Surgical Intensive Care, C65 P476-489 Flashcards

Question

INTENSIVE CARE UNIT FORMULAS AND TERMS YOU SHOULD KNOW What is MAP? P479

Answer 1

``` Mean Arterial Pressure: diastolic blood pressure + 1/3 (systolic–diastolic pressure) (Note: Not the mean between diastolic and systolic blood pressure because diastole lasts longer than systole) ```

Answer 2

Pulmonary Vascular Resistance: PA(MEAN) – PCWP / CO x 80 (PA is pulmonary artery pressure and LA is left atrial or PCWP pressure)

Answer 3

Hemoglobin x O(2) saturation (S(aO(2))) x 1.34

Answer 4

CO x (oxygen content)

Answer 5

CO x (1.34 x Hgb S(aO(2)) x 10

Answer 6

Increased CO by increasing SV, HR, or both; increased O(2) content by increasing the hemoglobin content, S(aO(2)), or both

Answer 7

S(vO(2)); simply, the O(2) saturation of the blood in the right ventricle or pulmonary artery; an indirect measure of peripheral oxygen supply and demand

Answer 8

``` S(vO(2)) (low with inadequate delivery), lactic acid (elevated with inadequate delivery), pH (acidosis with inadequate delivery), base deficit ```

Answer 9

Fractional Excretion of Sodium (Na⁺): | (U(Na) x P(cr) / P(Na) x U(cr)) x 100

Answer 10

Think: YOU NEED PEE = U (Urine) N (Na⁺) P (Plasma); U(Na) x P(cr); for the denominator, switch everything, P(Na) x U(cr) (cr = creatinine)

Answer 11

``` <1.0; renal failure from decreased renal blood flow (e.g., cardiogenic, hypovolemia, arterial obstruction, etc.) ```

Answer 12

6 hours = LASIX = LAsts SIX hours

Answer 13

Remember Power FoRward: | Pressure = Flow x Resistance

Answer 14

For every increase of P(aCO(2)) by 10 mm Hg, | the pH falls by 0.08

Answer 15

P(a)O(2) of 40, 50, 60 corresponds roughly | to an O(2) sat of 70, 80, 90, respectively

Answer 16

``` Low pH (acidosis), increased P(aCO(2)), normal bicarbonate ```

Answer 17

``` High pH (alkalosis), decreased P(aCO(2)), normal bicarbonate ```

Answer 18

Low pH, low bicarbonate, normal P(aCO(2))

Answer 19

High pH, high bicarbonate, normal | P(aCO(2))

Answer 20

Increased bicarbonate

Answer 21

Decreased bicarbonate

Answer 22

Decreased P(aCO(2))

Answer 23

Increased P(aCO(2))

Answer 24

Multiple Organ Failure

Answer 25

Systemic Inflammatory Response | Syndrome

Answer 26

+ + dopa agonist; renal vasodilation | a.k.a. “renal dose dopamine”

Answer 27

1, + a(1) + + ℬ(1); positive inotropy and some vasoconstriction

Answer 28

+ + + a(1) agonist; marked afterload | increase from arteriolar vasoconstriction

Answer 29

+ + + ℬ(1) agonist, + + ℬ(2)

Answer 30

↑ inotropy; ↑ chronotropy, decrease in | systemic vascular resistance

Answer 31

+ + + ℬ(1) and, ℬ(2) agonist

Answer 32

↑ inotropy; ↑ chronotropy; ( + vasodilation | of skeletal and mesenteric vascular beds)

Answer 33

+ + a(1), a(2), + + + + ℬ(1), and ℬ(2) agonist

Answer 34

↑ inotropy; ↑ chronotropy

Answer 35

Vasoconstriction

Answer 36

+ + + a(1), a(2), + + + ℬ(1), and ℬ(2) agonist

Answer 37

↑ inotropy; ↑ chronotropy; increase | in blood pressure

Answer 38

Severe vasoconstriction

Answer 39

Vasoconstriction (increases MAP, SVR)

Answer 40

Hypotension, especially refractory to other vasopressors (low-dose infusion— 0.01–0.04 units per minute) or as a bolus during ACLS (40 u)

Answer 41

+ + + venodilation; + arteriolar dilation

Answer 42

Increased venous capacitance, decreased | preload, coronary arteriole vasodilation

Answer 43

+ + + venodilation; + + + arteriolar | dilation

Answer 44

Decreased preload and afterload | allowing blood pressure titration

Answer 45

Cyanide toxicity

Answer 46

Load on the heart muscle that stretches it to end-diastolic volume (end-diastolic pressure) = intravascular volume

Answer 47

Load or resistance the heart must pump | against = vascular tone = SVR

Answer 48

Force of heart muscle contraction

Answer 49

Distensibility of heart by the preload

Answer 50

Cardiac output increases with increasing | preload up to a point

Answer 51

Demonstrates the importance of preload | in determining cardiac output

Answer 52

