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the 10 commandments Flashcards

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1
Q

Name 3 antibiotics for pseudomonas coverage (just the classes)

A
  • Extended spectrum penicillin with B-lactamase inhibitors (Piperacilin-Tazobactam = antipseudo penicillin)
  • Cephalosporins
  • Fluoroquinolones

Additional from amboss:
- Carbapenems
- Aminoglycosides
- Monobactams
- Polymyxins

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2
Q

What are 5 indications for dialysis?

A

AEIOU:
- Acidosis(<7.1 ph or refractory to therapy)
- Electrolytes(K+ over 6.5 mmol/l)
- Intoxication
- Overloaded with fluid,
- Uremia/uremic symptoms

-hypo/hypernatremia (<115, >160)
-AKI (>350 umol/l creat, >12hr anuria)

-hyperthermia(>39.5 )

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3
Q

Child CPR/ALS difference from adults?

A

15:2 ratio.

From Amboss:
· Children older than 1 year
o 5 initial rescue breaths → CPR
o Compression rate: 100-120/min
o Compression-to-ventilation ratio:
- § Medical professionals: 15:2
- § Lay rescuers: 30:2
o Further management should follow the guidelines for adults.
· Defibrillation: monophasic and biphasic waveforms: 2–4 J/kg of body weight

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4
Q

Symptomatic treatment of bradycardia, top 3 pharmacological agents.

A
  • Atropine (he asked dose, 500mcg IV each time for max 3mg)
  • dopamin
  • isoprenaline
  • adrenaline
  • glycopyrrolate
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5
Q

Ultrasound during CPR, you can investigate:

A

1 H, 3 Ts.

H
- Hypovolemia (collapsing IVC)

T
- Tamponade (Collapsed RV + fluid filled pericardium),
- PE (Enlarged RV and RA), collapsed left side
- PTX (Lack of lung sliding and B-lines).

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6
Q

How many joules for infants/children with the defib?

A

4 J/KG

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7
Q

Dose of Epinephrine and how do you give a patient in ICU?

A

Infusion, he was happy with 0.01- 0.03 mcg/KG/min

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8
Q

5 uses of end tidal CO2 during CPR? (capnography)

A

PQRST: Placement of airway device, ETT (endotracheal tube?),
Quality of compressions,
ROSC also know the values whats normal, what’s bad, and what is terminate-CPR bad.
Strategy : if <10 mmhg for long time> bad prognosis
Termination ( etCO3 >24, Rosc, spontaneous respiration)

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9
Q

etCO2 ROSC values

A

> 24
- stop ALS, check circulation ( ROSC)

20-24
- Chest Comp is effective

<20
- improve CC quality

=<10
- Poor prognosis

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10
Q

3 indications for systemic thrombolysis?

A

Early STEMI (< 12 hours) but rare

Early ischemic stroke (< 3 hours)

Massive pulmonary embolism

Acute peripheral arterial occlusion

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11
Q

Top nosocomial bacterias?

A

Klebsiella
Acinetobacter
MRSA
Pseudomonas

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12
Q

3 symptoms of hypoglycemia:

A

CNS(agitation, coordination, sleepiness)
pale,
sweating,
tachycardia

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13
Q

Basic difference between CRRT and IRRT? What do you use when?

A

CRRT= Continuous Renal Replacement Therapy, done over 24 hours, and is a slow type of dialysis

IRRT= Intermittent Renal Replacement
Therapy: performed for less than 24 hours in each 24 hour period,
two to seven times per week

CRRT has better
-haemodynamic stability (BP control)
- improved survival
- greater likelihood of renal recovery.

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14
Q

Name 5 opioids commonly used?

A

Morphine, fentanyl, sufentanyl, Remifentanil, tramadol, codeine

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15
Q

Name 3 non invasive airway measures?

A

Head chin tilt,
eschmark,
cpap bipap,
oxygen,
bag mask

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16
Q

4 symptoms of shock:

A

MOF,
Urine output<0,5ml/kg,
loss of consciousness, confused,
GI: absent bowel sounds

(adding)
Paleness
Cold-sweat
Cold skin (warm skin if distributive shock like sepsis/anaphylactic)

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17
Q

Lethal triad:

A

Coagulopathy, Hypothermia, metabolic acidosis

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18
Q

4 iv anesthetics

A
  • Thiopental (= barbiturate 3-6mg/kg)
  • Midazolam (= benzodiazepines 0.01-0.1 mg/kg)
  • Propofol (2-4mg/kg) most popular
  • Ketamine (1-5mg/kg)
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19
Q

3 inotropes:

A
  • Norepinephrine
  • Epinephrine
  • Dobutamine
  • Dopamine
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20
Q

