14211386
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
almost 6 years ago
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| Question | Answer |
| Normal Values for Cardiac Index | 2.5-4L/min/m2 |
| Normal Values for Cardiac Output | 4-8L/min |
| Normal Values for CVP or Rt Atrial Pressure | 2-6mmHg |
| Normal Values for Pulmonary Artery Pressure | Systolic20-30mmHg Diastolic 8-12 mmHg Mean 25 mmHg |
| Equation to calculate MAP | MAP = CO x SVR |
| Equation for Cardiac Index | CI = CO/BSA |
| 4 determinants for cardiac performance | preload, afterload, contractility, HR |
| Preload | ventricular end-diastolic volume or pressure |
| Afterload | Resistance against the ventricle contracting (SVR) |
| Equation for Stroke Volume | Stroke Volume = LVEDV - LVESV |
| Equation for Ejection Fraction | Stroke Volume / LVEDV |
| End-Diastolic Volume | determined by preload and distensibility of the ventricle |
| End Systolic Volume | determined by contractility and afterload |
| Atrial Kick | account for 20% of LVEDV |
| Anrep Effect | Automatic increase in contractility secondary to increased afterload |
| Bowditch Effect | automatic increase in contractility secondary to increased HR |
| Arterial O2 Content Equation | CaO2 = Hb x 1.34 x O2 sat + (PO2 0.003) |
| Oxygen delivery equation | O2 delivery = CO x arterial O2 content x 10 |
| Oxygen Consumption Equation (VO2) | VO2 = CO x (CaO2 - CvO2) |
| Normal Oxygen Delivery to consumption ratio | 4 : 1 |
| Causes of Right Shift (O2 unloading) | Increased CO2 (Bohr), increased temp, increased ATP production, Increased 2,3-DPG production, acidic environment |
| Causes of increase oxygen saturation in venous blood | increased shunting of blood, decreased oxygen extraction (sepsis, cirrhosis, cyanide toxicity, hyperbaric O2, hypothermia, paralysis, coma) |
| Causes of decreased venous oxygen saturation | occurs with increased O2 extraction, malignant hyperthermia or decreased O2 delivery |
| What factors can affect wedge pressure? | pulmonary HTN, mitral stenosis, mitral regurgitation, high PEEP, poor LV compliance |
| Where should a Swan-Ganz Catheter be placed? | in zone III lower lung, had less respiratory influence on wedge pressure |
| What to do if you develop hemoptysis after flushing a Swan Ganz catheter? | increase PEEP to tamponade the bleed mainstem intubate non-affected side place Fogarty balloon down mainstem of affected side Poss thoacotomy + lobectomy |
| Absolute contraindications for swan ganz catheter placement | right sided mechanical valve |
| relative contraindication for placing a swan-ganz catheter | previous pneumonectomy LBBB, recent PM, right sided endocarditis |
| Swan Ganz Catheter distances to wedge Rt SCV Rt IJ Lt SCV Lt IJ | Rt SCV: 45cm Rt IJ: 50cm Lt SCV: 55cm Lt IJ: 60cm |
| When should wedge pressure be measured? | at end-expiration |
| What are the 2 primary determinants of myocardial oxygen consumption? | HR and increased ventricular wall tension |
| Normal range of Alveolar-arterial gradient | 10-15mmHg |
| Blood with the lowest venous saturation | coronary sinus blood (30%) |
| Blood with the highest venous saturation | renal veins (80%) |
| Basic definition of shock | Inadequate tissue oxygenation |
| MCC of adrenal insufficiency | withdrawal of exogenous steroids |
| Acute Adrenal Insufficiency | cardiovascular collapse, characteristicall unresponsive to fluids and pressors n/v, andominal pain, fever, lethargy, decreased glucose, increased potassium |
| Treatment for adrenal insufficiency | dexamethasone |
| Steroid Potency 1x | Cortisone, Hydrocortisone |
