Download MICU Exam LATTEST UPDATE 2024-2025 QUESTIONS AND ANSWERS 100% CORRECT ARDS findings - AN and more Study Guides, Projects, Research Health sciences in PDF only on Docsity!
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ARDS findings - ANSWER: INFLAMMATORY Acute CXR - Bilateral infiltrates PaO2/FiO2 <300mmHg Predisposing condition Nothing else explains ARDS - WHAT TO SEE TO DIAGNOSE - ANSWER: Lavage CBC: 80% neutrophils Proteinacious fluid ARDS - What to Ignore - ANSWER: PCWP VENTING ARDS: - ANSWER: lung infiltration happens because the posterior portions of the lungs are gravidy dependent (Deadspace: volume of ventilated air not participating in gas exchange) Anatomical: Nose, trachea, bronchi Physiological: Alveoli not paricipating in gas exchange So pushing air just vents the anterior portions Overdisdentioin causes Ventilator Related Injury NOT Barotrauma VENTILATION GOALS - ANSWER: TIDAL VOLUME: 6ml/Kg PBW PlPressure: 30cm H SpO2: 88% - 95% pH: 7.35 - 7. ARDS CAUSE OF DEATH - ANSWER: Multiorgan failure Number of organs that fail from systemic inflammation predict mortality (adults) IN pediatric patients, progosis is mesured by FiO2 and PaO WHAT IS HYPOXEMIA - ANSWER: Hemoglobin saturation <60%
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NON INVASIVE FiO2 PERCENTAGES - ANSWER: NASAL CANNULA: Number 1-6; 20% - 40% o VENTILATED FACE MASK: Number 6-10; 40% - 60% o NON-REBREATHER: Number 10-15; 60% - 80% o NONINVASIVE VENTILATION (Tight Fitting Mask - reduces intubation rates and complications, mortality in Hypoxemic Respriatory Failure) - ANSWER: HF Nasal Cannula CPAP - PeeP only, oxygenation (CHF, OSA) BiPAP - Expiratory PosAirPRessure and Inspiratory PosAirPressure (COPD) NonInvasive Vent WHO IS IT NOT GOOD FOR - ANSWER: Unresponsive Facial Trauma Circulatory mess Impending cardiac or respiratory arrest Lots of secretions NonInvVent - Good for - ANSWER: OSA CHF COPD exacerbations ASTHMA (early) Hyperinflates at the end of expiration, makes for dynamic hyperinflation POSITIVE PRESSURE WHAT IS IT GOOD FOR - ANSWER: Reducing preload, reducing ventricular filling by increasing pulmonary vascular resistance Decreasing pressure gradient for venous flow into the thorax Increases interabdominal pressure by pushing diaphragm down HOWEVER A failing heart has increased preload with positive pressure ventilation
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NMS Symptoms - ANSWER: Hyperthermia Muscle Rigidity Altered Mental Status (coma/agitation) Autonomics: Arrhythmia, BP flactuation, Persistenty hypotension Myoglobinuric Renal Damage NMS Treatment - ANSWER: Either START the drug or STOP the drug Bromocriptine or Dantrolene SEROTONIN SYNDROME IMPORTANT FACTS - ANSWER: Iatrogenic overstimulation of serotonin receptors in CNS Caused by: MAOI's, SSRI's, TCA's, Lithium, Busspirone Serotonin Syndrome Sxs - ANSWER: Abrupt (6hrs) Hyperthermia Muscle Rigidity, Clonus Altered Mental Status (Delirium) Myoglobinuric Renal Damage Serotonin Syndrome Tx - ANSWER: Discontinue the drug Follow wiht serotonin antagonists Sedate with benzopiates Avoid physical restraints Use Cycloheptadine if severe HYPOTHERMIA IMPORTANT FACTS - ANSWER: <35F Body Temperature Body Vasoconstricts Body Shivers to double metabolic heat production Hypothermia Symptoms - ANSWER: 32C - 35C Confusion, pale, shiver, tachycardia
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28FC- 31.9C Lethargy, reduced/absent shivering, bradycardia/bradypenia 28C - 25C Coma, no shivering, edema, dialted/fixed pupils, bradycardia, hypotension, oliguria 25C and below Apnea, asystole Hypothermia Labs - ANSWER: ABG, Electrolytes, Coagulation factors, Renal function. Watch out for HYPERKALEMIA that happens because of shivering/rhabdomylalisis EKG will show J waves What are the two main methods of treating hypothermia? - ANSWER: External rewarming and internal rewarming How does external rewarming help in treating hypothermia? - ANSWER: It involves removing wet clothes and adding warm clothes, which can increase body temperature by 1-2 degrees Celsius per hour. What should be watched out for when performing external rewarming for hypothermia? - ANSWER: Ventricular fibrillation (V-Fib) may occur when removing clothes, so caution is needed to prevent this. How is internal rewarming performed in cases of hypothermia? - ANSWER: It involves increasing the temperature of gases to 40-45 degrees Celsius and raising the core body temperature by 2.5 degrees Celsius per hour, although it is difficult to do. INDUCED HYPOTHERMIA - ANSWER: 32C - 34C Comatose after recussitation from cardiac arrest What is the Glasgow Coma Scale (GCS) used for? - ANSWER: Assessing altered consciousness and predicting outcomes in patients with brain injury What are the components of the Glasgow Coma Scale (GCS)? - ANSWER: Eye response, verbal response, and motor response What range indicates mild alteration of consciousness on the Glasgow Coma Scale (GCS)? - ANSWER: 13 - 15
