Term
| what are 3 conditions which must occur in order for a patient to be eligible for a spontaneous breathing trial |
|
Definition
| oxygenation is stable (i.e., PaO2/FIO2 >200 and PEEP <5 cmH2O), cough and airway reflexes are intact, and no vasopressor agents or sedatives are being administered |
|
|
Term
| what does the spontaneous breathing trial consist? |
|
Definition
| period of breathing through the endotracheal tube without ventilator support [both continuous positive airway pressure (CPAP) of 5 cmH2O and an open T-piece breathing system can be used] for 30–120 min |
|
|
Term
| The spontaneous breathing trial is declared a failure and stopped if any of the following occur |
|
Definition
| (1) respiratory rate >35/min for >5 min, (2) O2 saturation <90%, (3) heart rate >140/min or a 20% increase or decrease from baseline, (4) systolic blood pressure <90 mmHg or >180 mmHg, (5) increased anxiety or diaphoresis |
|
|
Term
| what result on the spontaneous breathing trial indicates the patient can be extubated |
|
Definition
| the ratio of the respiratory rate and tidal volume in liters (f/VT) is <105 |
|
|
Term
| what is the MCC of anemia in the ICU |
|
Definition
|
|
Term
| what % of patients in the ICU suffer delirium? what is a method to assess it |
|
Definition
| 80%, a bedside questioniare confusion assessment method - ICU |
|
|
Term
| what is a method to avoid anoxic brain injury in patients who present to the ICU after circulatory arrest from ventricular fibrillation or pulseless ventricular tachycardia |
|
Definition
| lower body temprature to 32-34 via cooling blankets and ice packs |
|
|
Term
| which serum marker is associated with a protracted clinical course and increased mortality from ARDS |
|
Definition
| alveolar type III procollagen peptide, a marker of pulmonary fibrosis |
|
|
Term
| 3 physiological consequences of the fibrotic phase of ARDS |
|
Definition
| increased risk of pneumothorax, reductions in lung compliance, and increased pulmonary dead space |
|
|
Term
| 6 adjunct stategies of ventilation that are occasionally used in ARDS but have not been proven to reduce mortality |
|
Definition
| high PEEP, inverse ratio ventilation - inspiration longer than expiration, recruitment maneuvers - transiently increase PEEP, prone positioning, HFV, ECMO, and PLV |
|
|
Term
| 6 Evidence-Based Recommendations for ARDS Therapies |
|
Definition
Low tidal volume A
Minimize left atrial filling pressures B
High-PEEP or "open lung" C
Prone position C
Recruitment maneuvers C
ECMO C |
|
|
Term
| which factor is most significant in fluid management in ARDS |
|
Definition
|
|
Term
| what are the goals of volume/pressure limited ventilation in ARDS |
|
Definition
tidal volume < 6 ml/kg
plateau pressure < 30 cmH2O
respiratory rate < 35
PEEP < 10 cmH2O |
|
|
Term
| what are the goals of oxygenation in ARDS |
|
Definition
|
|
Term
| what is the goal of treating acidosis in ARDS |
|
Definition
|
|
Term
| what is the goal of diuresis in ARDS |
|
Definition
| MAP > 65, avoid hypotension |
|
|
Term
| patients with a direct lung injury causing ARDS have higher mortality rates the those with ARDS from an injury not associated with the lung |
|
Definition
|
|
Term
| whats the indication to use non invasive ventilation |
|
Definition
| COPD exacerbation with serum pH of 7.25-7.35 |
|
|
Term
| CIs to non invasive ventilation |
|
Definition
Cardiac or respiratory arrest
Severe encephalopathy
Severe gastrointestinal bleed
Hemodynamic instability
Unstable angina and myocardial infarction
Facial surgery or trauma
Upper airway obstruction
High-risk aspiration and/or inability to protect airways
Inability to clear secretions |
|
|
Term
| what is the problem with using opiates and BZDs as adjunct sedatives to intubation |
|
Definition
| can have a deleterious effect on hemodynamics in patients with depressed cardiac function or low systemic vascular resistance |
|
|
Term
| what is the problem with using morphine as a sedative for performing intubation |
|
Definition
| can promote histamine release from tissue mast cells and may worsen bronchospasm in patients with asthma |
|
|
Term
| definition of assist control ventilation |
|
Definition
| an inspiratory cycle is initiated either by the patient or, if none is detected within a specified time window, by a timer signal within the ventilator. Every breath delivered, whether patient- or timer-triggered, consists of the operator-specified tidal volume |
|
|
Term