| Steroid Potency 5x | prednisone, prednisolone, methylprednisolone |
| Steroid potency 30x | Dexamethasone |
| Neurogenic Shock & treatment | loss of sympathetic tone usually assoc with spine/head injury decreased HR, BP, warm skin tx: volume then phenylephrine |
| Treatment for Cardiogenic Shock | Dobutamine, IABP |
| Beck Triad | HoTN, JVD, muffled heart sounds |
| First sign of cardiac tamponade | impaired diastolic filling of right atrium |
| Treatment of Cardiac Tamponade | fluid resuscitate to temporize pericardial window, pericardiocentesis |
| Early Sepsis Triad | Hyperventilation Confusion HoTN |
| Early Gram Negative Sepsis | decreased insulin increased glucose (impaired utilization) |
| Late Gram Negative Sepsis | Increased insulin, increased glucose 2/2 to insulin resistance |
| Neurohormonal Response to hypovolemia | rapid: NE and epi sustained: renin, ADH, ACTH |
| Fat emboli | petechia, hypoxia, confusion bone fractures sudan red stain |
| pulmonary emboli | chest pain, dyspnea resp alkalosis, increase HR and RR HoTN and shock if massive |
| Where PEs usually arise from | iliofemoral region |
| Air Emboli, what to do | head down, foll to left to keep air in RV and RA aspirate air with central line |
| How Intra-aortic balloon pump works | inflates on T wave (diastole) deflates on P wave (systole) decreases afterload, improves DBP, improves diastolic coronary perfusion |
| When to use IABP? | cardiogenic shock after CABG or MI in patients with refractory angina awaiting revascularization, pre-op in high risk patients, acute MR, ventricular septal ruptures |
| Where to place an IABP catheter tip | distal to left subclavian (1-2cm below the top of the arch) |
| absolute contraindications for IABP | aortic dissection, severe aortoiliac disease, aortic regurgitation |
| relative contraindications for IABP | vascular grafts, aortic aneurysms |
| alpha-1 receptors | vascular smooth muscle constriction |
| alpha-2 receptors | venous smooth muscle constriction |
| beta-1 receptors | myocardial contraction and rate |
| beta-2 receptors | relaxes bronchial smooth muscle, relaxes vascular smooth muscle, increases renin |
| dopamine receptors | relax renal and splanchnic smooth muscle |
| Dopamine 2-5mcg/kg/min affects what | renal dopamine receptors |
| Dopamine 6-10mcg/kg/min affects what | beta-adrenergic receptors heart contractility and HR |
| Dopamine >10mcg/kg/min affects what | alpha adrenergic receptors, vasoconstriction and increased BP |
| Dobutamine starts at what rate? what does it affect? | 3mcg/kg/min beta-1, increases contractility, tachycardia with higher doses |
| Milrinone | phosphodiesterase inhibitor increases cAMP causes increase of calcium and myocardial contractility pulm vasodilation |
| Phenylephrine, intial dose and effects | 10mcg/min alpha-1, vasoconstriction |
| Norepinephrine, starting dose and effects | 5mcg/minute alpha-1, alpha-2, some beta-1 potent splanchnic vasoconstrictore |
| Epinephrine initial dose effects of low dose vs high dose | 1-2mcg/min Low: beta-1 & 2, increases contractility and vasodilation, can decrease BP High: alpha1 & 2, vasoconstriction increases cardiac ectopic pacer and myocardial O2 demand |
| Isoproterenol initial dose and effects | 1-2mcg/min initially beta-1 &2, increase HR + contractility, vasodilates |
| side effects of isoproterenol | extremely arrhythmogenic increase heart metabolic demand, may decrease BP |
| Vasopressin V-1 receptors | arterial vasoconstriction |
| Vasopressin V-2 receptors (intrarenal) | water reabsorption at collecting ducts |
