Sesap - Critical Care

Front 1

Nonocclusive bowel necrosis

Back 1

-A/W early enteral nutrition in critically ill, trauma, burn, postop pts (0.3-8%)
-typically occurs in 2nd week of TF
-tachy, fever, leukocytosis
-patchy distribution like NEC
-increase energy demand?, intraluminal toxin?, (in ileus-->bacterial overgrowth)

Front 2

Risk factors for decubitus ulcers

Back 2

Emergency Admission (36x)
elderly age
days in bed
days without nutrition

Front 3

Catheter-related bloodstream infection

Back 3

+ catheter tip culture with negative peripheral Bcx --> colonization (removing tip suffices)
+ tip cx + Bcx --> coag neg staph (5-10days) coag + staph (10-14days)

Front 4

I:E ratio

Back 4

Physiologic respirations I:E - 1:2
Inverse ratio mech vent --> increase inpiration time, decrease venous return, auto-peep, permissive hypercapnia reduces barotrauma

Front 5

Stress ulcers

Back 5

Gastric pH 4 or above
2.5-3% incidence
usually in fundus, body of stomach
impaired mucosal protection
RF: mechanical ventilation & coagulopathy (not steroids)

Front 6

When do you give prophylaxis for GI ulcers?

Back 6

-Coagulopathy (plt<50,000, INR>1.5, PTT>2x control -Mechanical ventilation > 48 hours
-History of GI ulceration or bleeding with the past year
-Two or more of the following risk factors — sepsis, ICU admission lasting >1 week, occult GI bleeding lasting ≥6 days, and glucocorticoid therapy (more than 250 mg hydrocortisone or the equivalent).

Front 7

IUH vs LDMW

Back 7

Fixed-dose low-molecular-weight heparin treatment appears to be as effective and safe as dose-adjusted intravenous unfractionated heparin for the initial treatment of nonmassive pulmonary embolism.

Front 8

Stress ulcer prophylaxis

Back 8

H2 blockers better than sucralfate (1.7 vs 3.8%)

Front 9

HIT

Back 9

4-14 days onset
2-5%
plts< 150,000 or <50%

Front 10

Type 1 HIT

Back 10

Mild thrombocytopenia, not immune mediated, caused by direct agglutinating effect, not a/w thrombosis, resolves despite continuation of heparin therapy

Front 11

Type 2 HIT

Back 11

Severe thrombocytopenia
Immune mediated
A/w venous & arterial thrombosis
stimulates PF4 --> IgG

Front 12

Treatment of HIT

Back 12

stop heparin and start argatroban, bivalirudin, lepriudin

Front 13

Recombinant activated factor VII

Back 13

approved for hemophilia A or B bleeding
combines with TF to activate factor X and IX
Off label use - emergent reversal of coumadin
pH 7.0 --> ineffective
AE --> 10% HTN

Front 14

SIRS

Back 14

Temp >38.5 or < 35
pulse >90
RR >20
PaCO2 <32
WBC >12 or < 4 or >10% bands

Front 15

Activated protein C

Back 15

endogenous protein that promotes -fibrinolysis and inhibits thrombosis and inflammation
-reduced levels in septic pts
-reduces mortality by 6% in pts with -severe sepsis
predisposes to severe bleeding (not recommended w/n 96 hours of surgery)
-give within 12-24 hrs for 96 hours

Front 16

Effective measures in reducing sepsis related mortality

Back 16

-Correcting central venous PO2 w/n 6 hours
-Steroids for non responders
-Tight glucose (80-120)

Front 17

Crystalloid vs colloid

Back 17

SAFE Trial - no diff in mortality or organ failure when given albumin or NS

Front 18

TRICC report

Back 18

Restrictive strategy of red cell transfusion was as effective as liberal strategy

Front 19

Acute adrenal insufficiency

Back 19

hypotension, hypoNa, hyperK

Front 20

Corticotropin test

Back 20

measure serum cortisol before and after 30-60 mins of IV 250mcg 1-24 ACTH
nonresponders should get 50q6

Front 21

Toxic megacolon

Back 21

total or segmental nonobstructive colonic dilation of at least 6cm a/w systemic toxicity

