ABSITE ch 16 critical care.txt

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ABSITE ch 16 critical care.txt
2010-01-28 19:31:15
critical care ABSITE

ABSITE ch 16 critical care
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  1. Normal CO
    4-8 L/min
  2. normal CI
    2.5-4 L/min
  3. normal SVR
  4. normal SVRI
  5. normal PCWP
  6. normal CVP
  7. normal PA pressure
  8. normal SvO2
  9. Mean arterial pressure
    CO X SVR OR 1/3(pulse pressure)+diastolic pressure
  10. Cardiac index
  11. Systemic vascular resistance index
  12. End-diastolic length, linearly related to end-diastolic volume and filling
  13. Resistance against the ventricle contracting
  14. Determinants of stroke volume
    LVEDV, contractility, afterload
  15. Stroke volume
  16. Ejection fracture
    Stroke volume/EDV
  17. HR with maximal CO
    120-150 (then decreases due to decreased diastolic filling time)
  18. automatic increase in contractility secondary to increased afterload
    Anrep effect
  19. Automatic increase in contractility secondary to increased HR
    Bowditch effect
  20. Oxygen delivery
    = CO X arterial O2 content = CO X (Hgb X 1.34 X O2 saturation + [O2 X 0.003])
  21. Ox consumption (VO2)
    VO2 = CO X (CaO2 - CVO2)
  22. Normal O2 delivery to consumption ratio
  23. percent of CO given to kidney
  24. percent of CO given to brain
  25. conditions that cause O2 unloading (right shift on oxygen-Hgb dissociation curve (5)
    inc CO2, inc temperature, ATP, inc 2,3-DPG, dec. pH
  26. causes of elevated SVO2
    inc shunting of blood, dec O2 extraction (sepsis, cirrhosis, cyanide toxicity, hyperbaric O2, hypothermia, paralysis, coma, sedation)
  27. causes of decreased SVO2.
    inc O2 extraction or dec O2 delivery (dec O2 saturation, dec CO)
  28. what to do if there is hemoptysis after Swan placement
    pull catheter back slightly and inflate balloon increase PEEP, mainstem intubate opposite site, may need thoracotomy and lobectomy
  29. contraindications to Swan placement
    previous pneumonectomy, left bundle branch block
  30. approximate Swan depth from RSC approach
  31. approximate Swan depth from RIJ approach
  32. approximate Swan depth from LSC approach
  33. approximate Swan depth from LIJ approach
  34. primary determinants of myocardial O2 consumption (2)
    inc ventricular wall tension and HR
  35. alveolar :arterial gradient in nonventilated patient
  36. blood with lowest venous saturation
    coronaries (30%)
  37. signs of acute adrenal insufficiency
    cardiovascular collapse, unresponsive to fluids and pressors
  38. signs of chronic adrenal insufficiency (7)
    hyperpigmentation, weakness, weight loss, hyperkalemia, hyponatremia, fever, hypotension
  39. potency of cortisone and hydrocortisone
  40. potency of prednisone, prednisilone, methylpred
  41. potency of dexamethasone
  42. loss of sympathetic tone, with dec BP and dec HR
    neurogenic shock
  43. treatment of neurogenic shock
    volume, then phenylephrine
  44. first BP discrepancy with hemorrhagic shock
    inc diastolic pressure
  45. decreased diastolic ventricular filling, hypotension, JVD, and muffled heart sounds
    cardiac tamponade
  46. first sign of cardiac tamponade
    impaired diastolic filling of right atrium
  47. early triad of symptoms for sepsis
    hyperventilation, confusion, respiratory alkalosis
  48. insulin and glucose pattern in early GN sepsis
    low insulin, high glucose
  49. insulin and glucose pattern in lat GN sepsis
    high insulin, high glucose
  50. signs of fat emboli (3)
    petechiae, hypoxia, confusion
  51. diagnostic test for fat emboli
    Sudan red stain showing fat in sputum and urine
  52. Signs of pulmonary embolus
    Systolic PA pressures >40, dec PO2, dec pCO2, respiratory alkalosis, chest pain, cough dyspnea, elevated HR
  53. Patient position when air emboli is suspected
    Head down and tilted left
  54. Inflation timing of IABP
    On T wave (diastole)
  55. Deflation timing of IABP
    On P wave or start of Q wave (systole)
  56. Role of IABP
    Decreases afterload, improves SBP to improve coronary perfusion
  57. Receptors causing vascular smooth muscle constriction, gluconeogenesis, glycogenolysis
    Alpha 1
  58. Receptors causing venous smooth muscle constriction
    Alpha 2
  59. Receptors causing myocardial contraction and rate
    Beta 1
  60. Receptors causing bronchial smooth muscle relaxation, vascular smooth muscle relaxation, increased insulin, glucagon and renin
    Beta 2
  61. Receptors that cause relaxation of renal and splanchnic smooth muscle
    Dopamine receptors
