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Section II General Surgery P203Surgical Recall Sixth > Surgical Intensive Care, C65 P476-489 > Flashcards

Surgical Intensive Care, C65 P476-489 Flashcards

1
Q

INTENSIVE CARE UNIT (ICU) BASICS
How is an ICU note written?
P476

A 
By systems:
    Neurologic (e.g., GCS, MAE, pain
      control)
    Pulmonary (e.g., vent settings)
    CVS (e.g., pressors, Swan numbers)
    GI (gastrointestinal)
    Heme (CBC)
    FEN (e.g., Chem 10, nutrition)
    Renal (e.g., urine output, BUN, Cr)
    ID (e.g., Tmax, WBC, antibiotics)
    Assessment
    Plan
    (Note: physical exam included in each
       section)
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2
Q 
INTENSIVE CARE UNIT (ICU) BASICS
What is the best way to
report urine output in the
ICU?
P477
A

24 hrs/last shift/last 3 hourly rate =
“urine output has been 2 liters over last
24 hrs, 350 last shift, and 45, 35, 40 cc
over the last 3 hours”

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3
Q

INTENSIVE CARE UNIT (ICU) BASICS
What are the possible causes
of fever in the ICU?
P477

A 
Central line infection
Pneumonia/atelectasis
UTI, urosepsis
Intra-abdominal abscess
Sinusitis
DVT
Thrombophlebitis
Drug fever
Fungal infection, meningitis, wound
    infection
Endocarditis
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4
Q

INTENSIVE CARE UNIT (ICU) BASICS
What is the most common
bacteria in ICU pneumonia?
P477

A

Gram-negative rods

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5
Q 
INTENSIVE CARE UNIT (ICU) BASICS
What is the acronym for the
basic ICU care checklist
(Dr. Vincent)?
P477
A 
“FAST HUG”:
    Feeding
    Analgesia
    Sedation
    Thromboembolic prophylaxis
Head-of-bed elevation (pneumonia
   prevention)
Ulcer prevention
Glucose control
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6
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is CO?
P477

A

Cardiac Output: HR (heart rate) SV

stroke volume

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7
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal CO?
P477

A

4–8 L/min

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8
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What factors increase CO?
P477

A

Increased contractility, heart rate, and

preload; decreased afterload

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9
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is CI?
P477

A

Cardiac Index: CO/BSA (body surface

area)

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10
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal CI?
P478

A

2.5–3.5 L/min/M2

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11
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is SV?
P478

A

Stroke Volume: the amount of blood
pumped out of the ventricle each beat;
simply, end diastolic volume minus the
end systolic volume or CO/HR

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12
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal SV?
P478

A

60–100 cc

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13
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is CVP?
P478

A

Central Venous Pressure: indirect

measurement of intravascular volume status

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14
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal CVP?
P478

A

4–11

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15
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is PCWP?
P478

A

Pulmonary Capillary Wedge Pressure:
indirectly measures left atrial pressure,
which is an estimate of intravascular
volume (LV filling pressure)

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16
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal PCWP?
P478

A

5–15

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17
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is anion gap?
P478

A

Na⁻ – (Cl⁻ + HCO⁻(3))

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18
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What are the normal values
for anion gap?
P478
A

10–14

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19
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
Why do you get an
increased anion gap?
P478
A

Unmeasured acids are unmeasured
anions in the equation that are part of the
“counterbalance” to the sodium cation

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20
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What are the causes of
increased anion gap acidosis
in surgical patients?
P478
A 
Think “SALUD”:
    Starvation
    Alcohol (ethanol/methanol)
    Lactic acidosis
    Uremia (renal failure)
    DKA
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21
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
Define MODS.
P478

A

Multiple Organ Dysfunction Syndrome

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22
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is SVR?
P478

A

Systemic Vascular Resistance:
MAP – CVP / CO x 80 (remember,
P = F x R, Power FoRward; and
calculating resistance: R = P/F)

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23
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is SVRI?
P478

A

Systemic Vascular Resistance Index:

SVR/BSA

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24
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal SVRI?
P479

A

1500–2400

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25
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is MAP?
P479

A 
Mean Arterial Pressure: diastolic blood
pressure + 1/3 (systolic–diastolic
pressure)
(Note: Not the mean between diastolic
and systolic blood pressure because
diastole lasts longer than systole)
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26
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is PVR?
P479

