PPT Review

Question 1

Starting pressor dose for norepinephrine?

Answer 1

5 mcg/min

Question 2

Starting pressor dose for dobutamine?

Answer 2

5 mcg/kg/min

Question 3

Starting pressor dose for vasopressin?

Answer 3

0.04 units/min
NOT TITRATABLE :)

Question 4

What antibiotics for CAP and doses?

Answer 4

Ceftriaxone (2 g IV daily) and azithromycin (500 mg IV daily)

Question 5

What antibiotics for VAP and doses?

Answer 5

Vancomycin 15 mg/kg/IV q 8-12 h
Piperacillin-tazobactam (Zosyn) 4.5 g IV q 6h

Question 6

MOA norepinephrine? Caveat?

Answer 6

vasoconstriction

Caveat: some ionotropic

Question 7

MOA angiotensin II? Caveat?

Answer 7

ATII agonists

Caveat: only used in distributive shock

Question 8

How does CO, CVP, PCWP, PA pressure, and SVR change in cardiogenic shock?

Answer 8

CO: low
CVP: high
PCWP: high
PA pressure: high
SVR: high

Question 9

How does CO, CVP, PCWP, PA pressure, and SVR change in obstructive (PE) shock?

Answer 9

CO: low
CVP: high
PCWP: NORMAL
PA pressure: high
SVR: high

Question 10

How does CO, CVP, PCWP, PA pressure, and SVR change in hypovolemic shock?

Answer 10

CO: down
CVP: down
PCWP: down
PA pressure: down
SVR: high

Question 11

How does CO, CVP, PCWP, PA pressure, and SVR change in distributive shock?

Answer 11

CO: up
CVP: down
PCWP: down
PA pressure: down
SVR: down

Question 12

what is a normal PA pressure?

Answer 12

systolic 15 – 25
diastolic 8-15

Question 13

what is a normal PCWP?

Answer 13

8-12

Question 14

If venous sat is no longer 75% but drops to 60% will the arterial sat be low?

Answer 14

Depends on health of the lung

If cardiogenic shock, anemia, low arterial saturation

If lung is normal will not impact

Question 15

What is the relationship between PaCO2, CO2 produced, and alveolar ventilation?

Answer 15

PaCO2 is directly proportional to amount of CO2 produced and indirectly proportional to alveolar ventilation

PaCO2 = (VCO2 X 0.863) / [RR X Vt (1-Vd/Vt)]

Question 16

What has more impact on CO2 - tidal volume or RR?

Answer 16

change tidal volume has more impact on CO2 than rate on the vent

Question 17

What is SVR equation?

Answer 17

SVR = [(MAP-CVP)/CO]*80

Question 18

Fluid resuscitation goals in sepsis?

Answer 18

Crystalloid fluid within first 3 hours (30 cc/kg)

Question 19

What does the ICU checklist entail?

Answer 19

Feeding
Analgesia
Sedation
Thromboprophylaxis
Head of bed elevated
Ulcer prophylaxis
Glucose control
Skin
Bowel
Indwelling catheters
De-escalation of antibiotics/delirium

Question 20

How are CO and cardiac index (CI) related?

Answer 20

CO = CI *BSA

Question 21

What is Winter’s formula?

Answer 21

pH = 1.5 x bicarb + 8 +/- 2 (this is what your PCO2 should be if appropriate compensation).

Question 22

How do you determine compensation for metabolic acidosis? for metabolic alkalosis?

Answer 22

For metabolic acidosis : Winter’s Formula
For metabolic alkalosis: pH = PaCO2

Question 23

How do you calculate delta-delta?

Answer 23

AG -10 + bicarb on chem panel

If too low (not around normal bicarb) = additional non gap met acidosis
If too high (higher than normal bicarb) = additional metabolic alkalosis