Side affects of local anesthetics:

A
  • Bradycardia and ventricular arrhythmias
  • Hematoma → nerve compression→ neurological symptoms
  • Infections
  • Allergic reactions
  • Spinal/epidural: Headache, bradycardia, hypotension…
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21
Q

How do you diagnose airway at risk

A

Listening for snoring, gurgling, choking + paradoxical movement

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22
Q

Criteria for empty stomach (how long do you need to fast):

A

Clear fluids (water, tea) = 2h
Breast milk = 4h
Nutritional drinks –cow milk – solid food = 6h

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23
Q

First line treatment of tpx:

A

Provide resp. support
Treat dyspnea
immediate tube thoracostomy

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24
Q

Caloric value of carbohydrates lipids protein and alcohol

A
  • Carbohydrate (60-80% of nutrition): Glucose = 4,2Kcal/g ;
    Max glucose dose of ICU patients 5mg/kg/min
  • Lipid (20-40% of nutrition): 9,1Kcal/g; lipid oxidation is limited, max dose = 1-1,5g/kg/day
  • Protein: daily requirement in critical care =1,5-2 g/kg/day
  • Alcohol: I guess 0 because the patient is in critical care ???
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25
Formula of osmolality:
= 2[Na+] + [Glucose]/18 + [BUN]/2.8 (mg/dl) In case: Osmolarity = 2Na + Glucose + Urea (mmol/L)
26
Shock definition:
Acute hemodynamic disorder (micro and macrocirculatory) independent of the cause, which leads to insufficient oxygen supply and tissue hypoxia.
27
3 Application of ETCO2:
noninvasive technique which measures the partial pressure or maximal concentration of carbon dioxide (CO2) at the end of an exhaled breath (N: 35-45 mmHg). Can be used to detect metabolic acidosis (but ABG is the gold standard)
28
3 SUBLINGUAL antihypertensive drugs and their dose –
nitrates, ACEI, niflodipin. Captopril = 25mg Nifedipine = 10mg Prozasin = 2mg
29
First choice of bradycardia treatment
Atropin
30
How to calculate PULMONARY MAP
= 1/3SBP + 2/3DBP
31
Atmospheric pressure in mmHg and mmH2O
760mmHg or 10332,276 mmH2O
32
5 reasons AMI can cause cardiogenic shock
- Wall rupture (late phase) - Arrhythmia - Valvular dysfunction (e.g papillary muscle necrosis) - Decreased contractility (pump function) - Wall rupture → tamponade
33
3 complications with Central venous catheter
Infection Rupture of Artery pneumothorax
34
4H & 4T
H:Hypoxia H: Hypovolemia H: Hypo/HyperKalemia H: Hypo/hyperthermia T: toxins T:tamponade T: Tension PTX T: Thrombosis
35
Gynecological emergencies in ICU
Placental abruption, miscarriage, ectopic pregnancy, Acute PID, Pelvic endometriosis…
36
Difference between dehydration and hypovolemia
Hypovolemia is a condition where the extracellular fluid volume is reduced and it results in decreased tissue perfusion. It can be produced by either salt and water loss. Dehydration: Is when there is only water loss.
37
Respiratory failure classes
Type I - hypoxemic failure Type II - hypercapnic failure Type III - post-operative failure Type IV - CV-associated failure (shock-ass hypoperfusion)
38
Type 1 respiratory failure values
decreased arterial oxygen = PaO2 < 60 mmHg (SaO2 < 90%, PaCO2 decreased/normal, pH increased/normal).
39
Type 2 respiratory failure values
increased arterial carbon dioxide = PaCO2 > 50 mmHg or pH < 7.3 (respiratory acidosis).
40
Anaphylactic shock symptoms (give the answer in ABCDE order)
A: Wheezing (bronchoconstriction) B: dyspnea C: Hypotension, Skin: hives, itching, urticaria, Angioedema D: dizziness, fainting E: nausea, vomiting
41
Define septic shock
Is a type of distributive shock caused by an excessive inflammatory response to disseminated infection, which leads to extravasation from the vascular space and loss of intravascular volume.
42
3 indications of central vein
- Dialysis - ICU - Longer hospital stay - Fluids
43
What is 60-40-20 rule
Total body water = 60% of body weight Intracellular fluid = 40% of body weight Extracellular fluid= 20% of body weight
44
Antidotes for opiates, benzodiazepine and non depolarizing muscle relaxant
- Opiates= Naloxone - BZ= Flumazenile - Non depolarizing muscle= Neostigmine (cholinestherase ihibitors)
