of alpha receptors have more of an affect on (CVP/SVR)
SVR; constriction of vascular smooth muscles typically occur on the arterial side Venous side (CVP) doesnt change shape much
34
Vasopressin V1 vs V2 receptors Which one increases SVR? What does the other one do?
V1 V2 - increased blood volume Both ultimately increases arterial pressure
35
``` Norepi Epi Phenylephrine Vasopressin Dopamine Dobutamine Isoproterenol Milrinone ``` Which drug can cause reflex bradycardia?
Phenylephrine It targets only alpha and body will compensate by lowering HR
36
``` Norepi Epi Phenylephrine Vasopressin Dopamine Dobutamine Isoproterenol Milrinone ``` Which drug has differing receptor effects depending on dose?
Dopamine Low - Dopamine and small beta 1 Medium - Dopamine, Beta 1 and small beta 2 High - Dopamine, Beta 1,2, and alpha
37
What receptors do norepi and epi target?
Norepi - alpha + beta 1 Epi - alpha, beta 1 + 2
38
``` Norepi Epi Phenylephrine Vasopressin Dopamine Dobutamine Isoproterenol Milrinone ``` Which drug is a PDE3 inhibitor?
Milrinone
39
What targets do dobutamine and isoproterenol target?
Both target beta 1 and 2 Dobutamine however targets alpha which can sort of prevent hypotension
40
``` Norepi Epi Phenylephrine Vasopressin Dopamine Dobutamine Isoproterenol Milrinone ``` Which drugs could cause hypotension?
Dobutamine Isoproterenol Milrinone
41
How is cardiogenic shock treated?
Treat the underlying cause Small amounts (250-500ml) of crystalloids in absence of pulmonary edema Diuretics (caution) Norepi is first line You may do norepi + another vasopressor + inotropes (watch for hypotension) Mechanical devices if nothing else works
42
Cardiogenic shock goal?
MAP >60-65mmHg
43
What did the SOAP II trial show?
Higher mortality rate with dopamine use in cardiogenic shock. That's why dopamine is not recommended in treatment Also causes more arrhythmias
44
How is distributive shock treated?
Crystalloids and then norepi as first line BUT you may add vasopressin or epi on top Target MAP is at 65mmHg Steroids can be used but is controversial Antimicrobials within 1 hr for 7-10 days
45
What condition is common in distributive shock?
Sepsis
46
What is the SIRS criteria?
Must be ≥2 to be qualified for sepsis Temp >38 or <36 HR>90 RR>20 WBC>12 or <4
47
What does the SOFA score look into?
Organ failure assessment (used in the newest sepsis scoring assessment)
48
Whats in the qSOFA scoring?
RR≤22bpm Altered mentation SBP≤100mmHg ≥2 suggest poor outcome
49
How much crystalloid should you give in distributive shock and for what reason?
30ml/kg For hypotension or lactate ≥4
50
What is the ACTH stimulation test?
Uses cosyntropin to stress adrenal glands to measure increased cortisol levels ≤9 is insufficient
51
What did the CORTICUS study show?
When given 50mg q6hrs x 5 days it reversed shock quicker but also increased hyperglycemia
52
What did the HYPRESS trial show?
Corticosteroids for refractory shock only
53
If patient needs steroids, what is the dose?
50mg q6 hrs or 100mg q8 hrs
54
Pros and cons of angiotensin 2 drugs?
Improve MAP within 3 hours but tapers off AE of thrombotic and peripheral ischemia
55
Obstructive shock treatment?
Modest fluids (diuresis for pulmonary HTN, fluids for PE) Vasopressors (NE) Thrombolytics for MASSIVE PE; Alteplase 100mg (90 for stoke) over 2 hrs
56
Hypovolemic shock treatment?
<1.5 L of isotonic crystalloids Adjunct vasopressors if life-threatening hypotension Hemostatic resuscitation eat at least 2 erythrocyte like 1 plasma:1 PLT
57
Distributive Hypovolemic Cardiogenic Obstructive Which one contains sepsis, neurogenic, and immune mediated shock?
Distributive
58
What are the indications for mechanical ventilation?
Hypoxia Hypoventilation Respiratory fatigue (anxiety, dyspnea, status asthmaticus) Seizures GCS<8
59
What is FiO2?
Fraction of inspired oxygen Ranges from 21% (environmental air) to 100%
60
What does the TLC ventilator mean?
Trigger - when breath starts Limit - how fast breath enters Cycle - when breath changes from inhalation to exhalation
61
What does the continuous mandatory ventilation do?
Ventilator does all the work Patient cannot trigger own breath
62
Which ventilator option is mode of choice for ARDS?
Assist-control ventilation
63
What does a assist-control ventilation do?
Assist pt to a full breath. Triggers when pt tries to inhale, if there is no breath, then it'll act as a continuous mandatory ventilator Causes hyperventilation and respiratory alkalosis
64
What is a synchronized intermittent mandatory ventilator?
No assistance when patient triggered breath occurs Allows them to contribute to their own respiratory effort
65
What is a pressure support ventilator?
Full spontaneous respiratory effort by patient
66
What is continuous positive airway pressure?
No inspiratory assistance Can be given to intubated or non-intubated pt via mask
67
What are the noninvasive ventilators?
BiPAP (usually for acute care) CPAP
68
ARDS is caused by a triad of symptoms which are:
Dyspnea Tachypnea Hypoxemia
69
What is the Berlin Definition of ARDS?
Within 1 week BILATERAL opacities Not explained by HF or fluid overload PaO2:FiO2 <300 Mild 201-300 Severe ≤100 Moderate inbetween
70
Risk Factors of ARDS?
1. Pneumonia 2. Sepsis 3. Trauma
71
Mechanical ventilation and ARDS? TV PaCO2 PEEP
Tidal volume = 4-6ml/kg IBW Permissive hypercapnia using A/C mode (PaCO2 50-55mmHg PEEP of 5cm H20
72
What are the pharmacological treatments used in ARDS?
Nimbex EARLY use of low/moderate dose of methylprednisolone or decadron

IPT: CC (7 decks)

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