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PGY-2 > Critical Care, Ventilation, Etc > Flashcards

Critical Care, Ventilation, Etc Flashcards

(115 cards)

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1
Q

Inotropy

A

increased cardiac output

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2
Q

Hypovolemic Shock

A

<p>**low preload**
low CO
high SVR</p>

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3
Q

<p>Cardiogenic Shock</p>

A

<p>high preload
**LOW CO**
high SVR</p>

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4
Q

<p>Causes of Cardiogenic Shock</p>

A 
<p>Cardiomyopathy/SHF
acute MR or AS
Arrthythmia (V fib or complete heart block)
Brady or tachy
</p>
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5
Q

<p>Distributive Shock</p>

A

<p>decreased preload
increased CO
decreased SVR</p>

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6
Q

<p>Causes of Distributive Shock</p>

A 
<p>Septic
Anaphylaxis
Neurogenic
Endocrine
Drugs</p>
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7
Q

<p>Obstructive Shock</p>

A

<p>decreased preload
**decreased CO**
increased SVR</p>

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8
Q

<p>Causes of Obstructive Shock</p>

A

<p>PE or severe RHF
Tension pTx
pericardial tampaonade
restrictive/constriction</p>

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9
Q

<p>Respiratory Acidosis =</p>

A

<p>increased PCO2

| compensation is increasing bicarb</p>

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10
Q

Respiratory Alkalosis =

A

decreased PCO2

compensate by decreasing hco3

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11
Q

Metabolic Acidosis =

A

decreased bicarb

copenensate by decreasing Co2

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12
Q

Metabolic Alkalosis=

A

increased bicarb

compensate by increasing co23

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13
Q

Delta Gap

A

AG-12/24-Bicarb;
<1 NGMA;
>1 met alkalosis

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14
Q

Winter’s formula

A

pco2= 1.5xbicarb + 8 +/-2

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15
Q

Metabolic Alkalosis with hypochloriduria/fluid responsive

A

vomiting
NG suction
over diuresis
post hypercapnia

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16
Q

<p>ARDS- Berlin Definition</p>

A 
<p>Timing w/in 1 week of symptoms/insult
Bilateral opacities
Edema (resp failure not fully explained by cardiac failure or volume overload)
Poor Oxygenation 
</p>
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17
Q

<p>Oxygenation Criteria for ARDS - Mild</p>

A

<p>200-300 PaO2/FiO2 w/ PEEP or CPAP >5</p>

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18
Q

<p>Oxygenation Criteria for ARDS- Moderate</p>

A

<p>100-200 PaO2/FiO2 w/ PEEP >5</p>

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19
Q

<p>Oxygenation Criteria for ARDS- Severe</p>

A

<p>Pao2/fio2 <100 w/ peep>5</p>

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20
Q

<p>Stages of ARDS</p>

A

<p>Exudative
Fibroproliferative
Recovery</p>

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21
Q

<p>Exudative Phase of ARDS</p>

A

<p>fluid, protein, and inflamm cells leave alveolar capillaries and accumulate in airspace resulting in decreased pulmonary compliance and VQ mismatch (both physiologic shunting and dead space)</p>

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22
Q

<p>Fibroproliferative Phase of ARDS</p>

A

<p>Chronic inflammation causes connective tissue to proliferates in response to initial injury causing fibrosis. Pulmonary HTN may develop as a result</p>

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23
Q

<p>Recovery Phase of ARDS</p>

A

<p>Lung reorganizes as the aveloar epithelila barrier is restored. Gradual improvement of lung function over 6-12 months</p>

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24
Q

<p>TV in ARDS</p>

A

<p>ideal is 6ml/kg </p>

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25

PEEP in ARDS

no difference in outcomes in low vs high PEEP, recommend only using high PEEP in severe ARDS

26

Steroids in ARDS

no clear evidence | increased mortality if given after 14+ days (fibroliferative phase)

27

HFNC in ARDS

decreases intubation

28

Cisatricurium in ARDS

given in severe ARDS that presented within 48 hours

29

Agitation in ICU- first line

propofol | dexmedetomadine

30

Propofol AE

hyperTG --> pancreatitis Infusion syndrome w/ lactic acidosis, liver and renal failure, GREEN URINE

