Critical Care Error List

Question 1

What is Diabetic Ketoacidosis

Answer 1

When the body is unable to use glucose because all the glucose is being flushed out of your system
Hyperglycemia

Question 2

What causes DKA

Answer 2

Hormonal changes cause excess glucose, leads to osmotic diuresis which leads to increased lipolysis and increased acetyl-CoA which churns out Ketones
There is a shift to anaerobic respiration: Ketones are made

Question 3

What are the 2 main Ketones made, which one predominates

Answer 3

Acetone and Beta-Hydroxybutyrate

Mostly Beta

Question 4

What is offending factor that starts up DKA

Answer 4

Infection, not taking insulin appropriately, first presentation of DM, MI

Question 5

Dx of DKA

Answer 5

Glucose >250

Serum pH

Question 6

Sx of DKA

Answer 6

Polyuria, Polydipsia, Weakness, Blurry Vision, “I ran out of insulin”
Dehydration, Acetone Smell, Abdominal Tenderness
Kussmaul Respiration

Question 7

Tx of DKA

Answer 7

IV fluids is 1st (Isotonic then D5)
Regular Insulin is next
Potassium (always, even if potassium levels are fine now)
Bicarbonate only in severe cases

Question 8

What is a Thyroid Storm

Answer 8

A complications of untreated Thyrotoxicosis (Hyperthyroidism)

Question 9

What causes a thyroid storm

Answer 9

Surgery, trauma, infection

Question 10

Sx of Thyroid Storm

Answer 10

Hypermetabolic State: Palpitations, A.Fib, Tachycardia, High Fevers, N/V, Psychosis, Delirium, Tremors

Question 11

Dx of Thyroid Storm

Answer 11

Decreased TSH

Increased T3/T4

Question 12

Tx of Thyroid Storm

Answer 12

Anti-Thyroid Meds: Methimazole, PTU
Beta Blockers for sx
Supportive IV
Glucocorticoids

Question 13

What is a Pericardial Effusion

Answer 13

Increased fluid in the pericardial space

Question 14

What causes a Pericardial Effusion

Answer 14

Pericarditis

Question 15

Sx of Pericardial Effusion

Answer 15

Distant Heart Sounds
Pleuritic Chest Pain worse with laying down, relieved with leaning forward
May radiate to trapezius

Question 16

Dx of Pericardial Effusion

Answer 16

EKG: Low voltage QRS Complex, Electric Alternans (QRS Alternates between big and small), Tachycardia

Question 17

Tx of Pericardia Effusion

Answer 17

Tx Pericarditis
ASA, NSAIDS, Colchicine
Pericardiocentesis if tamponade or large effusion

Question 18

What is Acute Respiratory Distress Syndrome

Answer 18

Non-Cardiogenic Pulmonary Edema
Life-Threatening acute hypoxemia respiratory failure, usually in critically ill patients
Usually due to sepsis

Question 19

What is a hallmark sign of Acute Respiratory Distress Syndrome

Answer 19

Not response to 100% oxygen

Question 20

Sx of ARDS

Answer 20

Acute Dyspnea, Hypoxemia with mulit-organ failure if severe

Question 21

Dx of ARDS

Answer 21

ABG
CXR: Diffuse, Bilateral pulmonary infiltrates, white out pattern
Resembles CHF but heart is normal
Cardiac Cath: PCWP

Question 22

Tx of ARDS

Answer 22

CPAP with full face mask

Question 23

What is a Hypertensive Urgency

Answer 23

Increased BP but without any acute end-organ damage

Question 24

What is considered increased BP in Hypertensive Urgency/Emergency

Answer 24

Systolic BP >220

Diastolic BP >120

Question 25

Tx for Hypertensive Urgency

Answer 25

Decrease BP by 25% in first 24-48 hours using ORAL agents

Question 26

What is a Hypertensive Crisis/Emergency

Answer 26

Increased BP (>220/110) WITH Acute end-organ damage

Question 27

Sx of end-organ damage in Hypertensive Crisis/Emergency

Answer 27

Neurologic damage: encephalopathy, hemorrhagic or ischemic stroke Cardiac damage: ACS, HF, Aortic Dissection Renal Damage: AKI, Proteinuria, Hematuria Retinal Damage: Maliganant HTN

Question 28

Tx for Hypertensive Crisis/Emergency

Answer 28

Decrease BP by 10% in the first hour Additional 15% decrease in the next 2-3 hours Both with IV agents

Question 29

What is Acute Angle Closure Glaucoma

Answer 29

Increased Intraocular pressure that can lead to optic damage (decreased visual acuity) This is an EMERGENCY

Question 30

What is Acute Narrow Angle Glaucoma related to

Answer 30

Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm

Question 31

Sx of Acute Angle Closure Glaucoma

Answer 31

Halos around lights, Peripheral visual loss (tunnel vision) Severe, unilateral ocular pain, N/V, Headache, intermittent blurry vision Conjunctiva erythema, steamy cornea, nonreactive pupil, eye fells hard to palpation

Question 32

Dx of Acute Angle Closure Glaucoma

Answer 32

Tonometry shows Increased IOP | Cupping of optic nerve

Question 33

Tx of Acute Angle Closure Glaucoma

Answer 33

``` First lower the IOP, then open the angle Acetazolamide IV is 1st line Topical Beta Blockers reduced IOP Miotics/Cholinergics (Pilocarpine, Carbachol) Peripheral Iridotomy is DEFINITIVE ```

Question 34

What is Cardiac Tamponade

Answer 34

Pericardial effusion that causes significant pressure on the heart It restricts ventricular filling which results in decreased CO

Question 35

Sx of Cardiac Tamponade

Answer 35

Beck's Triad: Distant muffled heart sounds, increased JVD, Systemic Hypotension Pulsus Parodoxus: More than 10mmHg decrease in systolic BP with inspiration Dyspnea, fatigue, peripheral edema

Question 36

Dx of Cardiac Tamponade

Answer 36

Echo: Effusion + Diastolic Collapse of cardiac chamber

Question 37

Tx of Cardiac Tamponade

Answer 37

Pericardiocentesis