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Critical Care > Critical Care Modules part I > Flashcards

Critical Care Modules part I Flashcards

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1
Q

what are the 5 H’s in H’s/T;s

A

hypovolemia, hypoxia, hypothermia, hypo/hyper K, hydrogen (acidosis)

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2
Q

what are the 5 T’s in H’s/T’s

A

tamponade, tension pneumothorax, toxins, thrombosis pulmonary, thormbosis coronary

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3
Q

what is the FiO2 for 2lpm nasal canula

A

= 21% + 3* ( _ lpm) = 27%

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4
Q

ESKAPE pathogens (increasing resistance)

A

enterococcus, staph aureus, klebsiella and ESBL e coli, acinetobacter, pseudomonas, enterobacter

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5
Q

time dependent abx

A

beta lactams, carbapenems, linezolid, erythromycin

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6
Q

conc-dependent abx

A

aminoglycosides, metronidazole

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7
Q

AE of daptomycin

A

myopathy

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8
Q

televancin and quinopristin-dalfopristin use

A

last resort for MRSA and VRE

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9
Q

AE FQs

A

qtc prolongation, drug itneraction w warfarin, avoid w/ divalent cations

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10
Q

abx good in legionnaries

A

macrolides

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11
Q

poly myxin good for and toxicity

A

MDR organisms. but neuro and nephro toxic

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12
Q

what connects RA and LA

A

buchmanns bundle

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13
Q

tx for sinus brady

A

atropine or pacing if unstable

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14
Q

a flutter rotates this direction

A

counter clockwise

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15
Q

bpm a flutter

A

250-300

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16
Q

wandering atrial pacemaker vs multifocal atrial tach

A

same but MAT > 100. 3 different p morphologies

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17
Q

criteria for v tach

A

absence of RS in v1-v6, onset of R to nadir of S is greater than 100 ms, AV dissociation

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18
Q

tx v tach

A

amiodarone if decreased LV function; DC cardioversion oif preserved LV function, defibrillation if pulseless vtach, procainamide, sotalol

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19
Q

tx torsades

A

magnesium

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20
Q

tx and dose for SVT

A

6 mg IV adenosine

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21
Q

plateau pressure =

A

peak airway pressure - resistance of circuit/airway

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22
Q

break down the rule of 9s for burns

A

whole arm = 9% each; whole leg = 18% each; front torso = 18%, back torso = 18%, head = 9%, genitals = 1%

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23
Q

resus burns with this fluid

A

LR

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24
Q

parkland formula

A

4 ml * body weight kg * %BSA (note: w/ 2* or 3* burns only). Give half in first 8 hours. half in next 16