Front 22

Diagnosing Cdif

Back 22

enzyme immunoassay that rapidly detects toxin A nd B (less sensitive than cytotoxin assay which detects toxin B only)

Front 23

PEEP

Back 23

increases FRC, compliance
decreases PIP
can cause hypotension

Front 24

Tertiary peritonitis bugs

Back 24

Candida
Enterococcus
staph epidermis

Front 25

Low dose vasopressin

Back 25

increases SBP, MAP

Front 26

Periop B-Blockers

Back 26

2 or more of Mangano criteria (>65 y.o, HTN, current smoker, chol>240, NIDDM
1 of the following (high risk surgical procedure, IHD, IDDM, CR>2.0, TIA/CVA)

Front 27

How does hyperglycemia cause infection?

Back 27

leads to G6PD inhibition --> lower levels of PMN superoxide production --> diminished bactericidal activity

Front 28

VAP

Back 28

8 days of antibx

Front 29

Contrast Induced Nephropathy

Back 29

-no RCTs proving efficacy of mucomyst or dopamine
-Prehydration with NaHco3 better than saline?

Front 30

Risk Factors for VAP

Back 30

>60
>48 hours
COPD
ARDS
Reintubation

Front 31

Upper extremity DVT factors

Back 31

Biggest RF --> Central venous cathether
young, lean patients
U/S less sensitive than for lower
treatment --> a/c for 3 months
can lead to PE, SVC syndrome, postthrombotic venous insufficiency

Front 32

What causes release of renin?

Back 32

decreased vascular volume
dehydration
negative sodium balance

Front 33

Where is aldosterone released?

Back 33

Adrenal zona glomerulosa

Front 34

What governs aldosterone secretion?

Back 34

Serum K concentration

Front 35

Hypernatremia treatment

Back 35

Half of the sodium deficit should be replaced in the first 24 hours

Front 36

Fluid of choice for hypochloremic hyponatremic alkalosis

Back 36

NS (not LR since lactate is converted to bicarb)

Front 37

Hyperkalemia

Back 37

peaked t waves
wide qrs
n/v/abd pain

Front 38

HyperMg

Back 38

flaccid paralysis
hyporeflexia

Front 39

HypoMg

Back 39

hyperreflexia
seizures
torsades de pointes (Vtach with long QT)

Front 40

HypoCa

Back 40

paresthesias
perioral tingling
carpal pedal spasm
prolonged QT

Front 41

Weak antiplatelet agent

Back 41

ASA via permanent COX1 and COX2 inhibition (stop 5 days before surgery)

Front 42

Mechanism of clopidogrel and ticlopidine

Back 42

inhibit ADP receptor mediated platelet aggregation (strong antiplatelet)

Front 43

Mechanism of abciximab (reropro)

Back 43

Inhibit GpIIb/IIIa receptor (most potent)
increased bleeding complications
severe thrombocytopenia

Front 44

Mechanism of cilostazol (pletal)

Back 44

reversible phosphodiesterase III inhibitor --> increase cAMP--> vasodilation and platelet inhibition

Front 45

NSAIDs mechanism

Back 45

reversible inhibit COX-1

Front 46

LMWH and fondaparinux

Back 46

bind to heparin beinding site of AT III (inactivates Xa but not IIa the way heparin does)

Front 47

Abdominal compartment syndrome features

Back 47

increased intrathoracic pressure
decreased cardiac output
decreased urine output

Front 48

Mechanism and uses of caspofungin and amphoB

Back 48

Caspofungin inhibits cell wall syntehsis
Ampho B binds to ergosterol leading to increased cell wall permeability
both can be used for empiric fungal infection

Front 49

Preop parenteral and enteral nutrition

Back 49

decreased morbidity for parenteral in severely malnourished
decreased morbidity and mortality in severely malnourished

Front 50

Why does enteral nutrition cause less infectious complications in critically ill?

Back 50

decreased hyperglycemia?
preservation of GALT?

Front 51

What 3 parameters affect PaO2

Back 51

FiO2
PEEP
I/E

Front 52

SIADH features

Back 52

hyponatremia
concentrae urine
high urinary sodium
absence of peripheral edema or dehydration
normal volume status
dcreasd BUN
normal potasim