| Vasopressin V-2 Receptors (extrarenal) | mediate release of factor VIII and vWF |
| Nipride | arterial vasodilator cyanide toxicity at doses >3mcg/kg/min for 72hrs; check thiocyanate levels |
| Treatment for cyanide toxicity | amyl nitrate then sodium nitrite |
| Nitroglycerin | predominately venodilation with decreased myocardial wall tension from decreased preload; moderate coronary vasodilator |
| Hydralazine | alpha-blocker lowers BP |
| Equation for pulmonary compliance | change in volume / change in pressure |
| diseases in which pulmonary compliance is decreased | ARDS, fibrotic lung diseases, reperfusion injury, pulmonary edema, atelectiasis |
| How aging affects lung function | decreases FEV1 and vital capacity increases functional residual capacity |
| V/Q ratio | highest in upper lobes lowest in lower lobes |
| With ventilation, how do you improve oxygenation? | increase PEEP - improves FRC increase FiO2 |
| On ventilator, how do you decrease CO2/improve ventilation? | increase rate or volume |
| Normal Weaning Parameters | Neg inspiratory force >20, FiO2 <40%, PEEP of 5, pressure support 5, RR <24/min, HR <120bpm, PO2 >60mmHg, PCO2 <50mmHg, pH 7.35-7.45, sat >93%, off pressors, follows commands, can protect airway |
| Pressure support | patient initiates every breath and the ventilator delivers support with the preset pressure value inspiratory pressure held constant |
| Excessive PEEP complications | decreases right atrial filling decreased BP, decreased RBF and U/O, increased wedge pressure, increase pulmonary vascular resistance |
| Total Lung Capacity | TLC = FVC + RV |
| Forced Vital Capacity | maximal exhalation after maximal inhalation |
| Residual Volume | Lung Volume after Maximal expiration (20%) |
| Tidal Volume | volume of air with normal inspiration and expiration |
| Functional Residual Capacity | lung volume after normal exhalation ERV + RV |
| Expiratory reserve volume | volume of air that can be forcefully expired after normal expiration |
| Inspiratory Capacity | maximum air breathed in from FRC |
| FEV1 | forced expiratory volume in 1 sec after maximal inhalation |
| Minute ventilation | TV x RR |
| Restrictive Lung Disease effects on TLC, RV, FVC, FEV | TLC, RV and FVC are decreased FEV1 can be normal or increased |
| Obstructive Lung Disease effects on TLC, RV, FEV1 and FVC | TLC, RV increase FEV1 decreases FVC normal or decreased |
| MCC of increased dead space | excessive PEEP |
| Other causes of increased dead space | PE, pHTN |
| What is a shunt? What causes it? | poor ventilation but good perfusion atelectiasis, mucus plug, ARDS |
| What is ARDS? | inflammation of lung parenchyma mediated primarily by PMNs, get increased proteinaceous material, increased A-a gradient, increased pulmonary shunt |
| ARDS Criteria | Acute onset bilateral pulmonary infiltrates PaO2/FiO2 <300 wedge <18mmHg |
| Mendelson's Syndrome | chemical pneumonitis from aspiration of gastric secretions |
| MCC of hypoxia early post-op | atelectasis |
| Tx for atelectasis | incentive spirometer, pain control and ambulation |
| How do patients develop fevers secondary to ateletasis? | alveolar macrophages release IL-1 |
| Factors causing pulmonary vasodilation | PGE1, Prostacyclin, inhaled nitric oxide, sildenafil (heehee) |
| Causes for pulmonary vasoconstriction | hypoxia, acidosis, histamine, serotonin, TXA2 |
| MCC of poor urine output post-op | hypovolemia |
| MCC of post-operative renal failure | hypotension intra-op |
| % of nephrons that need to be damaged to cause renal dysfunction | 70% |
| Best test to determine azotemia | FeNa fractional excretion of sodium |
