CCM

Question 1

ARDS grading

Answer 1

PaO2/FiO2 with PEEP or CPAP ≥ 5cm H2O
Mild 201-300
Mod 101-200
Severe ≤ 100

Question 2

To increase tissue oxygenation what adjustments do you need

Answer 2

Inc FiO2

Inc PEEP

Question 3

Inc PEEP affects on heart

Answer 3

Dec CO/BP by decreasing preload

Question 4

To inc/dec CO2 what adjustments do you need

Answer 4

RR

TV

Question 5

With increased RR watch out for

Answer 5

auto-PEEP which is a failure to complete alveolar exhalation before subsequent breath leading to residual + pr at end-expiration

Question 6

ARDS ventilator mx

1. TV goal
2. plateau pressure

Answer 6

1. 4 - 8 ml/kg predicted BW

2. keep plateau pr <30mmHg

Question 7

ARDS interventions that improve survival

Answer 7

1. low TV
2. low plateau pr
3. use of PEEP
4. early prone-positioning
5. intermittend, bolus sedation
6. early neuromuscular blockade
7. conservative fluid mx

Question 8

AutoPEEP can be caused by underlying

Answer 8

Obstructive airway dz

Question 9

AutoPEEP tx

Answer 9

1. treat obstruction
2. shorten inspiratory time (inc flow rate or change flow profile)
3. reduce minute vent (Dec RR or TV –> permissive hypercapnia)
4. ensure adequate sedation
5. paralyze pt in extreme cases

Question 10

Peak Ins Pr is a measure of

Answer 10

Airway resistance

Question 11

Plateau pr is a measure of

Answer 11

Total respiratory system compliance

Question 12

Causes of high peak but low plateau pr

Answer 12

1. bronchospasm
2. secretion in airway / ventilator tubing
3. obstructing mucus plugging
4. agitation with vent dyssynchrony

Question 13

Causes of high peak and plateau pressure

Answer 13

1. R mainstem bronchus intubation
2. PNTx
3. worsening airsapce dz - ARDS, PNA, pulmonary edema

Question 14

Spontaneous breathing trial indications

Answer 14

1. improving underlying cause of resp failure
2. FiO2 ≤0.4 with PEEP <5-8
3. pH >7.25
4. hemodynamic stability
5. able to spontaneously breath

Question 15

3 ways to prevent VAP in ICU

Answer 15

1. elevated head of bed to >45
2. mouth care
3. coordinating daily awakening trials and daily spontaneous breathing trials

Question 16

Agitation tx in patients receiving mech vent

Answer 16

Assess for pain and treat with analgesics

Question 17

Transfusion indication for Hg ≥7

Answer 17

1. hemodynamic instability
2. severe active bleeding
3. ACS

Question 18

Preferred nutrition route in ICU

Answer 18

enteral nutrition started within 24-48 hrs

Question 19

Preferred fluid therapy with mortality benefit in pt with sepsis

Answer 19

Crystalloid

Target MAP >65

Question 20

Septic shock vasopressor of choice

Answer 20

NE

Vasopressin can also be added to reduce the dose of NE

Question 21

Role of Glucocorticoid therapy in Septic Shock

and Glucocorticoid of choice

Answer 21

To be used for hemodynamic stability despite fluid + vasopressor therapy

Not more than 200mg qd of hydrocortisone

Question 22

Classic triad of Fat Embolism Syndrome

Answer 22

1. hypoxemia
2. neurologic changes
3. upper body petechial rash

Question 23

Toxic Shock Syndrome usual causative organism

Answer 23

Stap aureus

Group A beta hemolytic strep

Question 24

Characteristic rash in TSS

Answer 24

diffuse erythema or sunburn like rash that involves the palms and soles

Question 25

TSS abx choice

Answer 25

Broad spectrum: Carbapenem PNC / lactamase inh +Vanco is S. aureus is suspected

Question 26

HTNive Emergency goal for lowering mean arterial BP within the first hour in the absence of compelling indication

Answer 26

≤ 25% within 1 st hr If stable to 160/100 within next 2-6hrs Then cautiously to nml during the following 24-48hrs

Question 27

Compelling indication to tower BP quickly

Answer 27

1. Aortic dissection 2. Pheo crisis 3. Eclampsia or preeclampsia

Question 28

Medication of choice for Hypertensive Emergency in case of CNS hemorrhage

Answer 28

CCB - Nicardipine

Question 29

Medication of choice for Hypertensive Emergency in case of scleroderma renal crisis

Answer 29

ACEi

Question 30

Heat stroke therapy

Answer 30

Evaporative cooling | Ice water immersion in severe cases

Question 31

Meds that cause thermal regulatory dysfunction leading to heat stroke

Answer 31

Anticholinergic | Diuretics

Question 32

Malignant Hyperthermia cause

Answer 32

Severe hyperthermia in response to inhaled anesthetic agents or depolarizing paralytic agents

Question 33

Malignant hyperthermia MC sx

Answer 33

muscle rigidity | high fever

Question 34

Malignant hyperthermia Tx

Answer 34

d/c triggering agent active cooling Dantrolene

Question 35

Neuroleptic Malignant Syndrome cause

Answer 35

Idiosyncratic rxn to D2 R Ag meds 1. neuroleptic tranquilizers 2. antipsychotic drugs, 3.antiemetic 4. withdrawal of L-Dopa or dopamine A therapy)

Question 36

Serotonin Syndrome sxs

Answer 36

``` Shivering Hyperreflexia Myoclonus Ataxia +/- hyperthermia ```

Question 37

Serotonin Syndrome tx

Answer 37

Supportive; usually resolves within 24 hours

Question 38

Moderate Hypothermia therapy | Temp?

Answer 38

28-32.2C | Active external rewarming techniques of TRUNK

Question 39

Hypothermia Cx

Answer 39

1. Cardiac conduction abnormalities (brady, prolongation of PR, QRS, QT) - -> Osborn Wave: convex elevation of J point defined as the junction of QRS and ST segment 2. Respiratory depression 3. Neurologic impairment

Question 40

Mild Hypothermia therapy | Temp?

Answer 40

32.2 - 35 | Passive external rewarming (blankets)

Question 41

Severe Hypothermia therapy | Temp?

Answer 41

<28 | Active internal rewarming (warm IVF, peritoneal lavage)

Question 42

Indications for Hyperbaric O2 therapy for CO poisoning

Answer 42

1. severe CO poisoning with loss of consciousness 2. persistent neuro deficit 3. CarboxyHg level >25% and evidence of ischemia 4. Pregnant

Question 43

Reversal for dabigatran (pradaxa) overdose

Answer 43

Idarucizumab (praxbind)

Question 44

Reversal for factor X inhibitors (rivaroxaban-xarelto, apixaban-eliquis)

Answer 44

Andexanet alfa

Question 45

Methamphetamine overdose leads to | -pupil?

Answer 45

agitation | large pupils

Question 46

Criteria for succesful spontaneous breathing trial

Answer 46

Tolerate weaning trial for 30 mins | maintain RR < 35/min and SpO2 >90% without arrhythmias, sudden inc in HR / BP or development of respiratory distress