Critical Care

Question 1

Change in Delta Pressure to __ mmHg indicates fasciotomy

Answer 1

Change in Delta Pressure from 40 to 20mmHg indicates fasciotomy

Question 2

Calculation for Delta Pressure for compartments

Answer 2

DBP - compartment pressure = Delta Pressure

Delta P < 20-30 = fasciotomy

Question 3

Vasopressors are first line for_____ shock

Answer 3

Vasopressors are first line for NEUROGENIC shock

Question 4

Septic shock tx (3)

Answer 4

1. volume resus
2. Antibiotics
3. then pressors

Question 5

Cardiogenic shock tx

Answer 5

ionotropes and chronotropes - main goal is increasing contractility

Question 6

Manifestations of ACS (Inc Intraabdominal pressure leading to ischemia of bowel) (5)

Answer 6

1. Inc Intracranial Pressure (nml 7-15)
2. Inc Peak Pressures (up to 40)
3. Cardiac failure bc of dec preload and inc after load
4. Rena Failure- Inc SVR (>2500 dynes)
5. GI ischemia

Question 7

Why inc hyperpigmentation in Cushings?

Answer 7

In Cushings, Inc ACTH - ACTH similar to MSH - increase in melatonin

Question 8

Nurtition and Extubation; What Macro to change?

Answer 8

Dec the Colories, esp from carbos

Question 9

Respiratory Quotient >1.0

Answer 9

Overfeeding

balanced = 0.85

Question 10

What is the most common adverse effect of vasopressin?

Answer 10

Decreased CO (bc dec HR)
-- should be added after max Norepi

Question 11

Initial treatment for invasive aspergillosis in Neutropenic patient

Answer 11

VORIconazole
C. krusei - Vori
C. glabrata - Micfungin
C. albicans - Fluc

Question 12

Dopamine effects (Low v Mod v High)

Answer 12

Low Dopamine = Dopa-R to increase mesenteric blood flow
Mod Dopa = Beta adrenergic-R and inc contractility
High Dopa = alpha adrenergic, induce vasoconstriction

Question 13

Emergent Uremic Coagulopathy Tx

Answer 13

DDAVP temporary before

Dialysis

Question 14

_____ = MC inheritable coagulopathy; why?

Answer 14

Factor V Leiden - Activated Protein C is unable to inhibit the altered Factor V therefore more thombus is made

Question 15

AKI and increase in Serum Cr?

Answer 15

Increase in plasma Creatinine by < 50% indicative of AKI

Question 16

Suspected Treacheoinominate fistula s/p Trach 3 weeks ago, how to dx? (steps after)

Answer 16

Flexible bronch, then digital occlusion and cuff overinflation then to OR

Question 17

Lab findings associated with DIC?

Answer 17

High fibrin split products

Question 18

Found down, hypotensive brady and warm. Dx?

Answer 18

Neurogenic shock

Question 19

What causes right shift of O2 binding curve? (4)

Answer 19

1. Increased DPG
2. Inc Temp
3. Inc PP CO2
4. Increased H (acidosis)

Question 20

As the 02 binding curve, goes RIGHT, Hgb has ____ affinity for O2

Answer 20

Right shift of 02 binding curve, Hgb has LESS affinity for 02 meaning it will readily release 02 to tissues
(*think of lactic acidosis bc hypoperfusison)

Question 21

On the 02 binding curve, Left shift means Hgb has _____ affinty for 02

Answer 21

Left shift = HIGHER affinity, therefore holds on more

Question 22

__ and ___ cause a LEFT shift in oxygen binding curve

Answer 22

CO and Meth-Hgb

Question 23

MTP ratio of products

Answer 23

1:1:1

Question 24

If dx is Compartment syndrome, go to OR; if in doubt, what can you do?

Answer 24

Measure compartment pressure (if patient is obtunded or in kids)

Question 25

Classification of systolic v diastolic HF

Answer 25

HFrEF= EF < 40% is systolic | HFpEF EF>50 = DIAstolic

Question 26

MCC diastolic HF (HFpEF)

Answer 26

HTN>>DM, CM

Question 27

The use of nitroprusside to reduce after load must be used cautiously as it can induce _____ toxicity

Answer 27

The use of nitroprusside to reduce after load must be used cautiously as it can induce CYANIDE toxicity

Question 28

What is a secondary cause of hepatic failure

Answer 28

Septic shock bc its a reflection of the overall critical condition

Question 29

POD 3 s/o lobectomy with HR 150s and irregular. Dx and why?

Answer 29

A fib - usually fluid resus causes atrial distension and then A fib

Question 30

The use of US for CVC placement decreases? (3)

Answer 30

Rate or arterial puncture hematoma formation number of attempts

Question 31

GCS 7, TBI, most important info?

