critical care Flashcards
(117 cards)
1
Q
what tidal volume should be used in cases of ARDS
A
4-6ml/kg of ideal body weight
2
Q
indications for operative fixation of severely displaced rib fractures
A
- those undergoing thoracotomy for intrathoracic injuries
- progressive pulmonary deterioration despite aggressive nonoperative management
- those unable to be weaned from vent after resolution of pulm contusions
- significant chest wall deformity and nonunion fractures
3
Q
parkland formula
A
4ml/kg per % TBSA; give first half over 8 hours; give second half over 16 hours
example 80kg male with 80% tbsa: 80kgx4x80%=25600
25600/2= 12800: give this over 8 hours, then an additional 12800 over 16 hours
4
Q
what chest tube output for hemothorax suggests need for thoracotomy?
A
1L of blood output after immediate CT placement or 200-300 cc/hr over 4 hours
5
Q
what is an adequate UOP for a burn patient?
A
adults: 0.5mg/kg/hr
pediatrics: 1.0mg/kg/hr
6
Q
what type of fracture is often associated with hollow viscus, mesenteric and solid organ injuries?
A
chance fracture
7
Q
most effective means of rewarming patients with severe hypothermia?
A
cardiopulmonary bypass and ecmo
8
Q
CO2 pneumoperitoneum can cause increased pCO2 which can result in ______ after extubation.
A
hypoventilation-related respiratory failure
9
Q
true or false: septic shock responds well to vasopressors
A
false
10
Q
type of shock resulting in hypotension from failure of vascular smooth muscle to constrict, partly from upregulation of iNOS and NOS2 in the vessel wall
A
septic shock
11
Q
what patient population should never get a transvenous pacemaker?
A
pts with mechanical valves
12
Q
oculovestibular reflex:
A
test for brain death; instill cold saline in right ear elicits nystagmus with fast beat to left (this is normal and negative for brain death)
13
Q
electrolyte indication for delaying insulin therapy in DKA:
A
hypokalemia less than 3.3
14
Q
physiologic effects of abdominal compartment syndrome (intraabdominal hypertension/IAH):
A
decreased CO; decreased venous return; increased intrathoracic pressure due to diaphragm being displaced cephalad; increased airway pressures; inadequate renal perfusion
15
Q
respiratory quotient equation:
A
VCO2/VO2
16
Q
respiratory quotient of fat
A
0.7
17
Q
respiratory quotient of glucose
A
1.0
18
Q
respiratory quotient of protein
A
0.8
19
Q
respiratory quotient suggestive of over feeding
A
> 1.0
20
Q
CONTROL trial findings for recombinant factor VIIa(rFVIIa)
A
no mortality benefit in ongoing bleeding; did decrease RBC and FFP transfusion needs
21
Q
what does dabigatran prolong
A
aPTT; but not in a dose dependent fashion; direct thrombin inhibitor
22
Q
risk factors for postop delirium:
A
ASA 4 or higher; intraop transfusion of >1L; BMI <18; age >70; cognitive impairment with MMS exam score <25
23
Q
CRASH trial TXA results:
A
safe in patients with TBI; treatment within 3 hours of death with TXA reduces head-injury related death
24
Q
heart rhythms that necessitate defibrillation in ACLS:
A
Vfib, VTach
25
most common cause of acute liver failure in US
acetaminophen toxicity
26
how do you assess for intraabdominal hypertension?
bladder pressure at the end of expiration
27
EKG changes of hypomagnesemia:
wide QRS, transition from peaked T waves to dampened T waves; prolonged PR interval; polymorphic ventricular tachycardia
28
what drug can be given for cardiogenic shock after cabg?
dobutamine (inotrope) with goal CI >2
29
pharmacologic properties of dobutamine:
catecholamine that acts on beta adrenergic receptors; enhances myocardial contractility with modest (mild) change in HR
30
contraindications to PEG placement
massive ascites; severe malnutrition; life expectancy <30 days
31
hemodynamic changes of septic shock:
decreased CVP, decreased PCWP, increased CI, decreased SVR
32
types of distributive shock:
neurogenic, anaphylactic, septic; all with decreased SVR
33
contraindications to succinylcholine:
any patient who is hyperkalemic or at risk for hyperkalemia; prolonged immobilization, upper or lower motor neuron disorders, burn patients
34
HD changes of acute spinal cord injury:
bradycardia, hypotension, decreased CO, decreased PVR, cardiac dysrhythmias
35
characteristics of type 1 hepatorenal syndrome:
doubling of Creatinine within 2 weeks and creatinine of at least 2.5; urine sodium is low; no improvement with albumin; frequently follows precipitating event; if untreated mortality in 2 weeks; not associated with ascites
36
characteristics of type 2 hepatorenal syndrome:
less rapid deterioration than type 1; associated with diuretic resistant ascites; 4-6 month mortality if untreated
37
initial treatment of hypotension from neurogenic shock
fluids; maintain MAP 85-90
38
should steroids be used for septic shock?
