criticalcare.txt

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Anonymous
ID:
124988
Filename:
criticalcare.txt
Updated:
2011-12-25 04:36:39
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Description:
critical care
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  1. CO x SVT =
    MAP
  2. SVR=
    80 X ((MAP-CVP)/CO)
  3. wedge pressure is used as a measurement of
    LV preload
  4. EF=
    SV/LVEDV
  5. O2 delivery =
    CO x ((Hgx 1.34 x O2 sat + (pO2 x 0.003))x10
  6. right shift of Hg caused by
    • increase pC02, temp, atp, 2,3 DPG
    • decrease pH
    • methemoglobinemia
  7. most important determinant of myocardial consumption
    • wall tension
    • then HR
  8. normal A-a gradient in nonventilated pt
    10-15mmHg
  9. pulse ox misreads
    • dark skin
    • low Cardiac output
    • low Hct
    • carbon monoxide
    • hypothermia
  10. what are the causes of the wedge pressure being greater than LA pressure
    • pulm fibrosis
    • pulm HTN
    • pulmonary vein obstruction
    • High PEEP
  11. what causes LA pressure to be > than LV
    mitral regurg or stenosis
  12. when are wedge pressures taken
    at the end of respiration
  13. what two things indicate that you are now in the PA
    increase diastolic pressure and dicrotic notch
  14. what cannot be measured by an ECHO but only by a PA catheter
    pulmonary vascular resistance
  15. normal wedge pressure
    7-11
  16. normal cvp
    3-7
  17. what are the different treatment modalities for cardiogenic shock
    • inotrope to increase CI >2
    • pressor for MAP <60
    • lasix if MAP > 70
    • decrease preload with morphine and NTG
    • intraaortic balloon pump
  18. cosyntropin test is positive if
    baseline < 15 or change < 9
  19. MC ekg finding in PE
    SVT
  20. endothelin receptor in the lung causes
    pulmonary vasoconstriction
  21. why is milrinone a good long term inotrope
    it is not subject to downregulation
  22. tx of cyanide poisoning 2/2 Nipride use
    amyl nitrite then sodium nitrite
  23. absolute contraindications to an ACE inh
    • previous angioedema
    • renal artery stenosis
  24. blocks endothelin receptor
    Bosentan
  25. when does teh IABP inflate and deflate
    • inflate on T
    • deflate on P or start of Q
  26. absolute contraindications for IABP
    • aortic regurg
    • aortic dissection
    • sever aorto-iliac dz
  27. drugs that can cause prolonged QT
    • amiodarone
    • fluoroquinolones
  28. release of renin is caused by
    • decrease pressure sensed by JG apparatus
    • increased sodium at macula densa
    • B2 stimulation
    • hyperkalemia
  29. what inhibits renin release
    hypokalemia
  30. effect of angiotensin
    • primary- release of aldosterone
    • secondary:
    • vasoconstrictor, decrease RBF
    • inc sympathetic tone
    • releases ADH
  31. atrial natriuretic peptide does what
    • inhibits Na and H20 resorption
    • vasodilator
    • inhibits renin and aldosterone production
  32. renal toxic product converted from myoglobin
    ferrihemate
  33. mcc of renal ATN
    hypotension intraop
  34. normal I:E
    1:3
  35. what is the rapid shallow breathing index
    • RR/TV
    • if > 105 then 95% will fail
  36. criteria for ARDS
    • acute onset
    • bilateral diffuse patchy airspace dz on cxr
    • wedge<18
    • P:F <300
  37. criteria for VAP
    • new unilateral filtrate
    • fever
    • purulent sputum
    • >48hrs on vent
  38. criteria for SIRS
    • 2 or more
    • temp > 38 or less than 36
    • HR > 90
    • RR >20
    • pCO2 <32
    • WBC>12 or < 4
  39. classic sxs of air embolism
    • decrease ET C02
    • hypotension
    • tachycardia
  40. what preclude the diagnosis of brain death
    • uremia
    • temp < 32
    • BP <70/40
    • desat on apnea test
    • sedatives
    • metabolic derangements
  41. what is a positive apnea test
    pC02 > 60 or increase > 20

    but if BP drops to < 60 or pt desats then test is terminated
  42. agents causing methemoglobin
    • dapsone
    • hurricane spray
  43. tx of methemoglobinemia
    02 + methylene blue

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