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25
burn center referral criteria (doesn't mean urgent)
1) >10% BSA or 3rd degree burn. 2) Involve sensitive areas (e.g. hands, face, genitalia). 3)Electrical or chemical. 4) inhalation injury
26
coumadin affects these factors (and so does liver failure)
II, VII, IX, X, C, S
27
factors made outside liver
VIII by endothelial cells
28
difference in coag labs between liver dysfunction and sepsis DIC
in liver failure, VIII and vWF are increased
29
why is plt production impaired in liver failure
liver makes TPO. also cirrhotic livers sequester
30
why is arterial ammonia better to measure
its before tissues can consume some
31
AE metronidazole
neurotoxicity
32
AE lactulose
diarrhea and hypernatremia
33
ratio of spironolactone:lasix to maintain normokalemia
100:40
34
SAAG for transudate (portal HTN)
high, i.e. >1.1
35
tx hepatorenal syndrome
albumin and specific vasoconstrictors (nore, midodrine, octreotide) help in the short term. liver transplant is only cure
36
factors for MELD
bili, INR, Cr
37
factors for Child and which is worst class
bili, PT, ALBUMIN, encephalopathy, ascities
38
dx of hypoosmolar hypovolemic hypo Na
if FENa > 1% diuretics, aldosterone def, RTA. if <1%, actual dehydration or third spacing
39
dx of euvolemic hypoosmolar hypo Na
dilute urine (<100 mOsm), UNa <30 = polydipsia. concentrated = SIADH
40
correction of hyponatremia
1-2 mEq/L/hr but not more than 12 in 24 hrs
41
free water deficit in hyper Na
0.6 * total body weight * [MeasuredNa/140 - 1]
42
correction rate of hypernatremia
if symptomatic, correct 1-2 mEq/L/hr. Give 1st half of NS in first 12-24 hrs. Give rest in next 24 hrs. if asymptomatic, max 0.5 mEq/L/hr, max 10/day
43
sx low K
weakness, arrhythmia, glucose intolerance
44
dx renal potassium wasting
K-to-Cr ratio >13 mEq/g or 24 hr total > 30 mEq
45
hypo K with acidosis
RTA 1 (distal) or RTA 2 (proximal)
46
hypo K with alkalosis
primary mineralocorticoid excess, Barters, Gitelman
47
EKG hyper K
peaked T >> prolonged PR >> wide QRS >> short QT
48
tx hyper K
calcium to protect heart. redistribute w/ insulin + glucose, bicarb, albuterol. remove w/ lasix, sodium polystyrene sulfonate (kayexalate), dialysis
49
s/s hyper Ca
fatigue, confusion, brady, arrhythmia
50
tx hyper Ca
NS, lasix/loops, RRT, IV bisphosphonates, glucocorticoids, calcitonin
51
s/s hyper mag
loss of DTR --> respiratory and cardiac depression
52
tx hyper mag
stop mag. give loop diuretics and calcium
53
causes low mag
alcohol, renal, GI, manutrition, pancreatitis, burns, trauma
54
s/s low mag (conjunction w/ low k)
torsades and seizures
55
cleanest central line
subclavian
56
optimal duration for VAP tx
8 days, except if nonfermenting GNRs like pseudomonas (15 days)
57
indications for tx asymp bacteruria
pregnant, undergoign urologic surgery, or women who had shor term cath but persistent bacteria >48 hrs after removal
58
UTI tx duration
3 days of <65 Y without upper tract signs. otherwise: 5-7 if prompt resolution of sx. 10-14 for delayed resolution
59
cranberry product benefits in UTI
women w/ recurrent uti
60
methanomine salts and utis
help after gyn srugery w/ indwelling caths < 1 week
61
number of people that one can save w/ donated organs
9. | 2 lungs, 2 kidneys, 2 halves of liver, 1 heart, 1 small bowel, 1 pancreas
62
day 1 ICU care bundle
identify medicla decision maker. give leaflet of info
63
day 3 icu care bundle
social work and spiritual work
64
day 5 icu care bundle
family meeting
65
idea body weight
X kg + 2.3 * (inches over 60) x = 50 in males, 45 females
66
dosing body weight
IBW + 0.4 (TBW-IBW)
67
when to use dosing body weight
if TBW is 130% or more of IBW
68
dosing of vanc
15-20 mg/kg TBW
69
loading dose of vanc if suspect meningitis
25 mg/kg
70
t/12 of vanc
5-7 hrs
71
when to measure vanc levels
after 4-5 half lives (steady state). then check weekly when longer durations
72
interval dosing for aminoglycosides
based on population parameters. usually 8-12 hrs
73
pharmacokinetic considerations of amnioglycosides
positive charge, poorly absorbed by GI. so use IM or IV. however, avoid IM in septic shock due to decreased perfusion
74
t1/2 aminoglycoside
2-3 hrs
75
aminoglycosides have poor penetration in these tissues
brain, lung, prostate, fat
76
what body weight do you use to dose aminoglycosides
IBW because doesn't distribute into fat
77
the polarity of this abx helps concentrate it into extracellular compartments
aminoglycosides
78
this abx has a post-antibiotic effect
aminoglycosides
79
when to measure levels of aminoglycosides
twice after first dose. one at 2 hrs, one at 10. obtain random levels if rapidly changing renal function, intermittent dosing, or unsure how much was given
80
when can you use HartfordNomogram for abx
aminoglycosides if extended infusion and patient has normal/stable cr clearance
81
which causes reflex brady: phenylephrine or vasopressin
phenylephrine
82
inotropic vasodilators
milrinone and dobutamine
83
hct of a unit of blood
55-65
84
why does older blood carry less oxygen
decreased 2,3 dpg causes left shift
85
etiology nonhemolytic febrile transfusion rxn
recipient has antibodies to donor WBCs. can prevent by leukodepletion
86
MC prdct causing TRALI
FFP
87
etiology TRALI
anti-HLA in DONOR activates recipient neutrophils

Critical Care (2 decks)

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