only if fluids and vasopressors are unable to restore hemodynamic stability
39
rhythms for synchronized cardioversion:
SVT, afib, aflutter, atrial tachycardia, monomorphic VT with pulses
40
cardiogenic shock HD changes:
increased CVP, increased PCWP, decreased SVO2, decreased CO, increased SVR
41
what respiratory condition has improved mortality with administrations of early neuromuscular blockade (cisatracurium) for 48 hrs
ARDS
42
sympathetic fibers of the heart exit the spinal cord at what level
T1-T4; injuries at or above this cause decreased myocardial contractility and HR
43
refeeding syndrome electrolyte abnormalities:
hypokalemia, hypophosphatemia, hypomagnesemia, hyponatremia, and thiamine deficiency
44
pts with afib for over 48 hours or unknown amount of time should be treated with what?
rate control, then anticoagulation
45
pressor of choice for pts with anaphylactic shock and refractory hypotension despite immediate and adjunctive treatment with crystalloid
epinephrine
46
what drug has been shown to reduce postop pain and opioid consumption?
dexmedetomidine (IV)
47
diagnostic test to confirm anaphylaxis
total serum tryptase 1 hr after sx onset
48
in what time frame after prehospital CPR can a resuscitative thoracotomy still be performed
within 10 minutes for blunt; within 15 minutes for penetrating
49
first hemodynamic change seen with hemorrhage:
narrowed pulse pressure
50
total amount of air that can be expelled after maximal inhalation:
vital capacity
| inspiratory reserve volume + tidal volume + expiratory reserve volume
51
first physical exam finding of hemovolemic shock:
cutaneous hypoperfusion
52
heparin mechanism of action:
activates antithrombin III which antagonizes thrombin and factor Xa
53
amount of air moved in a normal breath
tidal volume
54
amount of air left after maximal exhalation
residual volume
55
amount of air that can additionally be expired from lungs by maximal effort after normal expriation
expiratory reserve volume
56
treatment of hepatorenal syndrome:
liver transplant is only treatment
57
second line vasopressor to norepinephrine in increasing blood pressure
vasopressin (also used for bleeding esophageal varices)
58
refeeding syndrome causes severe electrolyte and fluid shifts leading to cardiac, pulmonary, muscular, GI, neuro and heme complications because of what surge?
insulin surge in response to carbs causing extracellular K, Mg, and PH to move intracellularly
59
most fatalities from refeeding syndrome are from what type of complications?
heart failure and arrhythmias (cardiac)
60
what type of organisms cause most empyemas:
anaerobic
61
what medication is used in brain death patients to protect organs from diabetes insipidus?
vasopressin
62
type 1 hypersensitivity reaction:
binding of antigens to IgE causes mast cell and basophil degradation; e.g. anaphylaxis
63
type 2 hypersensitivity reaction:
immunoglobulins attach to surface antigens with subsequent complement fixation; autoantibodies develop to cell surface receptors; delayed after exposure to antigens; eg. Graves disease
64
type 3 hypersensitivity reaction:
circulating antigen-antibody immune complexes with subsequent complement fixation leads to deposition in vessels, joints, and kidneys; eg. serum sickness
65
type 4 hypersensitivity reaction:
cell-mediated immunity leading to local injury when antigen present; e.g. contact dermatitis
66
in patients without a brain injury with massive bleeding and an elevated INR, what is goal BP until major bleeding has been stopped?
SBP 80-90
67
true or false: PCC is superior to FFP in rapid reversal of vit K antagonists
true
68
TXA should be given within ___ of injury in bleeding trauma patients
3 hours
69
dobutamine effects:
beta 1 adrenergic receptors at low dose which increases contractility; beta 2 adrenergic receptors at high dose which has vasodilatory effect
70
what is delta pressure in compartment syndrome:
diastolic pressure minus compartment pressure; used to dx compartment syndrome needing fasciotomy between 20-30
71
vasopressin mechanism:
vasoconstriction via V1 receptor; no cardiac effect
72
leading cause of death due to hospital acquired infection:
pneumonia
73
substance used in trauma to inhibit fibrinolysis and reduce surgical blood loss; decreases mortality if given within 1 hour of presentation:
transexamic acid
74
true or false: TXA increases risk of PE or VTE
false
75
prothrombin complex concentrate contains what factors:
factor II, VII, IX, X, protein C, protein S; indicated for urgent reversal of vitamin K antagonists like warfarin; does not increase venous thromboembolism
76
pts with severe frostbite who present within 24 hrs of cold injury may be a candidate for what medical therapies:
tissue plasmingen activator (tPA) thrombolysis, prostacyclin, or both
77
what should be given to reverse rivaroxaban quickly (factor xa inhibitor)?