A

Pulmonary Vascular Resistance:
PA(MEAN) – PCWP / CO x 80 (PA is
pulmonary artery pressure and LA is left
atrial or PCWP pressure)

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27
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the normal PVR value?
P479

A

100 ± 50

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28
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the formula for
arterial oxygen content?
P479
A

Hemoglobin x O(2) saturation (S(aO(2))) x 1.34

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29
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the basic formula
for oxygen delivery?
P479
A

CO x (oxygen content)

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30
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the full formula for
oxygen delivery?
P479
A

CO x (1.34 x Hgb S(aO(2)) x 10

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31
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What factors can increase
oxygen delivery?
P479
A

Increased CO by increasing SV, HR, or
both; increased O(2) content by increasing
the hemoglobin content, S(aO(2)), or both

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32
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is mixed venous
oxygen saturation?
P479
A

S(vO(2)); simply, the O(2) saturation of the
blood in the right ventricle or pulmonary
artery; an indirect measure of peripheral
oxygen supply and demand

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33
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
Which lab values help assess
adequate oxygen delivery?
P479
A 
S(vO(2)) (low with inadequate delivery),
lactic acid (elevated with inadequate
delivery), pH (acidosis with inadequate
delivery), base deficit
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34
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is FENa?
P479

A

Fractional Excretion of Sodium (Na⁺):

(U(Na) x P(cr) / P(Na) x U(cr)) x 100

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35
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the memory aid for
calculating FENa?
P479
A

Think: YOU NEED PEE = U (Urine)
N (Na⁺) P (Plasma); U(Na) x P(cr); for
the denominator, switch everything,
P(Na) x U(cr) (cr = creatinine)

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36
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the prerenal FENa
value?
P480
A 
<1.0; renal failure from decreased renal
blood flow (e.g., cardiogenic, hypovolemia,
arterial obstruction, etc.)
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37
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
How long does Lasix® effect
last?
P480
A

6 hours = LASIX = LAsts SIX hours

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38
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the formula for
flow/pressure/resistance?
P480
A

Remember Power FoRward:

Pressure = Flow x Resistance

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39
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the “10 for 0.08 rule”
of acid-base?
P480
A

For every increase of P(aCO(2)) by 10 mm Hg,

the pH falls by 0.08

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40
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is the “40, 50, 60 for
70, 80, 90 rule” for O(2) sats?
P480
A

P(a)O(2) of 40, 50, 60 corresponds roughly

to an O(2) sat of 70, 80, 90, respectively

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41
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
One liter of O(2) via nasal
cannula raises F(iO(2)) by how
much?
P480
A

≈3%

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42
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is pure respiratory
acidosis?
P480
A 
Low pH (acidosis), increased P(aCO(2)),
normal bicarbonate
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43
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is pure respiratory
alkalosis?
P480
A 
High pH (alkalosis), decreased P(aCO(2)),
normal bicarbonate
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44
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is pure metabolic
acidosis?
P480
A

Low pH, low bicarbonate, normal P(aCO(2))

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45
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What is pure metabolic
alkalosis?
P480
A

High pH, high bicarbonate, normal

P(aCO(2))

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46
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
List how the body compensates for each
of the following:
Respiratory acidosis
P480
A

Increased bicarbonate

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47
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
List how the body compensates for each
of the following:
Respiratory alkalosis
P480
A

Decreased bicarbonate

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48
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
List how the body compensates for each
of the following:
Metabolic acidosis
P480
A

Decreased P(aCO(2))

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49
Q 
INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
List how the body compensates for each
of the following:
Metabolic alkalosis
P480
A

Increased P(aCO(2))

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50
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What does MOF stand for?
P480

A

Multiple Organ Failure

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51
Q

INTENSIVE CARE UNIT FORMULAS AND TERMS
YOU SHOULD KNOW
What does SIRS stand for?
P480

A

Systemic Inflammatory Response

Syndrome

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52
Q 
SICU DRUGS
DOPAMINE
What is the site of action and effect at the following
levels:
Low dose (1–3 g/kg/min)?
P481
A

+ + dopa agonist; renal vasodilation

a.k.a. “renal dose dopamine”

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53
Q 
SICU DRUGS
DOPAMINE
What is the site of action and effect at the following
levels:
Intermediate dose
(4–10 g/kg/min)?
P481
A