``` Oxygen content is composed largely of that oxygen bound to hemoglobin, and is thus determined by the hemoglobin concentration and the arterial oxygen saturation; the partial pressure of oxygen dissolved in plasma plays a minor role ```

Answer 53

Oxygen delivery (hemoglobin concentration, arterial oxygen saturation, cardiac output) and oxygen extraction by the peripheral tissues

Answer 54

Serum lactic acid levels

Answer 55

That part of the inspired air that does not participate in gas exchange (e.g., the gas in the large airways/ET tube not in contact with capillaries) Think: space = air

Answer 56

That fraction of pulmonary venous blood that does not participate in gas exchange Think: shunt = blood

Answer 57

Overventilation (emphysema, excessive PEEP) or underperfusion (pulmonary embolus, low cardiac output, pulmonary artery vasoconstriction)

Answer 58

At high shunt fractions (50%), changes in F(iO(2)) have almost no effect on arterial P(iO(2)) because the blood that does “see” the O(2) is already at maximal O(2) absorption; thus, increasing the F(iO(2)) has no effect (F(iO(2) can be minimized to prevent oxygen toxicity)

Answer 59

Acute Respiratory Distress Syndrome: lung inflammation causing respiratory failure

Answer 60

“CXR”: Capillary wedge pressure 18 X-ray of chest with bilateral infiltrates Ratio of P(aO(2)) to F(iO(2)) < 200

Answer 61

Bilateral fluffy infiltrates

Answer 62

Think: “PUFF” ratio: PF ratio = P(aO(2)): | F(iO(2)) ratio

Answer 63

``` F(iO(2)) of >60% x 48 hours; thus, try to keep F(iO(2)) below 60% at all times ```

Answer 64

Low tidal volumes ( ≤6 cc/kg) and low | plateau pressures <30

Answer 65

Hypoventilation, increased dead space ventilation, and increased carbon dioxide production (as in hypermetabolic states)

Answer 66

Respiratory Quotient (RQ) is the ratio of CO(2) production to O(2) consumption and is highest for carbohydrates (1.0) and lowest for fats (0.7)

Answer 67

``` Because of the need for frequent measurements, the inaccuracy of frequently repeated cuff measurements, the inaccuracy of cuff measurements in hypotension, and the need for frequent arterial blood sampling/labs ```

Answer 68

CVP, PA pressures, PCWP, CO, PVR, | SVR, mixed venous O(2) saturation

Answer 69

1. CVP/right atrium 2. Right ventricle 3. Pulmonary artery 4. Wedge

Answer 70

Pulmonary Capillary Wedge Pressure

Answer 71

Wedge or wedge pressure, pulmonary | artery occlusion pressure (PAOP)

Answer 72

Pulmonary capillary pressure after balloon occlusion of the pulmonary artery, which is equal to left atrial pressure because there are no valves in the pulmonary system Left atrial pressure is essentially equal to left ventricular end diastolic pressure (LVEDP): left heart preload, and, thus, intravascular volume status.