| what is the problem with assist control ventilation |
|
Definition
| in hyperventilation, there is a risk of auto-PEEP - not enough time for expiration |
|
|
Term
| how does SIMV differ from assist control ventilation |
|
Definition
| only the preset number of breaths is ventilator-assisted. |
|
|
Term
| what is the problem with SIMV |
|
Definition
| it is hard to breath when tachypneic |
|
|
Term
| what is pressure support ventilation |
|
Definition
patient initiates every breath, machine detects inspiratory effort of patient and assists to a point of achieved predetermined pressure value
PSV is good for waning from ventilation |
|
|
Term
| what is pressure control ventilation |
|
Definition
the machine initiates breathes at a rate and pressure predetermined by the operator
good for patients with existing barotrauma and patients post thoracic surgery |
|
|
Term
what is the first action to take in ACLS
d/t VF or pulseless VT |
|
Definition
within 5 mins of cardiac arrest: Immediate defibrillation should precede intubation and insertion of an intravenous line;
if 5 mins elapsed before the onset of ACLS the initial step should be: 60–90 s of CPR before the first shock |
|
|
Term
| in ACLS, after given the first shock (that did not help), what is the next step? |
|
Definition
|
|
Term
| if CPR fails, what is the next step? |
|
Definition
1. intubate, IV access
2. administer IV epinephrine 1 mg or IV vasopressin 40 units
3. give shock maximal power |
|
|
Term
|
Definition
| repeat epinephrine higher dose, give sodium bicarbonate |
|
|
Term
| if repeat epinephrine and sodium bicarbonate are of no help |
|
Definition
|
|
Term
| antiarrhytmics don't help |
|
Definition
| give shock, antiarrhythmics, shock, antiarrhythmics |
|
|
Term
| The algorithms for bradyarrhythmia/asystole (left) or pulseless electrical activity are dominated initially by |
|
Definition
| continued life support and a search for reversible causes |
|
|
Term
| the outcome of VF resuscitation is determined primarily by |
|
Definition
|
|
Term
| which patients are candidates for ICD after a successful out-of-hospital cardiac rescusitation? |
|
Definition
| Survivors of cardiac arrest due to non-ACS disease, such as the hypertrophic or dilated cardiomyopathies and the various rare inherited disorders (e.g., right ventricular dysplasia, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT, and so-called idiopathic VF) |
|
|
Term
| Prevention of SCD in High-Risk Individuals Without Prior Cardiac Arrest |
|
Definition
| Post-MI patients with EFs <35% and other markers of risk such as ambient ventricular arrhythmias, inducible ventricular tachyarrhythmias in the electrophysiology laboratory, and a history of heart failure are considered candidates for ICDs 30 days or more after the MI. |
|
|
Term
| 3 conditions where EEG is useful in the determination of the cause of coma |
|
Definition
| unrecognized seizure, to herpesvirus encephalitis, or to prion (Creutzfeldt-Jakob) disease |
|
|
Term
| 5 cerbrovascular conditions that may be the cause of coma |
|
Definition
(1) basal ganglia and thalamic hemorrhage
(2) pontine hemorrhage
(3) cerebellar hemorrhage
(4) basilar artery thrombosis
(5) subarachnoid hemorrhage |
|
|
Term
| signs of coma associated with pontine bleeding |
|
Definition
| sudden onset, pinpoint pupils, loss of reflex eye movements and corneal responses, ocular bobbing, posturing, hyperventilation, and excessive sweating |
|
|
Term
| signs of coma associated with basilar artery thrombosis |
|
Definition
| neurologic prodrome or warning spells, diplopia, dysarthria, vomiting, eye movement and corneal response abnormalities, and asymmetric limb paresis |
|
|
Term
| 3 criteria to determine brain death at the bedside |
|
Definition
| (1) widespread cortical destruction that is reflected by deep coma and unresponsiveness to all forms of stimulation; (2) global brainstem damage demonstrated by absent pupillary light reaction and by the loss of oculovestibular and corneal reflexes; and (3) destruction of the medulla, manifested by complete apnea |
|
|
Term
| 2 instances that require waiting 24 hours before initiating a brain death test |
|
Definition
| cardiac arrest and hypothermia |
|
|
Term
| in which conditions causing increased ICP do you administer glucosteroids and in which you avoid such practice |
|
Definition
give - vasogenic edema from tumor, abscess
avoid - head trauma, ischemic and hemorrhagic stroke |
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