45
3 ways to measure cardiac output
- Doppler ultrasound - Pulse pressure methods - Impedance cardiography - MRI - Calculate = SV x HR swan ganz catheter arterial line
46
Puncture in ribs
- midaxillary line: 4-5 intercostal space or - mid clavicular: 2 intercostal space (just above the third rib) for needle decompression (faster)
47
Parameters in mechanical ventilation
*Mode: - Assisted control - Intermittent mandatory ventilation - pressure ventilation which is CPAP and BiPAP - volume ventilation * FiO2, * Tidal volume and respiratory rate which will change the alveolar ventilation and positive end expiratory pressure which is the PEEP * Flow
48
Horowitz index
ratio of partial pressure of oxygen in blood (PaO2), in millimeters of mercury, and the fraction of oxygen in the inhaled air (FIO2) — the PaO2/FiO2 ratio. → used to assess the lung function in patients, especially those under ventilators.
49
Treatment protocol for tachycardia
- Beta Blockers, - vagal maneuvers, - cardioversion electrical or chemical - ICD, - PM, - ablation
50
Hyperkalemia : ECG
- Peaked T waves on prechordial leads - PR prolongation -wide QRS - p wave flattening
51
Treatment for hyperkalemia?
Mention 5: - Insulin-glucose - Ca-gluconate I.V, - Haemodialysis - B-agonist (activates Na/K pump moving K into cells) - NaHCO3- (alkalosis drives K into cell)
52
Indications for HCO3-:
- CPR when severe acidosis pH<7,1 - strong suspicion of metabolic acidosis, - Correct hyperkalaemia (K+ + HCO3+), pH < 7,1
53
Correction of symptomatic bradycardia:
Atropine 0,5mg —> 3mg (0,5 every bolus)
54
Layers for spinal anesthesia
Injection site: Injection usually performed below L2 to avoid damage to the spinal cord Needle inserted into subarachnoid space between the arachnoid and pia mater Layers the needle goes through: Skin Subcutaneous fat Supraspinal ligament Interspinal ligament Ligamentum flavum Epidural space Dura mater Arachnoid mater Subarachnoid space
55
Epidural anesthesia layers
Can be used for acute pancreatitis → Increased blood flow to the pancreas for healing. No parasympathetic fibers in epidural anesthesis Injection site: May be performed at any vertebral level (cervical, thoracic and lumbar spine) Needle inserted into the epidural space between the ligamentum flavum and dura mater
56
HCO3- dosage for DKA
50mmol
57
3 symptoms of upper GI bleeding:
- Hematemesis - Melena (digested blood) - Drop of BP, lightheadedness
58
EtCO2 normal value?
35-45
59
Reversible causes of cardiac arrest: Hypoxia signs and treatment
Signs - colour of skin Treatment - Ventilation with suppl. O2
60
Reversible causes of cardiac arrest: Hypovolaemia signs and treatment
Signs: - Pale skin - History - DRE - US findings (collapsed IVC) Treatment: - Volume therapy +/- transfusion (Hb <7 is transfusion indication)
61
Reversible causes of cardiac arrest: Hypo- / hyperkalaemia signs and treatment
Signs: - Identified by ABG/lab Correction: - hypokalemia - Mg++ and K+ - hyperkalenia - Calcium-gluconate IV
62
Reversible causes of cardiac arrest: Hypo/hyperthermia signs and treatment
Signs - Core temperature Treatment - Active warming / cooling - Treat underlying issue
63
Reversible causes of cardiac arrest: Thrombosis signs and treatment
Signs: - Chest pain - Difference in lower limbs - US findings Treatment - ACS: PCI - PE: Fibrinolysis
64
Reversible causes of cardiac arrest: Tension ptx signs and treatment
Signs: - dyspnea - assymetric chest - US pleural sliding sign Treatment: - Decompression
65
Reversible causes of cardiac arrest: Tamponade signs and treatment
Signs: - US -> RV collapse in diastole -> RA collapse in systole -> Pericardial effusion Treatment: - Pericardiac puncture
66
Reversible causes of cardiac arrest: Toxins signs and treatment
Signs: - history, medical documents, enviroment Treatment: - Elimination - Antidotes
67
ABCDE: A
- Patent airway - Airway in-danger? - Secretions - Foreign object - Snoring - Obstructed airway (paradoxical breathing)
68
ABCDE: B
- Rate (normal 12-20) - Work of breathing (accessory muscles)? - Symmetry of chest movement and sounds? - SaO2 % (normal > 94%)
69
ABCDE: C (5p's)