31

Vascular tone=

resistance

32

alpha 1&amp;2

blood vessels | VASOCONSTRICT

33

beta one

myocardium | inotropy/chronotropy

34

Beta two

blood vessels | vasodilation

35

V1

blood vessels | vasoconstriction

36

NE- what receptors

alpha > beta 1 | Increase SVR w/ slight increase in CO

37

NE- adverse effects

arrhythmias

38

Ne- use

first line septic shock

39

Phenylephirne

alpha one (increase SVR)

40

Epi

b1 / b2 --> alpha one | increased SVR w/ higher dose

41

Phenylephinephrine use

use if arrhythmias w/ NE or as adjunct

42

Dopamine

D --> B1 --> alpha one

43

Vasopressin

V1, vasoconstriction adjunct high doses decrease UOP

44
Dobutamine receptors
B1 and B2 increase inotropy, chronotropy vasodilation and afterload reduce
45

Dobutamine AE

dysrhythmia, hypotension

46
Dobutamine indications

cardiogenic shock and HTN | better w/ RF patients

47
Milirinone
PD3 inhibitor inotropy, profound systemic and pulmonary vasodilation use if PAH/RHF
48

First line for anaphylaxis shock

EPI

49

Compliance =

Volume/Pressure

50

Alveolar Ventilation=

(TV-dead space) x RR

51

BiPaP- how it works

Inspiratory pressure / PEEP (IPAP and EPAP) | backup respiratory rate

52

Peak Inspiratory Pressure

pressure required to deliver TV

53

Plataea Pressure

pressure required to distend the lung measured during inspiratory phase measure of compliance!

54

PEEP

pressure applied during exhalation | increases recruitment of collapsed alveoli

55

Assist Control

breaths triggered by preset machine rate or negative pressure/patient effort preset rate acts as a backup overbreathing, CO2 is high, can develop mild resp alk

56

SIMV

combines spontaneous breaths with ACV breaths mandatory minimum resp rate is set Set rate gives you TV for those, for generated breathes you determine TV

57

Problems when increasing PEEP

decrease venous return increase PIP increase risk for barotrauma

58

Urine Anion Gap

greater then 0 --> RTA type 1 and 4 excretion of ammonium chloride impaired RTA, reanl failure, HYPOaldosteronism

59

Mechanism behind Urine Anion Gap

Acidosis causes secretion of NH4+ then Cl- is secreted for balance use Cl- for measurement of acid excretion Urine NA + K - Cl

60

Differential for Elevated Osmolar Gap

```

greater than calculated, consider methanol ethylene glycol isopropyal alcohol toluene

```
61

paO2 should be

greater than 60

62
inspiration and thoracic pressure
inspiration --> decrease thoracic pressure | increases venous return to the heart
63

IVC as measure of hydration

collapse = dehydration; correlate to CVP less than 1.5 cm = CVP of 0-5 respiratory= total collapse

