Critical Care Flashcards
(156 cards)
1
Q
CO2 acid or base controlled by what
A
Acid lungs
2
Q
Integrillin dose for renal impairment
A
CrCl <50 1mg/kg/min
3
Q
Milrinone MOA
A
inhibit PDE which normally degrades cAMP into inactive peptides
4
Q
Propofol special consideration
A
10% lipid emulsion so has 1.1 kcal/mL
5
Q
Cardiogenic shock tx
A
Cold/wet= inotrope + diuretic
Cold/dry= inotrope +/- fluid
6
Q
Septic shock tx
A
Fluids -30mL/kg of crystalloid
pressors if hypotension
-NE
empiric antimicrobial
7
Q
Which NMBA are non-depolarizing agents
A
Amine Structure
- Atracurium
- Cisatracurium
Steroidal Structure
- Pancuronium
- Rocuronium
- Vecuronium
8
Q
Cangrelor to Prasugrel
A
Cangrelor 30mcg/kg bolus then 4 mcg/kg/min infusion Prasugrel 60mg immediately
9
Q
Dexmedetomidine special considerations
A
does not cause respiratory depression for <24 hours in ICU
10
Q
PCI treatment
A
UFH, LMWH, or Bivalirudin ASA 325mg x1 LD os P2Y12 Stent placement +/- GP 2b/3a
11
Q
sepsis Gram - bacteria
A
S. aureus S. pneumoniae
12
Q
pH <7.35 is what type of hemodynamic problem
A
acidosis
13
Q
SAH tx
A
BP control -SBP <140 Vasospasm control -Nimodipine
14
Q
Preload in left side of heart is what
A
PCWP
15
Q
Obstructive shock hemodynamic parameters
A
CO ↓
16
Q
ADHF when to hold ivabradine
A
Cardiogenic shock symptomatic ↓HR, BP new AFib
17
Q
H’s and t’s 5, 4
A
H
- hypoxia
- hypovolemia
- H ion
- hypo/hyperkalemia
- hypotermia
T
- toxin
- tamponade
- tension pneumothorax
- thombosis
18
Q
ADHF when to hold ACEi/ARB/ARNi
A
cardiogenic shock symptomatic ↓ BP AKI ↑K
19
Q
ADHF Cold &wet tx
A
SBP <90 w/ symptoms
-Inotrope + diuretics
if no symptoms
-IV diuretics +/- vasodilators
20
Q
Arterial Line measures what
A
blood gas BP continuously
21
Q
AIS BP goals
A
received tPA <180/<105
no tPA or thrombectomy <220/<120
No tPA with thrombectomy SBP <160
Hemorrhagic converson SBP <160
22
Q
Sepsis 3 definition
A
> 2 qSOFA –for ED/Floor pt SOFA –ICU patients >2 pts
23
Q
Define metabolic alkalosis
A
pH >7.45 HCO3 >26
24
Q
PRIS s/s 3
A
ARF cardiac arrest dyslipidemia
25
Anion gap formula
Na - (HCO3 + Cl) normal \<12
26
Angiotensin 2 Action
Vasoconstriction ↑ SVR
27
ADHF "cold" symptoms 8
fatigue
early satiety, nausea, anorexia
altered mental status
cool extremeties
tachycardia
narrow pulse pressure
sympomatic hypotension
↓Na
28
Dexmedetomidine ADE 5
↓ BP ↓ HR HTN N/V heart Block
29
Pancuronium ADE 2
tachycardia HTN
30
Thromboembolic prophylaxis LMWH dose
40mg SQ q24h 30mg SQ q12h if high risk
31
ADHF warm & wet tx
IV loop diuretic
naive--furosemide 40
experienced--2-2.5x home dose
+ HCTZ, metolazone, chlorothiazide
+/- vasodilators
32
Metabolic acidosis etiology
Anion gap
-MUDPILES --methanol, uremia, Diabetic ketoacidosis, propylene glycol, isoniazid and iron, lactic acid, ehtylene glycol, salicylates
Non-anion gap
-ACCRUED --Aldosterone inhibitors, compensation, carbonic anhydrase inhibitors, renal tubular acidosis, ureteral diversion, extraailmentation, diarrhea
33
pH ___ as HCO3\_\_\_ pH ___ as PaCO2\_\_\_
increases, increases decreases, increases
34
ADHF when to hold BB
cardiogenic shock symptomatic ↓BP, HR
35
Andexanet alfa MOA