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MOST COMMON CAUSES OF ALTERED CONSCIOUSNESS - ANSWER: Ischemic Stroke (upon admission) Septic Encepalopathy (after admission) What is Septic Encepalopathy - ANSWER: Global brain disorder Infection starting outside the CNS 50% - 70% of septic patients have it Early sign of infection in the elderly Cerebral Edema Ammonia and Aromatic Amino Acid accumulation Inflammatory - Blood Brain Barrier permeability Delirium - Who - ANSWER: Vent-dependent folk Psychosis symptoms - ANSWER: Attention Deficits Disorderd thinking Flactuating course Psychosis Subtypes - ANSWER: Hyperactive Hypoactive MIxed Psychosis Predispositions - ANSWER: Age
- Sleep deprivation
- Unrelieved Pain
- Prolonged bed rest
- Major surgery
- Encepalopathy
- Inflammation
- Drugs What are the treatment strategies for psychosis? - ANSWER: Pain management, maintaining sleep- wake cycles, promoting out-of-bed time, encouraging family visits Which drugs should be avoided in psychosis treatment? - ANSWER: Midazolam and Lorazepam
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What sedative is recommended for psychosis treatment to reduce the risk of delirium? - ANSWER: Dexmedetomidine (alpha 2 agonists) Alcohol Withdrawal - What to see (4) - ANSWER: EEG shows increased motor activity CNS depression by stimulating GABA and inhibiting NDMA Withdrawal upregulates NDMA and downregulates GABA Dehydration Hypokalemia Hypomagnesimia (and possibly hypocalcemia if pancreatitis is involved) Generalised seizures 5 days to 2 weeks What is the first treatment for Wernicke Encephalopathy? - ANSWER: Thiamine (to protect mamillary bodies) What is the next treatment after Thiamine for Wernicke Encephalopathy? - ANSWER: Dextrose What symptoms can be confused with Alcohol Withdrawal Delirium 2 days after admission for Wernicke Encephalopathy? - ANSWER: Nystagmus and Oculomotor palsies What are the characteristics of a coma? - ANSWER: Unarousable, Unaware What are some causes of coma related to cerebral damage? - ANSWER: Diffuse bilateral cerebral damage, Unilateral cerebral damage What are some causes of coma related to mass lesions? - ANSWER: Supratentorial mass lesion, Posterior fossa mass lesion What are some other causes of coma? - ANSWER: Toxic metabolic encephalopathies, Apparent coma (locked-in, hysteria), Cardiac Arrest, Stroke, Brain Bleed reflexes coma evaluation? - ANSWER: Spontaneous body movements, eye movements (indicating locked-in/vegetative state), spontaneous myoclonus (indicative of cerebral seizure), flaccid movements (suggesting brainstem or brain injury), clonic movements (associated with encephalopathy), and focal movements (indicating space-occupying lesions or spinal cord injury) What does eye movement indicate in coma evaluation? - ANSWER: Locked-in/vegetative state
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What are the pupillary findings in COma for acute liver failure and postanoxic encephalopathy? - ANSWER: Midposition, unreactive What are the pupillary findings in COma for brain death? - ANSWER: Midposition, unreactive What unit is used to measure the size of a catheter? - ANSWER: Gauge or French size How is catheter size measured by gauge? - ANSWER: Higher gauge = narrower wire How does the French size of a catheter change from 0 to 1? - ANSWER: Each increment is 1/3mm larger How does catheter length affect flow rate? - ANSWER: Longer catheter = Slower flow What type of catheter is used for rapid infusion? - ANSWER: LARGE bore, SHORT length What are the typical dimensions of peripheral vascular catheters? - ANSWER: 1 - 2 inches, 16 - 20 gauge What material are PICC lines typically made of? - ANSWER: Silicone What material are catheters, other than PICC lines, typically made of? - ANSWER: Polyurethane How is body weight predicted in ARDS for males and females? - ANSWER: male: 50, female: 45.5 + [2.3 x height in inches - 60] What is the recommended initial tidal volume for ventilating lungs in ARDS? - ANSWER: 8ml/kg How should tidal volumes be adjusted in ARDS patients? - ANSWER: Reduce by 1ml/kg per hour until reaching 6ml/kg
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What is the recommended maximum end inspiratory pressure in ARDS? - ANSWER: Less than 30 What is the target oxygen saturation range in ARDS patients? - ANSWER: 88% to 95% What should be done if plateau pressure is greater than 30 in ARDS? - ANSWER: Lower the tidal volume by 1ml/kg until reaching 6ml/kg or a tidal volume of 4 MAP Formula - ANSWER: Cardiac Output X Systemic Vascular Resistance Cardiac Output Formula - ANSWER: Heart Rate X Systolic Volume Systolic Volume takes into account - ANSWER: Preload X Conractility What are some pathologies that affect SVR? - ANSWER: Sepsis, Anaphylaxis, Trauma, Addisons Disease, Anaesthesia, Vasoconstriction, INOconstrictors What are the symptoms of Addisons Disease? - ANSWER: Hypoglycemia, postural HTN, skin and hair changes, GI disturbances, Weakness, Hyponatremia, Hyperkalemia What factors affect SYStolic Volume - ANSWER: Preload and Conractility Contractility pathologies: MI, CHF SIRS Criteria (4) - ANSWER: Temp >38 or < Heart rate > Respiratory Rate > WBC >12 or < What to do for SIRS - ANSWER: 30cc/Kg IVfluids Antibiotics Source Control Pressors if needed (NOrEpi, Dopamine)