Answer 31

PMH; specifically if taking any blood thinners

Question 32

Before considering brain death exam, patient must have? (4)

Answer 32

1. irrevesible and proximate cause of coma 2. normotension 3. no sedation or paralytics 4. no acid base or electrolyte disturbances

Question 33

Criteria for brain death exam?

Answer 33

1. Normothermia for > 6 hours 2. Loss of all reflexes 3. Failed apnea test = 4. If apnea aborted (when pt deasts tp < 85% during 8 mins off vent) then need CT A or MR-A brain flow study

Question 34

3 Phases of ARDS

Answer 34

1. Exudative = protein rich fluid moves to alveolar fluid Leukocytes proliferate and cause intrinisic lung injury 2. Fibroproliferative - collagen formation stiff lung 3. Resolution when the lung clears the edema

Question 35

Anorexia/Refeeding

Answer 35

HypoPhosphotemia and HypoKalemia in AN. TPN =carbs which increases Insulin which moves K and Phos into the cell. Electrolyte imbalance

Question 36

Sepsis from ___ is associated with lowest mortality rate in ICU

Answer 36

UTI

Question 37

s/p intubation with hypotension, hyperresonace and absent breath sounds. Dx? Pathophy?

Answer 37

Tension PTX (bc hemothorax is dullness to percussion). Tension PTX causes dec venous return

Question 38

CPP equation and value? | what about TBI?

Answer 38

CPP = MAP-ICP MAP 60+ and ICP (10) So CPP should be above 60 In TBI, CPP 60-70 and ICP <20

Question 39

Afib and HDS tx?

Answer 39

B blockade

Question 40

Hypovolumic shock can be caused by ??

Answer 40

hemorrhage, dec intravascular volume from diarrhea, adrenal insuff, DI and dehydration

Question 41

Obestity hypoventilation characterized by _

Answer 41

hypoxemia and hypercapnia; chest wall compression leading to alveolar collapse; dec ventilation

Question 42

Transcutaneous pacing indications

Answer 42

``` Sx bradycardia Av blcok (TII second or TIII) ```

Question 43

Avoiding Iatrogenic catherter placement in Men

Answer 43

1. standard Foley 2. 18. Fr Coude catheter 3. Urology consult

Question 44

Low v med v high risk surgerys

Answer 44

``` Low = <1% risk MI breast and endoscopy Med = 1- 5% risk = ENT, Thoracic, abdominal, ortho, CEA High= >5% emergent, cardiac and vasc ```

Question 45

Periop cardiac risk increased in patients unable to perform _ METs

Answer 45

4 METs - climbing a flight of stairs, walking up a hill, walking at 4mph, or mod intensity chores

Question 46

Mechanism: hypokalemnia in GOO

Answer 46

Vomiting --> Dehydration --> kidneys inc the Na reabsorption (more than K) -- leads to hypokalemia

Question 47

Berlin criteria of ARDS

Answer 47

1. Resp dysfxn within 1 week 2. CXR with b/l opacities 3. P/F 201-330 =mild P/F 100-200 = moderate P/F < 100 severe

Question 48

Pancreatitis + possible aspiration. HOw to feed?

Answer 48

Naso Jejunal feeding tube

Question 49

2 biggest RFs for bleeding from gastric stress ulcers are ? And PPx?

Answer 49

coagulopathy and mech vent > 48 hours. Other RFs: h/o GI bleed, renal failure, TBI, burns, sepsis Start PPI > H2 blocker

Question 50

HAP that is not present on admission occurs _ 48 hours or more after time of admission

Answer 50

48 hours

Question 51

HTN + hypokalemia +weakness. DDX and w/u?

Answer 51

Hyperaldosteronism (primary or secondary) Renin/Aldo ratio > 20 = primary R/A ~10 secondary

Question 52

32 M with pheo undergoin Left adrenalectomy. During the case, pt was HTN and after case went to ICU. Pt unresponsive with lactic acidosis 3.2. what tx would be helpful?

Answer 52

AMS + lactic acidosis usually cyanide toxicity by notroprusside. IV nitroprusside used in cases of hypertensive crises. Tx hydroxocobalamin and sodium thiosulfae

Question 53

what is a RF for multi drug resistant HAP?

Answer 53

renal replacement therapy

Question 54

UGI s/p transfusion and 15. inutes later patient complains of chills

Answer 54

acute transfusion reaction | release of cytokines from donor WBCs

Question 55

ICU with necrotizing panc is hypotensive with UOP 10cc/hr. Maxed with NE. Another vasopressor started and hour later \UOP increased. what was the agent?

Answer 55

Doapamine