decoy protein that sequesters and prevents binding to endogenous factor 10a
36
Activated 4-factor product
Feiba
37
Kcentra MOA
PCC 4 factor, unactivated replaces factors 2,9,10, and unactivated 7
38
Vecuronium Contraindication 2
Renal failure Liver failure
39
Ketamine MOA
NMDA blocker ACh blocker L-type Ca block
40
Vasopressors ADE
HTN tissue necrosis ARF Ischemia
41
Dopamine 1 & 2 action
Vasodilation ↑ UOP ↓ SVR
42
What happens when you add acid to buffer system
combine with HCO3 generating CO2 that is dissolved in the blood and subsequently eliminated via the lungs
43
4-factor product
Kcentra
44
Sepsis Gram + bacteria
E. coli Klebsiella spp. Pseudomonas
45
Phenylephrine Selectivity and action
Alpha 1 & 2 vasoconstriction
46
Alpha 1 Action
Vasocontriction ↑SVR ↑MAP
47
Initial resuscitation of Shock
"VIP" Ventilate Infuse Pump 30mL/kg IV crystalloid in 1st 3hrs MAP \>65 normalize lactate
48
Which drug is a venous vasodilator
Nitroglycerin
49
pH normal value
7.35-7.45
50
Compensation for respiratory alkalosis
Acute
-for each ↓10 of PaCO2 HCO3 ↓ 2mEq/L
Chronic
-for each ↓10 of PaCO2 HCO3 ↓5 mEq/L
51
Beta 2 action
Vasodilation Bronchodilation ↓SVR
52
Norepinephrine Selectivity and Action
Alpha 1 \> beta 1 \> Beta 2 ↑ Chronotropy/Inotropy Vasoconstriction
53
Respiratory Alkalosis etiology
Central stimulation hypoxia latrogenic
54
Vecuronium ADE 2
Bradycardia Prolonged blockade on D/C
55
Beta 1 action
Chronotropy Inotropy Vasodilation ↑CO ↑HR ↓SVR
56
Distributive shock hemodynamic parameters
SVT ↓
57
Milrinone Hemodynamic effect HR, MAP, CO, SVR
HR ↑ MAP ↓ CO ↑ SVR ↓
58
Hemorrhagic shock treatment
identify source of bleeding volume rsuscitate --crystalloids --Packe red blood cells Vasopressors to MAP \>60
59
Cardiogenic Shock hemodynamic parameters
CO ↓
60
TX of hyperkalemia
Ca gluconate
regular insulin
albuterol
sodium bicarb
furosemide
Na polystyrene sulfonate
61
Suggammadex MOA
modified cyclodextrin that encapsulates rocuronium and vecuronium to inhibit their binding to ACh receptor
62
Propofol MOA
GABA receptor
63
AIS primary prevention
ASA 81 for women 55-79
64
Epi, NE, DA ADE
Tachycardia Hyperglycemia
65
Pancuronium Contraindication 3
CAD renal failure Liver failure
66
Venous vasodilation MOA
↓ preload \> ↓ pulmonary congestion ↓ CVP + PCWP = symptom relief
67
Succinylcholine MOA
inactivates AChE so inactive metabolites are made results in prolonged depolarization followed by paralysis
68
Metabolic alkalosis treatment
cl responsive --replace Cl
cl unresponsive --correct hypokalemia
69
Rocuronium Contraindication
Severe Liver failure
70
Hypovolemic shock hemodynamic parameters
CVP ↓ PCWP ↓
71
Epinephrine Selectivity and Action
Alpha 1 = beta 1 \> beta 2 ↑ Chronotropy/Inotropy Vasoconstriction
72
Angiotensin 2 ADE
Hypernatremia hypokalemia thrombosis lower dose if on ACEi
73
Cangrelor to ticagrelor
Cangrelor 30mcg/kg bolus then 4 mcg/kg/min infusion Ticagrelor 180mg
74
What 3 drugs also need added when on NMBA
Sedation--RAAS -4 to-5 prior --CIV benzo CIV opioid
75
pH \>7.45 is what type of hemodynamic problem
Alkalosis
76
non-shockable rhythms
PEA asystole
77
Septic shock definition