* Pulse * P-QRS-T (rhythm) - Electrical activity present on ECG? - Frequency - Narrow/wide QRS? - Regular/irregular rhythm? - P waves present? - P waves followed by QRS complexes? * Pressure * Perfusion (peripheral circulation) - CRT * Preload - JVP - Lung crackles
70
ABCDE: D
* Mental status - AVPU scale (alert, voice, pain, unresponsive) - Glasgow coma scale (GCS) < 9 * Symmetry - Pain localizing - Pupils -lateralizing signs * Blood sugar
71
ABCDE: E
ƒ 'RUSH' exam - Rapid US in shock ƒ Bleeding source? ƒ Injury? ƒ Temperature ƒ ABG DRE ƒ Drugs ƒ Toxicities ƒ Further anamnesis
72
Shockable and non-shockable rhythms
Shockable - VF, pulseless VT Non-shockable - PEA, asystole
73
Shockable rhythms - drug protocol
First dose - Adrenaline 1mg after 3rd shock - Amiodarone 300mg after 3rd shock Additional doses - Adrenaline 1mg every 2nd shock (2-5min) - Amiodarone 150 mg after 5th shock
74
Non-shockable rhythm - drug protocol
Adrenaline 1mg as soon as IV access Additional adrenaline 1mg every 2nd cycle (3-5min)
75
PE - US signs
Collapsed left ventricle Grossly enlarged right ventricle
76
US signs - hypovolemia
Collapsed left ventricle Collapsed right ventricle Collapsed IVC
77
Indications of ICU and circumstances of admission:
• Indication: 1. severe life-threatening illnesses and injuries, which 2. require constant, close monitoring and support from specialist equipment 3. and medications in order to ensure normal bodily functions • circumstances of admission: -surgery, -trauma -severe illness
78
ICU limitation
• ICU beds are a very expensive • and limited resource: – specialised monitoring equipment – a high degree of medical expertise – constant access to highly trained nurses • reserved for those patients with 1. reversible medical conditions + 2. who have a reasonable prospect and physiological reserve for substantial recovery
79
Invasive arterial pressure monitoring • Indications:
– hemodinamics instability – vasoactive therapy (both hypo and hypertension) – Surgery of a high risk patient (perioperative monitoring)
80
Invasive arterial pressure advantages
Advantages: – Continuous pressure measurement – Accurate – both the wave and the values can be seen
81
relative Contraindications of Epidural Anesthesia
RELATIVE: 1. Hypovolemia/ shock-state 2. Severe cardiovasular disease 3. Lack of Informed consent
82
absolute Contraindications of Epidural Anesthesia
1. Haemophilia and/or coagulation disturbances – Aquired/iatrogenic – Hereditary – Consequence of diseases (eg. DIC) 2. Inflammation/wound on skin
83
IV Anti-HTN drugs? (3)
Labetalol Metoprolol Nicradipine Hydralazin fenoldopam (D1 agonist) Nitroprusside (release NO) diazoxide (K ch opener)
84
Muscle paralysis agents? (3 examples)
Succinylcholine AtraCURIum RoCUROnium
85
Inhalation anesthetics? (4 examples)
Halothane (most potent)- hepatotoxic Isoflurane Sevoflurane (most common, rapid onset & recovery) Desflurane (least potent) nitrous oxide 1. induction (pediatric) 2. maintenance sedation lower MAC ; more potent
86
NSAID side effects? (3)
blurred vision dizziness nausea vomiting gastric ulcer
87
MAP equation
MAP = [SBP + (2*DBP)]/3
88
Which organs affected MOF and symptoms? SOFA
Respiration: PaO2 Coagulation: PLT count Liver: Bilirubin Cardiovascular: MAP CNS: Glasgow Coma Score Renal: Creatinine, Urine output SOFA > 2 ; organ dysfunction
89
Causes of delirium?
Advanced age Pre-op cognitive disorder Severe general status Preop anemia Preop hypoalbuminemia BZD: midazolam Chronic alcohol consumption
90
ASA Scoring?
General risk assessment
91
normal Lactate?
0.5 to 1.5 mmol/L
92
Causes of cardiogenic shock?
Pump function decrease Valvular disorder Arrhythmia Intracardiac shunt
93
placement of intraosseous IV
tibia humerus - 45 angle
94
Metabolic acidosis symptoms
increased sympathetic activity Kussmal respiration Hyperkalemia Hyperventilation Emesis
95
Invasive ventilation
1. ETT 2. Tracheostomy 3. oropharyngeal 4. supraglottic air device
96
O2 carrying capacity of blood
100 ml blood contains 15g Hb which can bind 20.1 ml of O2 1gram Hb: 1.34 ml O2
97
How much oxygen can 1g Hb carry
1g Hb : 1.34 ml O2
98
Vessel placement CVL
IJV Subclavian v femoral vein

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