Crit. Care

Front 1

1. physiologic state characterized by significant reduction of systemic tissue perfusion, resulting in decreased tissue oxygen delivery. This creates an imbalance between oxygen delivery and oxygen consumption.

Back 1

1. Shock - causes cell membrane ion pump dysfxn, intracellular edema, leakage of intracellular contents into EC space, inadequate pH regulation
Systemic effects: alter serum pH, endothelial dysfxn, more inflammation

Front 2

1. 3 types of shock
2. Bleeding, GI losses (D/V), urinary loss, dehydration cause what shock?
3. 2ndary to cardiac pump failure
4. vasodilation due to inflammatoin

Back 2

1. hypovolemic, cardiogenic, dstributive
2. Hypovolemic - low preload, SV and CO drop, ^SVR
3. Cardiogenic - CO drops, SVR ^ to compensate
4. Distributive

Front 3

1. SVR = TPR = ?
2. Out of cardiogenic, hypovolemic and Distributive shock, which has decreased TPR = SVR?
Cardiogenic shock is due to myocardial injury or obstruction to flow

Back 3

1. (MAP - CVP) / CO x 80 - SVR is inverse of CO
2. Distributive - others it is increased

Front 4

Distributive shock is all forms of shock other than cardiogenic or hypovolemic, usu inflammatory in nature

Back 4

If in shock: look at medical Hx, physical exam & lab data - CBC, chemistries, ABG, DIC panel, serum lactate, cardiac enzymes etc

Front 5

1. Signs of? - hypotension, oliguria, change in mental status, metabolic acid/ lactic acidosis, cool clammy skin
2. SIRS is dx by 2 or more of what 4 criteria?
3. When does SIRS become ka sepsis?

Back 5

1. Shock
2. temp >38.5 or < 35.0 C, HR>90; RR > 20 breaths/min or PaCO2 of <32; WBC > 12,000, < 4000, or >10% immature bands
3. A documented infection

Front 6

1. Goals in Sepsis resuscitation?
admin IV antibio., if low procalcitonin stop the antibio.
2. Give fluids in sepsis?
3. Drugs to give?

Back 6

1. in 1st 6 hrs, CVP 8-12, MAP >65; urine output > 0.5, SVC O2 sat of 70%; normalize lactate levels
2. Yes, Crysatlloids (0.9% saline or lactated ringers),
3. Vasopressor (NE) MAP > 65, Dopamine is a bad choice

Front 7

Decreased arterial PO2/FiO2 ration for:
1. Mild ARDS
2. Moderate
3. Severe

Back 7

1. 201-300 mmHg
2. 101-200
3. <100
a minimum positive end expiratory pressure of 5 cm H20 is imp

Front 8

1. Form of noncardiogenic pulmonary edema that results from acute alveoli damage
2. what is a cardiogenic cause of pulm. edema

Back 8

1. ARDS - diffuse infiltrative lung lesions w/ resulting interstitial and alveolar edema, severe hypoxemia
2. CHF

Front 9

1. What are the 3 phases of ARDS
2. What is a top cause of ARDS
3. Mech. ventilation to give in ARDS
4. why set a high PEEP in ARDS?
low tidal volume, high peep in ARDS

Back 9

1. Exudative, Fibroproliferative and resolution phase
2. Sepsis - others aspiration, or trauma
3. 6 mL/kg
4. Positive end expiratory pressure - avoids extensive lung collapse at end expiration

Front 10

ARDS phases:
1. Mesenchymal cells fill the alveolar space and initiate fibrosis, with collagen and fibronectin accumulating in the lung
2. Alveolar edema is resolved as type II pneumocytes repopulate the epithelium

Back 10

1. Fibroproliferative phase
2. Resolution phase
3. Exudative phase - disruption of alveolar epithelium leading to a protein-rich edema fluid and leukocytesin to the alaveolus

Front 11

1. syndrome characterized by the acute onset of cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking or an altered level of consciousness
2. Drug for this? cautions of it?

Back 11

1. Delirium
2. Haldol - QT prolongation, torsades

use propofol, benzos dexmedetomidine for sedation

Front 12

Sedation drugs:
1. has sedative, hypnotic, anxiolytic, amnestic, antiemetic and anticonvulsant - no analgesic
2. Selective a2 receptor agonist w/ sedative, analgesic, sympatholytic properties no anticonv.

Back 12

1. Propofol
2. Dexmedetomidine - pts on this are more easily arousable and interactive, less respiratory depression

Front 13

1. Drugs to Rx pain in the crit. ill
2. Only depolarizing NMBA? CI?
3. nondepolarizing NMBA that are not effected by renal or hepatic dysfxn?

Back 13

1. Fentanyl morphine (active ingredient that accumulates in renal failure)
2. Succinylcholine - hyperkalemic and burns
3. Atracurium - degraded in plasma by ester hydrolysis and Hofman elimination

Front 14

1. best way to prevent ventilator ass. pneumonia
ARF if PaO2<60 or PaCO2 > 45

Noninvasive ventilation (CPAP) is used for resp failure in COPD, acute cardiogenic pulm. edema, immunocompromise,

Back 14

1. elevate head of bed to 30-45 deg. or oral chlorhexidine

Resp alkalosis - ^ CNS resp. drive due to anxiety fever, sepsis, liver disease, pregnancy, progesterone, hyperthyroidism, CNS disease, Salicylates (metab. acidosis, resp alk), exercise

Front 15

1. How to calculate PAo2?
2. A-a gradient
3. a high A-a gradient suggests?

Back 15

1. 150-(pCO2 / 0.8)
2. Alveolar - arterial
3. defect in diffusion, V/Q misatch, rt to lt shunt

Front 16

1. type of macrophages in diffuse alveolar hemorrhage - accumulation of No, fibrinoid necrosis and adherent alveolar fibrin in air spaces
2. Clinical presentation?

Back 16

1. Hemosiderin laden macrophages DAH - results in ARF and death
2. Hemoptysis, alveolar opacities on CXR, anemia
broncheoalveolar lavage shows ^ RBC, hemosiderin containing RBCs

Front 17

1. 2 causes of Diffuse alveolar hemorrhage
2. Rx?

Back 17

1. Wegeners, Goodpastures
2. Steroids, plasmapheresis in Goodpastures

Front 18

Give antidote for:
1. Acetaminophen
2. anticholinergics
3. Anticholinesterases
4. iron

Back 18

1. N-acetylcysteine
2. Physostigmine
3. Atropine
4. Deferoxamine meslate

Front 19

Antidote for:
1. INH
2. Methemoglobinemia
3. Opioids
4. Organophosphate

Back 19

1. Pyridoxine
2. Methylene blue
3. Naloxone
4. Atropine, Pralidoxamine

Front 20

Antidote for:
1. Cyanide
2. Heavy metals

Back 20

1. Sodium thosulfate, amyl nitrite, hydroxycobalamin
2. dimercaprol penicillamine