| Equation for FeNa | (urine Na/Cr) / (Plasma Na/Cr) |
| Prerenal RF Urine Osm, BUN:Cr, UNa, FeNa | Urine Osm: >500 BUN:Cr >20 Urine Na: <20 FeNa: <1% |
| Parenchymal RF Urine Osm, BUN:Cr, UNa, FeNa | Urine Osm: 250-350 BUN:Cr <10 Urine Na: >40 FeNa: >3% |
| Treatment for Oliguria | 1st: volume load 2nd: diuretic trial 3rd: dilaysis |
| MCC of renal ATN | HoTN intra-op |
| Causes of Post-renal Oliguria | obstructive uropathy ureteral obstruction severe BPH |
| Indications for Dialysis | fluid overload, hyperK, metabolic acidosis, uremic encephalopathy, uremeic coagulopathy, poisoning |
| How much does Hct increase per liter taken off during dialysis? | 5 |
| Continuous Veno-Venous Hemofiltration (CVVH) | temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis and are unstable |
| When is Renin Released? | decreased pressure sense in juxtaglomerular apparatus increased Na conc in macula densa beta-adrenergic stim & hyperK |
| Effects of Renin | converts angiotensinogen to angiotensin I |
| Aldosterone | acts on distal convoluted tubule to resorb water by upregulating Na/K ATPase Na resorbed, K secreted |
| Effects of AngII | vasocontricts as well as inhibits renin release |
| Atrial Natriuretic Peptide | released from atrial wall with atrial distention inhibits Na and water resorption in collecting ducts vasodilator |
| what part of the kidney controls GFR? | efferent limb |
| Antidiuretic Hormone (ADH) | released by posterior pituitary when osmolality is high collecting ducts for water resorption vasoconstrictor |
| Renal Toxic Drugs | NSAIDs Aminoglycosides Myoglobin Contrast Dyes |
| How NSAIDs affect Kidneys | inhibits prostaglandin synthesis, results is renal arteriole vasoconstriction |
| Aminoglycosides effects on kidneys | direct tubular injury |
| Mediators of SIRS | IL-1, TNF-alpha |
| Causes of SIRS | shock, infection, burns, multitrauma, pancreatitis, ARDS, |
| Most important stimulus for SIRS | endotoxin, LPS - lipid A |
| SIRS Criteria | Temp >38C or <26C HR >90 RR >20bpm or PaCO2 <32 WBC >12,000 or <4,000 |
| Multisystem Organ Dysfunction | Progressive but reversible dysfunction of 2 or more organs arising from an acute disruption of normal homeostasis |
| What must exist for 6-12 hours before someone is considered brain dead? | unresponsive to pain, absent cold caloric oculovestibular reflexes, absent oculocephalic reflex (patient doesn't track) no spontaneous respirations, no corneal reflexes, no gag reflex, fixed and dilated pupils, +apnea test |
| Results of EEG and MRA in brain dead person | MRA - no blood flow to brain EEG - electrical silence |
| Apnea test and brain death | patient disconnected from ventilator for 10 minutes CO2 > 60mmHg or increase CO2 > 20 at the end of the test |
| Affinity to Hb, O2 vs CO | CO has 250x more affinity than oxygen |
| Abnormal levels of carboxyHb in smokers vs nonsmokers | smokers: >20 nonsmokers >10 |
| Tx for methemoglobinemia | methylene blue |
| cyanide toxicity | disrupts the electron transport chain; can't utilize oxygen; get left to right shunt |
| treatment for cyanide toxicity | amyl nitrite, then sodium nitrite hydroxycobalamin |
| critical illness polyneuropathy | motor > sensory neuropathy occurs with sepsis can lead to failure to wean from vent |
| xanthine oxidase | in endothelial cells forms toxic radicals with reperfusion involved in metabolism of purines to uric acid |
| ICU psychosis | generally POD#3 and is frequently preceded by lucid interval |
| MCC of delayed discharge after cardiac surgery | AFib |
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