Answer 73

As an indirect measure of preload | intravascular volume

Answer 74

Air through the lungs; monitored by | P(CO(2))

Answer 75

``` Oxygen delivery to the alveoli; monitored by O(2) sats and P(O(2)) ```

Answer 76

Increased respiratory rate (RR), increased tidal volume (minute ventilation)

Answer 77

Volume of gas ventilated through the | lungs (RR x tidal volume)

Answer 78

Volume delivered with each breath; | should be 6 to 8 cc/kg on the ventilator

Answer 79

Basically no; you can have an O(2) sat of 100% and a P(CO(2)) of 150; O(2) sats do not tell you anything about the P(CO(2)) (key point!)

Answer 80

``` Increased F(iO(2)) Increased PEEP ```

Answer 81

Increased RR Increased tidal volume (i.e., increase minute ventilation)

Answer 82

``` Intermittent Mandatory Ventilation: mode with intermittent mandatory ventilations at a predetermined rate; patients can also breathe on their own above the mandatory rate without help from the ventilator ```

Answer 83

``` Synchronous IMV: mode of IMV that delivers the mandatory breath synchronously with patient’s initiated effort; if no breath is initiated, the ventilator delivers the predetermined mandatory breath ```

Answer 84

Assist-Control ventilation: mode in which the ventilator delivers a breath when the patient initiates a breath, or the ventilator “assists” the patient to breathe; if the patient does not initiate a breath, the ventilator takes “control” and delivers a breath at a predetermined rate In contrast to IMV, all breaths are by the ventilator

Answer 85

``` Continuous Positive Airway Pressure: positive pressure delivered continuously (during expiration and inspiration) by ventilator, but no volume breaths (patient breathes on own) ```

Answer 86

``` Pressure is delivered only with an initiated breath; pressure support decreases the work of breathing by overcoming the resistance in the ventilator circuit ```

Answer 87

Airway Pressure Release Ventilation: high airway pressure intermittently released to a low airway pressure (shorter period of time)

Answer 88

High Frequency Ventilation: rapid rates | of ventilation with small tidal volumes

Answer 89

Venous return and cardiac output are | decreased

Answer 90

Positive End Expiration Pressure: positive pressure maintained at the end of a breath; keeps alveoli open

Answer 91

PEEP of 5 cm H(2)O; thought to approximate normal pressure in normal nonintubated people caused by the closed glottis

Answer 92

Barotrauma (injury to airway = pneumothorax), decreased CO from decreased preload

Answer 93

Intermittent mandatory ventilation

Answer 94

6–8 ml/kg

Answer 95

10 breaths/min

Answer 96

100% and wean down

Answer 97

5 cm H(2)O From these parameters, change according to blood-gas analysis

Answer 98

To allow for longer inspiration in patients with poor compliance, to allow for “alveolar recruitment”

Answer 99

COPD, to allow time for complete | exhalation (prevents “breath stacking”)

Answer 100

Airway or endotracheal tube obstruction, bronchospasm, ARDS, mucous plug, CHF (pulmonary edema)

Answer 101

Prevention of alveolar collapse and atelectasis, improved gas exchange, increased pulmonary compliance, decreased shunt fraction

Answer 102

``` Decreased cardiac output, especially in the setting of hypovolemia; decreased gas exchange; ↓ compliance with high levels of PEEP, fluid retention, increased intracranial pressure, barotrauma ```

Answer 103

Patient alert and able to protect airway, gas exchange (P(aO(2)) >70, (P(aO(2)) 5 cc/kg), minute ventilation ( < --20 cm H(2)O, or more negative), F(iO(2)) ≤40%, PEEP 5, PH >7.25, RR <105

Answer 104

Rate: Tidal volume ratio; Tobin index 105 is associated with successful extubation (Think: Respiratory Therapist = RT = Rate: Tidal volume)

Answer 105

Sinusitis (diagnosed by sinus films/CT)

Answer 106

Normal values: pH = 7.357.45 P(CO(2)) = 3545

Answer 107

``` Think “NAVEL”: Narcan Atropine Vasopressin Epinephrine Lidocaine ```

Answer 108

1. Tension pneumothorax | 2. Abdominal compartment syndrome

Surgical Intensive Care, C65 P476-489 Flashcards

(137 cards)