vasopressors to maintain MAP \>65 Lactate \>2 in absence of hypovolemia
78
HCO3 acid or base controlled by what
base kidneys
79
Propofol type of sedation
sedation w/out amensia or analgesia
80
ADHF when to hold aldosterone antagonist
renal dysfunction ↑K
81
When to add corticosteroids for shock
if not stable on fluids and pressors alone -hydrocortisone
82
Which NMBA is a Depolarizing agent
Succinylcholine
83
Dobutamine Hemodynamic effect HR, CO, SVR
HR ↑ CO ↑ SVR ↓
84
Define respiratory alkalosis
pH \>7.45 PaCO2 \<35
85
Cangrelor to Clopidogrel switch
Cangrelor 30 mcg/kg bolus then 4 mcg/kg/min infusion Clopidogrel 600mg immediately
86
Crystalloids example
non-balanced-NS balanced-LR, plasmalyte
87
Ciraparantag MOA
binds heparins, factor 10a inhibitors, DTI through hydrogen bonds
88
PA catheter measures what
PCWP CO CI SVR CVP
89
Which drug can cause cyanide/thiocynate toxicity
nitroprusside
90
PRIS risk factors
Dose \>83 mcg/kg/min \> 48 h concomitant catecholamine or glucocorticoid ketogenic diet
91
Heparin and LMWH Reversal agent
Protamine
92
HCO3 inc/dec in metabolic acidosis and alkalosis
↑ metabolic alkalosis ↓ metabolic acidosis
93
qSOFA levels
RR \> 22 Altered mental status SBP \>100
94
HCO3 normal values
22-26 mEq/L
95
Preload in right side of heart is what
CVP
96
SAH S/S
Worst HA of life Loss of consciousness N/V Nuchal rigidity
97
Dexmedetomidine MOA
Alpha2 agonist to block reuptake of NE to initially but long will ↓ NE concentration
98
Propofol ADE 3
respiratory depression hypertriglyceridemia PRIS
99
ICH S/S
Acute HA N/V pupillary changes HTN
100
Aggrastat dose for renal impairment
CrCl \<60 0.075 mcg/kg/min
101
Lytic Tx
lytic therapy started ASA 325 x1 clopidogrel 75-300 --\> 75 years = 75mg --\<75 years = 300mg Anticoag--UFH, LMWH, Fondaparinux
102
Succinylcholine Contraindication 5
Burn Trauma ↑K crush injury denervating injury
103
Etomidate MOA
mediated through GABA to inhibit 11beta-hydroxylase
104
pCO2 normal values
35-45 mmHg
105
alteplase Dose
0.9mg/kg -actual body weight -max dose 90mg
106
When to start Insulin infusion in ICU
glucose \>200
107
Dopamine Selectivity and Action
D \> Beta 1 \> alpha \> beta 2 ↑UOP ↑ Chronotropy/inotropy Vasoconstriction ↑ Na ↓K
108
Furosemide PO 40mg = to __ IV Furosemide \_\_PO Torsemide \_\_Bumetanide
20mg 20mg 1mg
109
Direct Factor Xa inhibitor reversal agents
Andexanet alfa Kcentra FEIBA
110
Anaphylactic shock tx
epi fluids supportive care -Histamine blockers -steroids -albuterol
111
Warfarin Reversal agents
Vitamin K Kcentra
112
Alpha 2 Action
Constriction 2a ↓ SVR 2b ↑ SVR
113
Risk of arrhythmias if on vasopressors
DA\>\>Epi/NE\>Phenylephrine/vasopressin
114
Idarucizumab MOA
binds to bound and free dabigatran
115
Alteplase Contraindication
ICH
in last 3 months
--Ischemic stroke
--severe head trauma
--intracranial/intraspinal surgery
SAH
GI malignancy
Coagulopathy
--Plt \<10000
--INR \>1.7
--aPTT \>40 sec
--PT \>15 sec
LMWH in 24 hours
NOAC in 48 hrs
GP2b/3a inhibitors
116
Alteplase inclusion criteria
\>18
Symptoms \<3 hours
Extended window=3-4.5 hr
- if on warfarin and INR \<1.7
- previous stroke and DM
117
Compensation for respiratory acidosis
