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Critical Care Flashcards

(45 cards)

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1
Q

Calculate free water deficit

A

[(plasma Na/140)-1] x (weight in kg x 0.6)

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2
Q

SIADH labs

A

HypoNa + urine Na >20

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3
Q

Fire at tire factory poisoning and treatment

A

Cyanide = hydroxycobalamin

Sodium thiosulfate and nitrate not used because causes methHb and slow onset

High O2 on VBG (not using O2)
Prolonged SNP infusions can cause

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4
Q

Effect of Glycine solution for TURP

A

Transient blindness

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5
Q

Effect of distilled water for TURP

A

Hemolysis, fluid overload, dilution hypoNa and high chance of TURP syndrome

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6
Q

Effect of saline and other balanced salt solutions for TURP

A

Significant current dispersion

Normally used sorbitol/mannitol combination for TURP

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7
Q

Calculate Sodium deficit

A

(140 - serum Na) x Total body water (kg x 0.6)

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8
Q

Factors increasing likelihood of post-op ventilation following thymectomy for MG

A
  1. Duration of disease >6 years
  2. Hx of chronic respiratory disease (asthma, COPD)
  3. Pyridostigmine dose >750mg/day
  4. Vital capacity <2.9L or 40ml/kg
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9
Q

Type of shock:
PCWP >18
CI <2.2

A

Cardiogenic

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10
Q 
Cause of oliguria:
FeNa 1%
BUN: Cr >20
Urine:Serum Cr >40
Urine Osm >500
Random Urine Na <20
A

Pre-renal

- hypovolemia

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11
Q 
Cause of oliguria:
FeNa 2%
BUN: Cr <20
Urine:Serum Cr <20
Urine Osm <400
Random Urine Na >20
A

Intrinsic or post-renal

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12
Q

Formula to calculate FeNa

A

[(pCr x uNa) / (pNa x uCr)] x100

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13
Q

Causes of inc MvO2

A

Inc SaO2: supplemental O2

Dec VO2: Carbon monoxide, cyanide, hypothermia, sepsis

Inc CO: dobutamine, sepsis, thyroid storm, AV fistula, cirrhosis

Inc Hb: Transfusion

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14
Q

Cause of hypoPhos with TPN

A

Glucose loading w/ TPN –> intracellular shift of Phos

Other causes of hypophos:
Refeeding
DKA
Hyperventilation
Diuretics - aucetazolaimide (proximal tubule)
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15
Q

Toxin that travels via neuronal retrograde transport and enters inhibitory interneurons in the spina cord

A

Tetanus

- prevents release of GABA

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16
Q

Inhibitors of HPV

A 
Hypocarbia
Vasodilators
Infection
Metabolic alkalosis
Volatiles >1MAC
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17
Q

Indications for hyperbaric O2

A 
Air embolism
Carbon monoxide, brown recluse other poisoning
chronic infections
Acute ischemia from crush, CRAO
Burns
Lung lavage

Ability to deliver 1 MAC of N2O –> decompression sickness when suddenly stopped,
Higher Desflurane delivered = dial down

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18
Q

Causes of inc PIP + inc Pplateau

A

Compliance issue

  • Abd insufflation
  • Ascites
  • Intrinsic lung disease
  • Obesity
  • Pulmonary edema
  • PTX
  • Trendelenburg
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19
Q

Causes of inc PIP + unchanged Pplateu

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A

Airway resistance problem

  • Airway compression
  • Bronchospasm
  • Foreign body
  • Kinked ETT
  • Mucous plug
20
Q

Predicts INC mortality following pneumonectomy

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A
  1. VO2 Max <15ml/kg/min
  2. Inability to ascend 2 flights of stairs
  3. ppoFEV1 <30%
  4. Combined ppoFEV1 <35 + DLCO <35
21
Q

Cause of hypoxemia with normal A-a gradient

Study These Flashcards
A

Hypoventilation

22
Q

Labs in Conn Syndrome

Study These Flashcards
A

HypoK metabolic alkalosis

  • primary hyperaldosteronism
  • Fatigue, HA, HTN from hypervolemia
  • Tx = spironolactone and K
23
Q

change in pH for every degree decrease

pH 7.25 @ 37 when drawn from 27 degree patient

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A

1 degree decrease = pH increase 0.017

pH –> 7.42 (10 x 0.017)

24
Q

Changes at high altitude

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A

Hyperventilation - dec PaCO2 (PaCO2 30, PaO2 55)

Kidneys compensate in a few days to normalize pH but still have dec PaCO2

H moves from CSF to plasma (inc CSF pH)

Left shift oxygen-Hb curve (hypocarbia) —> right shift from hypoxia and inc 2,3 DPG

Chronic hypoxia inc PVR

Inc Hb –> inc viscosity and risk of clotting
Brief inc in CO

25
Signs of cyanide toxicity
Cyanosis only very late, typically no cyanosis present Inc PaO2 d/t inability to utilize O2 SvO2 inc Anion gap metabolic acidosis
26
``` Labs for ATN: Urine Na Urine Osm Spec Grav FeNa ```
Urine Na >40 (can't reabsorb) Urine Osm <350 SG very low ~1.0035 FeNa >1%
27
Tx Sarin gas poisoning
Atropine and Pralidoxime Organophsphates inhibit Ach-esterase = excess Ach --> bradycardia, mitosis, salivation, respects distress
28
Wavelengths for pulse ox
DeoxyHb - 660 | OxyHb - 940
29
Bezold-Jarisch Reflex
apea, bradycardia, hypotension following inferior and posterior MIs as a result of dec preload or stretch of the ventricles mediated by vagal Commonly seen with spinal anesthesia
30
MELD score
``` Cr (greatest effect) Yea/No Dialysis Na INR Bilirubin ```
31
Childs-Pugh score
``` Bilirubin INR Albumin Ascities Hepatic encephalopathy ```
32
Features of TRALI
``` Pulmonary edema - high protein content Transient leukopenia Normal cardiac filling pressures Multiparous donors Inc temp ```
33
Calculate A-a gradient
PAO2 = (FiO2 x 713) - (PaCO2 x 1.25) If <20 = hypoxemia is due to hypoventilation or dec fio2
34
Post-thyroidectomy complication time course: 1. immediate 2. within 6 hours 3. 24 hours
immediate = b/l recurrent laryngeal injury within 6 hours = hematoma 24 hours = hypocalcemia
35
Volume of total dead space
2ml/kg
36
Labs in Cushing syndrome
HypoK metabolic alkalosis + hyperglycemia
37
Labs with vomiting/pyloric stenosis
``` 7.51 PCO2 47 HCO3- 31 Na 130 K 2.9 Cl 93 ```
38
Most predictive of pulmonary complications following wedge resection
``` FEV1 <60% of predicted DLCO<60% of predicted PPO FEV1 <800ml PPO FEV1% >40% VO2 Max <15ml/kg/min ```
39
Mechanism of high altitude pulmonary edema
excessive uneven HPV 2-4 days after ascent Tx = rapid descent, O2, hyperbaric
40
ICU feeding strategies
Enteral w/o antioxidants | Protein-based full feeds
41
Pulmonary changes with obesity
Inc Tv Dec everything else
42
Electrolyte dec in ESRD
Calcium
43
Initial compensation for acute respiratory acidosis
Plasma protein buffer (including Hgb)
44
Factor for calculating qSOFA
0-3 - AMS - RR >22 - SBP <100
45
How does hyperbaric oxygen work?
Increases amount of dissolved oxygen

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