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*Surgery > Surgical Critical Care > Flashcards

Surgical Critical Care Flashcards

(71 cards)

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1
Q

examples of conditions that need surgical critical care

A 
trauma
burns
severe pancreatitis
rupture aneurysms
cholangitis
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2
Q

what are some post op complications that can cause someone to be in the surgical ICU

A

renal failure
PE
myocardial infarction
sepsis

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3
Q

evaluation of the critically ill or injured patient

A

ABC
obtain history (AMPLE)
rapid primary survey and tx or correct problems
perform a secondary survey

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4
Q

what are some resuscitation fluids

A

crystalloid (NS, LC)
colloids (Hespan, Albumin)
blood products

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5
Q

typically into radial artery, get pulse by pulse BPs, can draw ABGs right from it

A

Arterial pressure monitoring

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6
Q

Measures cardiac output, mixed venous oxygen saturation, systemic venous resistance and most importantly, pulmonary artery diastolic pressure (PADP) and PAWP

A

Pulmonary Artery catheter

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7
Q

what are the pressures from teh pulmonary artery catheter used to estimate?

A

Left ventricular filling pressure and help guide fluid and vasoactive drug administration

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8
Q

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in inflammation which leads to generalized cellular hypoxia

A

Shock

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9
Q

caused by a problem with heart rate or stroke volume

A

low cardiac output

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10
Q

caused by a problem with heart rate or stroke volume

A

low blood pressure

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11
Q

hypovolemia with direct soft tissue injury and bone fractures

A

traumatic shock

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12
Q

compression of the heart or great veins

A

compressive cardiogenic shock

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13
Q

loss of autonomic control of the vasculature

A

neurogenic shock

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14
Q

intravascular volume depletion through hemorrhage or loss of plasma volume (3rd spacing, burns or GI losses)

A

Hypovolemic shocks

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15
Q

tx for hypovolemic shock

A

replace fluids
2-3 L crystalloid over 10-30 minutes
blood products if needed
stop volume loss

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16
Q

over what percent blood volume loss does your HR increase

A

15%

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17
Q

when does the BP start to drop with hemorrhagic shock

A

30-40%

1500-2000 mL

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18
Q

is BP reliable for blood loss?

A

No

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19
Q

what is the most reliable thing for blood loss

A

urine output (decrease)

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20
Q

tx for traumatic shock

A

volume and pressors

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21
Q

type of shock caused by Failure of the heart as an effective pump

A

intrinsic cardiogenic shock

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22
Q

causes of intrinsic cardiogenic shock

A

MI or arrhythmias are the most common

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23
Q

how do you tx cardiogenic shock

A

treat MI or underyling disorder
judicial use of fluids
ionotropes

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24
Q

signs of cardiogenic shock

A

edema- LE
crackles/ rales
JVD

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25
compressive causes of cardiogenic shock
pericardial tamponade tension pneumothorax (PTX) mediastinal hematoma positive pressure from mechanical ventilation
26
Causes of a tension PTX
known trauma or central line, cardiac cath vs. spontaneous
27
tx for Tension PTX
needle compression and tube thoracostomy
28
Tx for pericardial tamponade
pericardicentesis
29
beck's triad
JVD muffled heart sounds pulsus paradoxus/ HPOTN
30
type of shock with ↓ CVP, ↓ SVR), ↑ CO, , fever, tachypnea, tachycardia, HPOTN, end-organ dysfunction
Septic shock - hyper dynamic "warm"
31
tx for septic shock
broad spectrum abx heavy fluid resuscitation (doe this before operation) ionotropes, vasopressors debride, drain, operate as needed
32
causes of neurogenic shock
neurologic injury spinal anesthesia tachy w/ HPOTN and warm, well perfused extremities
33
with a high C-spine injuries what may the HR be?
bradycardia
34
Tx for neurogenic shock
extremely large voluem resucitation | vasoactive agents
35
shock most Most often from chronic use of high dose corticosteroids, causing adrenal suppression.
hypoadrenal shock
36
diagnosis for hypoadrenal shock
shock not responding to tx | hyperthermia, dramatic HPOTN
37
tx for hypoadrenal shock
volume resuscitiation pressors stress dose corticosteroids- hydrocortisone 100 mg q6-8 hours
38
vasopressors
norepinephrine (stimulates alpha-1, mild beta) dopamine (Beta 1, alpha 1) - dose dependent epinephrine phenylephrine
39
vasopressor that stimulate beta 1 in low doses and alpha 1 in medium doses
dopamine
40
strong alpha 1 agonist, increases PVR, has myocardial depression
phenylephrine
41
is the systemic inflammatory response of either infectious or non-infectious origin to a wide variety of severe clinical insults manifested
Systemic inflammatory response syndrome (SIRS)
42
criteria for SIRS
1. Temp >38 2. HR >90 bpm 3. Resp rate >20 4. WBC >12,000 or 10% bands
43
what may SIRS turn into if not treated
Multiple Organ-system Dysfunction syndrome (MODS)
44
failure of 2 or more of the six vital organ systems | Cardiovascular, respiratory, nervous, renal, liver, host defense
MODS (multi organ system dysfunction)
45
risk factors for MODS
shock SIRS massive blood transfusions
46
Tx for MODS
supportive and correction of underlying disorder
47
Diffuse pulmonary parenchymal injury associated with noncardiogenic pulmonary edema and resulting in severe respiratory distress and hypoxemic respiratory failure.
ARDS- adult respiratory distress syndrome
48
pathological hallmark of ARDS
pathologic hallmark is diffuse alveolar damage | DAD
49
What id diffuse alveolar damage (DAD)?
loss of integrity of the alveolar capillary barrier and transduction fo protein-rich fluid across the barrier pulmonary edema hypoxemia from intrapulmonary shunting
50
what will ARDS look like on chest x-ray
B/L puffy infiltrates
51
what will PAWP be w/ ARDS
normal or low
52
Causes of ARDS
``` infection systemic sepsis shock aspiration trauma (pulmonary contusions, fat embolism) bypass massive blood transfusions ```
53
tx for ARDS
tx underlying condition | supportive with agressive ventilator management
54
what do you want to be high with ARDS tx
PEEPS (positive end expiratory pressure) | and a low tidal volume (decrease injury of lung)
55
signs of pulmonary failure
RR>36, labored ventilation, use of accessory muscles and tachycardia
56
what is failure of oxygenation
PAO2 50%
57
what is failure of ventilation
PACO2 >45-
58
what is assist control
sets the same tidal volume for all breaths (whether patient initiated or machine inititaed)
59
with normal lungs what should the tidal volume be?
8 mL/kg (TV) | PEEP-3
60
with ARDS what should you set at?
TV- 6 mL/kg | PEEP of 4-15
61
what should you check after initial vent settings?
ABG
62
what affect pCO2
tidal volume | RR
63
what affect O2
FIO2 | PEEP
64
what improves survival in burn and trauma patients
early feedings
65
surgical critical care patients may develop what?
transient insulin resistance
66
most common cause of renal failure w/ critically ill patients
inadequate volume repletion
67
diagnosis of renal failure
rising creatinine
68
what is FENa
Fractional excretion of sodium
69
what is a normal FENa
<1-2%
70
what FENa would indicate prerenal?
<1% FENa
71
what FENa would indicate a renal cause
>2-3%

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