PCC
78
physiologic changes of pregnancy:
increased tidal volume; decreased PaCO2; increased blood volume; decrease LE sphincter competency; increased coagulation; decreased GB emptying
79
test used to detect occult placental hemorrhage in pregnant trauma pt
kleihauer betke test
80
crystalloid resuscitation in pediatric trauma:
20cc/kg
81
blood resuscitation in pediatric trauma:
10cc/kg
82
hemodynamic response of elderly in trauma differ in that they have ___ cardiac function, ___ after load, ___ sensitivity to catecholamines, and ___ robust sympathetic response
decreased cardiac function, increased afterload from atherosclerosis, decreased sensitivity to catecholamines, and less robust sympathetic response
83
True or false. A short course of 7-8 days of abx is as effective as 14-15 days of abx for VAP.
true
84
Cause and symptoms of proprofol infusion syndrome:
caused by impaired mitochondrial function leading to metabolic acidosis, rhabdomyolysis, hyperkalemia, hepatomegaly, renal failure, arrhythmia, cardiac failure, and hypertriglyceridemia
85
True or false. Hypernatremia does not need to be corrected for a brain death exam.
False
86
What constitutes a positive apnea test for brain death?
PaCO2>60mm Hg or 20mmHg above baseline
87
Three treatment factors associated with improved mortality for ARDS:
low tidal volume ventilation (6-8cc/kg)
early neuromuscular blockade
prone positioning
88
True or false. Early enteral nutrition in patients with severe pancreatitis decreases incidence of pancreatic infections and mortality.
True
89
True or false. For patients with TBI, use of unfractionated heparin for VTE ppx results in lower odds of VTE and lower mortality compared to LMWH
False. LMWH is the preferred management
90
Common drugs that suppress adrenal function?
ketoconazole and etomidate
91
Why are high doses of IV lorazepam dangerous?
the diluent includes propylene glycol which can cause lactic acidosis, myocardial depression, and shock
92
Flexible bronchoscopy causes ____ PaO2 levels and _____ PaCO2 levels in intubated patients.
decreased PaO2
| increased PaCO2
93
In the critical care setting, the target temperature of a patient after cardiac arrest is _____ for 24 hours
33-36C
94
Two strongest independent risk factors of stress ulcer formation:
respiratory failure requiring mechanical ventilation (strongest factor)
coagulopathy
95
What alpha 2 agonists can be used as adjuncts to lorazepam in treatment of critically ill patients with alcohol withdrawal for hypertension and tachycardia?
clonidine and dexmedetomidine
96
Long acting oral agent for alcohol withdrawal:
chlordiazepoxide
97
Inotrope that is available in premixed bags. Greater effect on cardiac output than NE
dopamine
98
Pressor that can be given peripherally. Pure adrenergic vasoconstrictor. Can cause reflex bradycardia in spinal cord injury
phenylephrine
99
Pressor that acts on all 5 adrenergic receptors causing vasoconstriction, vasodilation, inotropy chronotropy, bronchodilation, glycogenolysis, and lipolysis.
epinephrine
100
Pressor that constricts arterioles via V1a receptor. Second line agent to catecholamine agents in septic shock.
vasopressin
101
Recommendation for initial crystalloid infusion in sepsis:
30cc/kg within 1st 3 hours
102
True or false. Hetastarch should be used in sepsis due to decreased risk of AKI & death
False. increased risk of death and AKI
103
treatment of monomorphic ventricular tachycardia
immediate cardioversion
104
treatment of monomorphic ventricular ectopy
amiodarone
105
tx of narrow complex ventricular tachycardia
calcium channel blockade of AV node
106
tx of bradycardia
atropine
107
Definition of sepsis:
qSOFA score of at least 2 in the setting of suspected infection
108
components of qSOFA:
RR>/= 22, altered mental status, SBP = 100
109
definition of septic shock:
persistent hypotension requiring pressors to maintain MAP>65 and lactate >2 despite adequate resuscitation
110
Associated factors for patients over the age of 75 with posteroperative delirium:
ASA III-IV
impaired mobility
use of opioids
111
Nutritional needs for critically ill patients:
25-30 kCal/kg
112
TBI and intracranial hemorrhage patient chemoprophylaxis:
LMWH within 24-48 hrs
113
criteria for use of TXA in trauma:
1. adult patient in hemorrhagic shock within known predictors of fibrinolysis
2. give only if less than 3 hours from injury
3. dose 1 g IV over 10 minutes followed by 1 g IV over 8 hours
114
HDS patients with positive pericardial fast should be managed with:
subxiphoid pericardiotomy
115
Increasing PEEP will cause what cardiovascular effects?
reduction in cardiac output secondary to decreased venous return and left ventricular stroke volume; elevates intrathoracic pressure and restricts right ventricular heart filling
116
Goal cerebral perfusion pressure and intracranial pressure for TBI patients:
60-70mm Hg for CPP and <20 for ICP
117
how is CPP calculated?
MAP-ICP
