ABSITE ch 16 critical care

1. Normal CO

4-8 L/min

2. normal CI

2.5-4 L/min

3. normal SVR

800-1400

4. normal SVRI

1500-2400

5. normal PCWP

7-15

6. normal CVP

5-9

7. normal PA pressure

20-30/6-15

8. normal SvO2

65-75

9. Mean arterial pressure

CO X SVR OR 1/3(pulse pressure)+diastolic pressure

10. Cardiac index

CO/BSA

11. Systemic vascular resistance index

 SVR X BSA

12. End-diastolic length, linearly related to end-diastolic volume and filling

Preload

13. Resistance against the ventricle contracting

Afterload

14. Determinants of stroke volume

LVEDV, contractility, afterload

15. Stroke volume

LVEDV-LVESV

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

 5:1

23. percent of CO given to kidney

25%

24. percent of CO given to brain

15%

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

45cm

31. approximate Swan depth from RIJ approach

50cm

32. approximate Swan depth from LSC approach

55cm
33. approximate Swan depth from LIJ approach

60cm

34. primary determinants of myocardial O2 consumption (2)

inc ventricular wall tension and HR

35. alveolar :arterial gradient in nonventilated patient

10-15

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

1X

40. potency of prednisone, prednisilone, methylpred

5X

41. potency of dexamethasone

30X

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

Dopamine

63. Drug that acts on beta 1 and 2 receptors (contractility, vasodilation, inc HR)

Dobutamine

64. Drug that is a phosphodiesterase inhibitor that causes calcium flux and myocardial
contractility, as well as vascular smooth muscle relaxation and vasodilation

Milrinone
65. Drug that causes vasoconstriction via alpha 1 activation

Phenylephrine

66. Drug that activates beta 1 at low dose and alpha 1 and 2 at high dose, potent
splanchnic vasoconstrictor

Norepinephrine

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

Epinephrine

68. Drug that activates beta 1 and 2 (inc HR and contractility, vasodilates)

Isoprotenerol

69. Drug that activates V1 receptors (vasoconstriction) and V2 recptors (water

resorption, factor VIII and vWF release)

Vasopressin

70. Arterial and venous dilator that can cause cyanide toxicity with prolonged use

Nipride

71. Treatment of cyanide toxicity

Amyl nitrate, then sodium nitrite

72. Drug that causes primarily venodilation, and decreases myocardial wall tension by
decreasing preload

Nitroglycerin

73. Alpha blocker used to lower blood pressure

Hydralazine

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

<60%

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?

Vasodilates

92. Acidosis: vasoconstricts or vasodilates pulmonary vasculature?

Vasoconstricts

93. Most common cause of postoperative renal failure

Hypotension

94. Amount of nephron damage required before renal dysfunction occurs

70%

95. FeNa

= (urine Na/Cr)/(plasma Na/Cr)

96. FeNa in prerenal failure

 <1%

97. urine Na in prerenal failure

<20

98. BUN/Cr in prerenal failure

>20

99. urine osm in prerenal failure

>500mOsm

100. increase in Hct for each liter removed with HD

5-8

101. released in response to dec BP sensed by juxtaglomerular apparatus and in

response to increased Na concentration in macula densa

renin

102. converts angiotensinogen to angiotensin 1

renin

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?

 Efferent

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