64

Acid/Base: Timeline for respiratory vs metabolic compensation

hours for respiratory | 2-5 days for metabolic

65
Acid/Base: Disorders where pH can normalize?
classically: chronic resp alkalosis | some evidence for chronic resp acidosis
66
AGMA: Why does the gap increase physiologically?
Bicarb decreases (have more cations)
67
AGMA: Why does albumin matter?
weak acid
68
AGMA + Normal Lactate, consider.....
alcoholic ketoacidosis | ketonuria measures acetoacetate NOT B-hydroxyl which is predominate in alcohlid
69
AGMA: D-lactic acidosis
short bowel syndrome
70
Physiology behind NAGMA
decrease in bicarb with increase in chloride ions | = hyperchloremic metabolic acidosis
71
NAGMA loss of bicarb due to
GI losses: diarrhea, utereal diversion | Renal loss: RTA, early renal failure
72
ACIDOSIS: GOLD
Glycols-ethylene, proplene 5-Oxoproline L-lactate, D-Lactate
73
ACIDOSIS: MARRK
``` Methanol Aspirin Renal Failure Rhabdo Ketoacidosis ```
74
Metabolic Alkalosis: Chloride Responsive Mechanism
blood volume reduced --> RAAS activated --> reabsorb Na, Cl, Bicarb
75

Intubation- preinduction agents

fentanyl (pain) | lidocaine (prevent bronchospasm, ICP)

76

Intubation- induction agent

ketamine, etomidate, versed, propofol

77

Intubation- paralytic

roc or succ

78

Internal Jugular Vein VASCULAR anatomy

IJV + subclavian --> brachiocephalic --> SVC --> RA

79

Internal Jugular Vein anatomy for central line placement

- between two heads of SCM and clavical | - lateral and anterior to carotid a

80

IJV Central Line Pros and Cons

lower risk of PTX, infection | however can puncture carotid, CI in CEA

81

Subclavian Central Line Pros and Cons

more comfortable and lower infection risk | highest PTX risk

82

Subclavian Line Contraindications

coagulopathy SVC thrombosis upper thoracic trauma

83

Subclavian Line Insertion Anatomy

Intraclavicular | seprated from subclavian a by scaline muscle

84

Femoral Line Pros and Cons

good for coagulopathics | no neeed for CXR

85

Femoral Line contraindications

DVTs, IVC filter, local infection

86

Indications of low cardiac output in shock

narrow pulse pressure cool extremities delayed cap refill

87

Indications of high cardiac output in shock

wide pulse pressure +/- low diastolic pressure warm extremities bounding pulses

88

Initial CPAP settings

5-10

89
Initial BiPAP settings
10/5
90

GCS - Basics

Eye - 4 Verbal - 5 Motor - 6

91

GCS: Eyes

```

none -1 pain - 2 verbal -3 spontaneous -4

```
92

GCS: Verbal

```

Intubated/no response -1 Incomprehsnible sounds 2 Inappropriate owrds 3 COnfused 4 Oriented 5

```
93

GCS: Motor

```

none-1 extension to pain-2 flexion to pain-3 withdrawal-4 localize-5 commands-6

```
94

Ground Glass Opacity Differential

- inflamm - edema - neoplasm - interstitial thickening - fibrosis

95

Nodular Pattern on CXR Ddx

Granulomatous Disease Pneumococosis Malignancy

96

Air Bronchogram =

Airspace disease

97

Airspace Disease DDx

```

Water/Pulm Edema Pus: Infectious or inflammation Blood: Diffuse alveolar hemorrhage Cells: carcinoma, lymphoma Lipoprotein: pulmonary alveolar proteinosis

```
98

Reticular Pattern Ddx

```

Interstitial pulm edema IPF Granulomas Interstitial PNA Collagen Vascular Disease Pneumoconiosis

```
99

Navigating the vent problems- how to use peak and plateau

increased peak and plateau = compliance issue | increased peak w/ normal/decreased plateau= airway problem

100

Plateau pressure=

pressure in alveoli at end of inspiration | measure w/ inspiratory hold

101

RSBI

RR/TV(L) less than 105 to extubate

102

NIF and weaning

less than 20

103

ABCs of ventilator weaning

patient is AWAKE patient is BREATHING patient can gag/COUGH

104

Status epilepticus- what to give initially

4mg lorazepam | load with pheny or fospheny at 20mg/kg

105

Goal ICU Blood Glucose

140-180

106

Trophic Feeds

if on pressors | 10-20cc/hr

107

Altered mental status mmnemoic

DONT Dextrose, Oxygen, Narcan 0.4, Thiamine 100mg IV

108

Oxygen content of room air

21%

109

Nasal Canula- Oxygen Delivery

roughly 4% per L | 1-6L; 24-44%

110

Venturi Mask

FiO2 0.24-0.5, Variable LPM

111

Non-Rebreather

10-15L (flow has to keep bag from deflating), FiO2 .7-1.0 (85-95%)

112

Goals of High Flow Nasal Oxygen

Eliminate dead space | Reservoir of FiO2 in nasal cavity

113

LPM w/ High Flow Nasal Oxygen

8L in pediatrics | 60L in adults

114

Warm Shock =

Cap Refill <2 Secs, warm, flushed Bounding pulse, tachycardia Normotension w/ wide pulse pressure

115

Cold Shock =

Cap Refill >2 seconds, cold clammy tachy or brady hypotension

PGY-2 (21 decks)

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