1,
+ a(1) + + ℬ(1); positive inotropy and some
vasoconstriction

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54
Q 
SICU DRUGS
DOPAMINE
What is the site of action and effect at the following
levels:
High dose (>10 g/kg/min)?
P481
A

+ + + a(1) agonist; marked afterload

increase from arteriolar vasoconstriction

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55
Q 
SICU DRUGS
DOPAMINE
Has “renal dose” dopamine
been shown to decrease
renal failure?
P481
A

NO

56
Q

SICU DRUGS
DOBUTAMINE
What is the site of action?
P481

A

+ + + ℬ(1) agonist, + + ℬ(2)

57
Q

SICU DRUGS
DOBUTAMINE
What is the effect?
P481

A

↑ inotropy; ↑ chronotropy, decrease in

systemic vascular resistance

58
Q

SICU DRUGS
ISOPROTERENOL
What is the site of action?
P481

A

+ + + ℬ(1) and, ℬ(2) agonist

59
Q

SICU DRUGS
ISOPROTERENOL
What is the effect?
P481

A

↑ inotropy; ↑ chronotropy; ( + vasodilation

of skeletal and mesenteric vascular beds)

60
Q

SICU DRUGS
EPINEPHRINE (EPI)
What is the site of action?
P481

A

+ + a(1), a(2), + + + + ℬ(1), and ℬ(2) agonist

61
Q

SICU DRUGS
EPINEPHRINE (EPI)
What is the effect?
P481

A

↑ inotropy; ↑ chronotropy

62
Q 
SICU DRUGS
EPINEPHRINE (EPI)
What is the effect at high
doses?
P481
A

Vasoconstriction

63
Q

SICU DRUGS
NOREPINEPHRINE (NE)
What is the site of action?
P481

A

+ + + a(1), a(2), + + + ℬ(1), and ℬ(2) agonist

64
Q

SICU DRUGS
NOREPINEPHRINE (NE)
What is the effect?
P481

A

↑ inotropy; ↑ chronotropy; increase

in blood pressure

65
Q 
SICU DRUGS
NOREPINEPHRINE (NE)
What is the effect at high
doses?
P482
A

Severe vasoconstriction

66
Q

SICU DRUGS
VASOPRESSIN
What is the action?
P482

A

Vasoconstriction (increases MAP, SVR)

67
Q

SICU DRUGS
VASOPRESSIN
What are the indications?
P482

A

Hypotension, especially refractory to
other vasopressors (low-dose infusion—
0.01–0.04 units per minute) or as a bolus
during ACLS (40 u)

68
Q

SICU DRUGS
NITROGLYCERINE (NTG)
What is the site of action?
P482

A

+ + + venodilation; + arteriolar dilation

69
Q

SICU DRUGS
NITROGLYCERINE (NTG)
What is the effect?
P482

A

Increased venous capacitance, decreased

preload, coronary arteriole vasodilation

70
Q

SICU DRUGS
SODIUM NITROPRUSSIDE (SNP)
What is the site of action?
P482

A

+ + + venodilation; + + + arteriolar

dilation

71
Q

SICU DRUGS
SODIUM NITROPRUSSIDE (SNP)
What is the effect?
P482

A

Decreased preload and afterload

allowing blood pressure titration

72
Q 
SICU DRUGS
SODIUM NITROPRUSSIDE (SNP)
What is the major toxicity of
SNP?
P482
A

Cyanide toxicity

73
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Preload
P482

A

Load on the heart muscle that stretches
it to end-diastolic volume (end-diastolic
pressure) = intravascular volume

74
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Afterload
P482

A

Load or resistance the heart must pump

against = vascular tone = SVR

75
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Contractility
P482

A

Force of heart muscle contraction

76
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Compliance
P482

A

Distensibility of heart by the preload

77
Q

INTENSIVE CARE PHYSIOLOGY
What is the Frank-Starling
curve?
P482

A

Cardiac output increases with increasing

preload up to a point

78
Q 
INTENSIVE CARE PHYSIOLOGY
What is the clinical
significance of the steep
slope of the Starling curve
relating end-diastolic
volume to cardiac output?
P483
A

Demonstrates the importance of preload

in determining cardiac output

79
Q 
INTENSIVE CARE PHYSIOLOGY
What factors influence the
oxygen content of whole
blood?
P483
A 
Oxygen content is composed largely of
that oxygen bound to hemoglobin, and
is thus determined by the hemoglobin
concentration and the arterial oxygen
saturation; the partial pressure of oxygen
dissolved in plasma plays a minor role
80
Q 
INTENSIVE CARE PHYSIOLOGY
What factors influence
mixed venous oxygen
saturation?
P483
A