Acute
-for each ↑10 of PaCO2 HCO3 will ↑ 1mEq/L
Chronic
-for each ↑ 10 of PaCO2 HCO3 will ↑ 4mEq/L
118
Define metabolic acidosis
pH \<7.35 HCO3 \<22
119
Vasoactive meds for shock
NE 1st line -add vasopressin or epi to raise MAP or add vasopressin to ↓ NE dose
120
Tx if PCI is unavailable and within what time frame
tPA Reteplase Tenecteplase 120 mins
121
metabolic alkalosis etiology
Cl responsive
-vomiting, previous diuretic use
Cl unresponsive
-current use of diuretic, refeeding syndrome, excess mineralcorticoid
122
ADHF cold & dry tx
If SBP \<90 w/ symptoms
-IV inotrope
if no symptoms
-IV vasodilator
123
Arterial Vasodilation MOA
↓ arterial vasoconstriction ↓ afterload \> ↑ CO ↑ SV and ↓ SVR
124
ADHF "wet" symptoms
SOB, dyspnea on exertion edema, weight gain ↑ JVP ↑ BNP
125
Dexmedetomidine type of sedation
cooperative sedation analgesia
126
HFrEF systolic or diastolic
systolic
127
3 Stress ulcer prophylaxis indications
INR \>1.5 PTT \>2x ULN Plt \<50000
128
Define respiratory acidosis
pH \<7.35 PaCO2 \>45
129
What happens when a base is added to buffer system
combines with H2CO3 to generate HCO3 which is eliminated via the kidneys
130
PCC definition
prothrombin complex concentrate factor 10 complex prepared from human plasma with blood factors 2,7,9,10
131
Neurogenic shock tx
Fluids Pressors atropine for bradycardia
132
JFpF systolic or diastolic
diastolic
133
ADHF warm & dry tx
optimize goal directed medical therapy
134
Vasopressin Selectivity and action
V1 & V2 agonism Vasoconstriction
135
Succinylcholine ADE
↑K = arrythmia Tachycardia Malignant Hyperthermia
136
Ketamine type of sedation
dissociative anesthetic, analgesic, hypnosis
137
Glucose control in ICU
100-180
138
metabolic acidosis compensation
winter's formula PaCO2=1.5(HCO3) +8+/-2
139
Tx for ↓Na
Tolvaptan
140
Exacerbating factor for ADHF
"Failured"
F-failure to comply to meds
A-Afib
I-Ischemia
L-Levothyroxine
U-Uncontrolled HTN
R-Renal failure
E-Embolus
D-drugs-steroids,NDHP, NSAID, TZD
141
FASTHUG meaning
Feeding Analgesia Sedation Thromboembolic prevention Head of bed elevation stress ulcer prevention Glucose control
142
Atracurium and Cisatracurium MOA
copmetitive antagonist for ACh which blocks depolarization
143
ICH tx
BP control \<160
Nicardipine DOC
Anticoag reversal
144
Which drug is a mixed arterial/vasodilator
Nitroprusside
145
Dabigatran reversal agent
Idarucizumab
146
shockable rhythms
v fib pulseless v. tach
147
Respiratory acidosis etiology
COPD central respiratory depression --sedation airway obstruction decline in gas exchange
148
Vasopressin Action
Vasoconstriction ↑ SVR
149
Dobutamine MOA
bind to beta receptor to ↑ cAMP to ↑ Ca release from SR
150
Etomidate type of Sedation
Anesthetic, hypnosis, no analgesia
151
Colloid example
Albumin, blood
152
2 3-factor products
Profilnine SD Bebulin VH
153
Absolute contraindication to tPA
previous hemorrhagic stroke
other stroke within 1 year
intracranial neoplasm
active internal bleeding
suspected aortic dissection
154
CVC measures what
CVP TPN administration
155
Atracurium and Cisatracurium elimination?
Hofmann elimination/Ester hydrolysis
156
AIS tx
alteplase Treat BP