  62. Drug that acts on dopamine receptors at low dose, beta receptors at medium dose, and alpha receptors at high dose
  63. Drug that acts on beta 1 and 2 receptors (contractility, vasodilation, inc HR)
  64. Drug that is a phosphodiesterase inhibitor that causes calcium flux and myocardial contractility, as well as vascular smooth muscle relaxation and vasodilation
  65. Drug that causes vasoconstriction via alpha 1 activation
  66. Drug that activates beta 1 at low dose and alpha 1 and 2 at high dose, potent splanchnic vasoconstrictor
  67. Drug that activates beta 1 and 2 at low dose (contractility, vasodilation), and alpha 1 and 2 at high dose (vasoconstriction); also increases cardiac ectopic pacer activity and myocardial O2 demand
  68. Drug that activates beta 1 and 2 (inc HR and contractility, vasodilates)
  69. Drug that activates V1 receptors (vasoconstriction) and V2 recptors (water resorption, factor VIII and vWF release)
  70. Arterial and venous dilator that can cause cyanide toxicity with prolonged use
  71. Treatment of cyanide toxicity
    Amyl nitrate, then sodium nitrite
  72. Drug that causes primarily venodilation, and decreases myocardial wall tension by decreasing preload
  73. Alpha blocker used to lower blood pressure
  74. Compliance
    Change in volume/change in pressure
  75. Lung disease states with decreased compliance
    ARDS, fibrosis, reperfusion injury, pulmonary edema
  76. Normal vent weaning parameters
    NIF >20, FiO2<35%, PEEP 5, PS 5, RR<24, HR <120, pO2>60, pCO2<50, pH 7.35-7.45, sat>93%, off pressors, follows commands
  77. FiO2 to prevent O2 radical toxicity
  78. pressures with high risk of barotrauma
    peak>50, plateau >30
  79. PEEP complications
    Dec RA filling, dec CO, dec renal blood flow, dec UOP, inc pulmonary vascular resistance
  80. Minute ventilation
    = TV X RR
  81. lung capacity pattern for restrictive disease
    dec TLC, dec RV, dec VC
  82. lung capacity pattern for obstructive disease
    inc TLC, inc RV, dec FEV1, VC nL/dec
  83. physiologic states that increase dead space
    drop in cardiac output, PE, pulmonary HTN, ARDS, high PEEP
  84. mediators of SIRS
    TNF alpha and IL1
  85. Vital signs of SIRS
    Temp >38 or <36, RR >20, CO2<32, WBC>12 or <4, HR>90
  86. Chemical pneumonitis from aspiration of gastric secretions
    Mendelson's syndrome
  87. Most frequent site of aspiration
    RUL, superior portion of RLL
  88. Things that can throw off a pulse oximeter (6)
    Nail polish, dark skin, low flow, ambient light, anemia, vital dyes
  89. Factors/enzymes causing pulmonary vasodilation (4)
    Bradykinin, PGE1, prostacyclin (PGI2), nitric oxide
  90. Factors/enzymes causing pulmonary vasoconstriction (7)
    Histamine, serotonin, TXA2, epinephrine, norepinephrine, hypoxia, acidosis
  91. Alkalosis: vasoconstricts or vasodilates pulmonary vasculature?
  92. Acidosis: vasoconstricts or vasodilates pulmonary vasculature?
  93. Most common cause of postoperative renal failure
  94. Amount of nephron damage required before renal dysfunction occurs
  95. FeNa
    = (urine Na/Cr)/(plasma Na/Cr)
  96. FeNa in prerenal failure
  97. urine Na in prerenal failure
  98. BUN/Cr in prerenal failure
  99. urine osm in prerenal failure
  100. increase in Hct for each liter removed with HD
  101. released in response to dec BP sensed by juxtaglomerular apparatus and in response to increased Na concentration in macula densa
  102. converts angiotensinogen to angiotensin 1
  103. vasoconstricts, increases HR, contractility, permeability, glycogenolysis, and gluconeogenesis, inhibits renin
    angiotensin II
  104. hormone released from atrial wall with atrial distantion and acts as a vasodilator
    atrial netriuretic peptide
  105. released by posterior pituitary when osmolality is high; acts on collecting ducts for water resorption
    antidiuretic hormone/vasopressin
  106. GFR of kidney controlled by afferent limb or efferent limb?
  107. Renal toxic drugs (2 basic mechanisms for injury)
    NSAIDS (inhibit prostaglandins, cause renal arteriole vasoconstriction), aminoglycosides and myoglobin and contrast dyes (all direct tubular injury)
  108. Conditions that preclude brain death
    Uremia, temp <30, BP<70/40, desaturation with apnea test, Phenobarbital or pentobarbital, metabolic derangements
  109. Abnormal carboxyhemoglobin
    >10% (>20% in smokers)
  110. treatment for methemoglobinemia
    methylene blue
  111. drug involved in reperfusion injury that forms toxic oxygen radicals with reperfusion
    xanthene oxidase
  112. HTN, tachycardia, delirium, seizures after 48 hours
    ETOH withdrawl
  113. Treatment for ETOH withdrawl
    Thiamine, folate, Mg, K, B12, Prn ativan