Kiwon Lee 01 Sah

Front 1

PbtO2 levels that correlate to severe brain hypoxia

Back 1

<15mm Hg

Front 2

(Based on K. Lee's Algorithm) What are the variables to treat with brain hypoxia and a metabolically stressed brain (PbtO2 <15 and LPR >40)

Back 2

Address the following: CO, Hb, SaO2, intravascular volume, then optimize CPP

Front 3

How do you improve CO in brain hypoxia?

Back 3

IV milrinone or IV dobutamine

Front 4

Best parameters to monitor when addressing intravascular volume

Back 4

CVP, SVV, GEDVI, PAWP

Front 5

Ideal CVP / PAWP for adequate intravascular volume?

Back 5

CVP 8-12

PAWP 10-14

Front 6

Ideal SVV showing adequate intravascular volume?

Back 6

SVV <10%

Front 7

Ideal GEDVI showing adequate intravascular volume

Back 7

GEDVI 600-800

Front 8

How do you optimize CPP?

Back 8

Increase MAP, decrease ICP, normalize PbtO2 to >20mm Hg

Increase MAP by utilizing levophed and dopamine

Front 9

Define the Lindegaard ratio?

Back 9

Mean TCD velocity of MCA divided by mean TCD velocity of ipsilateral, extracranial ICA

Front 10

What is the normal Lindegaard ratio?

Back 10

<1.7, values >2.0 indicates higher risk f VSP

Institution-dependent, some say <1.5 is noraml

Front 11

Lindegaard ratio for hyperemia, mild, mod, severe VSP?

Back 11

Hypermedia 1.5-2.5

Mild 2.5-3.5

Mod 3.5-4.5

Severe >4.5

Front 12

Interventions to decrease risk of contrast-induced nephropathy (CIN) - name 3

Back 12

NS 1ml/kg/h x 12h

NaHCO3 3ml/kg/h x 12h

N-acetylcysteine 600mg IV prior then 600 mg PO BID x 2d

Front 13

3 perfusion maps provided by CTP

Back 13

MTT

CBV

CBV

Front 14

CTP findings in vasospasm / DCI

Back 14

MTT prolonged

CBF reduced

CBV normal or increased if autoregulation intact; reduced with infarction / ischemia

Front 15

CTP showing a window of opportunity to intervene in DCI

Back 15

When MTT is increased and CBF is reduced, and CBV shows either normal or incresaed blood flow

Front 16

What is hyperdynamic therapy?

Back 16

Increased cardiac index without significantly increasing BP

Front 17

Parameters for hypovolemia

Back 17

CVP 0-3

Anemia Hb <7

Low PAWP <10

GEDVI <680

SVV >13%

SVI <40 ml/m2

Low UO <0.5ml/kg/h

Front 18

Normal cardiac output?

Back 18

5-8 L/min

Front 19

Normal cardiac index?

Back 19

3-5 L/min/m2

Front 20

Name 4 agents used in intra-arterial therapy of vasospasm

Back 20

Papaverine

Nicardipine

Verapamil

Milrinone

Front 21

What happens to FENa in CSW vs SIADH?

Back 21

FENa is low (<1%) in CSW and high (>1%) in SIADH

Front 22

What happens to serum uric acid levels in CSW and SIADH?

Back 22

Serum UA level is low for both CSW and SIADH