Oxygen delivery (hemoglobin
concentration, arterial oxygen saturation,
cardiac output) and oxygen extraction
by the peripheral tissues

81
Q 
INTENSIVE CARE PHYSIOLOGY
What lab test for tissue
ischemia is based on the
shift from aerobic to
anaerobic metabolism?
P483
A

Serum lactic acid levels

82
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Dead space
P483

A

That part of the inspired air that does not
participate in gas exchange (e.g., the
gas in the large airways/ET tube not
in contact with capillaries)
Think: space = air

83
Q

INTENSIVE CARE PHYSIOLOGY
Define the following terms:
Shunt fraction
P483

A

That fraction of pulmonary venous blood
that does not participate in gas exchange
Think: shunt = blood

84
Q

INTENSIVE CARE PHYSIOLOGY
What causes increased dead
space?
P483

A

Overventilation (emphysema, excessive
PEEP) or underperfusion (pulmonary
embolus, low cardiac output, pulmonary
artery vasoconstriction)

85
Q 
INTENSIVE CARE PHYSIOLOGY
At high shunt fractions, what
is the effect of increasing
F(iO(2)) on arterial P(O(2))?
P483
A

At high shunt fractions (50%), changes
in F(iO(2)) have almost no effect on arterial
P(iO(2)) because the blood that does “see” the
O(2) is already at maximal O(2) absorption;
thus, increasing the F(iO(2)) has no effect
(F(iO(2) can be minimized to prevent
oxygen toxicity)

86
Q

INTENSIVE CARE PHYSIOLOGY
Define ARDS.
P484

A

Acute Respiratory Distress Syndrome:
lung inflammation causing respiratory
failure

87
Q

INTENSIVE CARE PHYSIOLOGY
What is the ARDS diagnostic
triad?
P484

A

“CXR”:
Capillary wedge pressure 18
X-ray of chest with bilateral infiltrates
Ratio of P(aO(2)) to F(iO(2)) < 200

88
Q

INTENSIVE CARE PHYSIOLOGY
What does the classic chest
x-ray look like with ARDS?
P484

A

Bilateral fluffy infiltrates

89
Q

INTENSIVE CARE PHYSIOLOGY
How can you remember the
P(aO(2)) to F(iO(2)), or PF, ratio?
P484

A

Think: “PUFF” ratio: PF ratio = P(aO(2)):

F(iO(2)) ratio

90
Q

INTENSIVE CARE PHYSIOLOGY
At what concentration does
O(2) toxicity occur?
P484

A 
F(iO(2)) of >60% x 48 hours; thus, try to
keep F(iO(2)) below 60% at all times
91
Q 
INTENSIVE CARE PHYSIOLOGY
What are the ONLY
ventilatory parameters that
have been shown to decrease
mortality in ARDS patients?
P484
A

Low tidal volumes ( ≤6 cc/kg) and low

plateau pressures <30

92
Q

INTENSIVE CARE PHYSIOLOGY
What are the main causes of
carbon dioxide retention?
P484

A

Hypoventilation, increased dead space
ventilation, and increased carbon dioxide
production (as in hypermetabolic
states)

93
Q 
INTENSIVE CARE PHYSIOLOGY
Why are carbohydrates
minimized in the diet/TPN
of patients having difficulty
with hypercapnia?
P484
A

Respiratory Quotient (RQ) is the ratio of
CO(2) production to O(2) consumption and
is highest for carbohydrates (1.0) and
lowest for fats (0.7)

94
Q 
HEMODYNAMIC MONITORING
Why are indwelling arterial
lines used for blood pressure
monitoring in critically ill
patients?
P484
A 
Because of the need for frequent
measurements, the inaccuracy of
frequently repeated cuff measurements,
the inaccuracy of cuff measurements in
hypotension, and the need for frequent
arterial blood sampling/labs
95
Q 
HEMODYNAMIC MONITORING
Which pressures/values are
obtained from a Swan-Ganz
catheter?
P484
A

CVP, PA pressures, PCWP, CO, PVR,

SVR, mixed venous O(2) saturation

96
Q

HEMODYNAMIC MONITORING
Identify the Swan-Ganz
waveforms:
P485 (picture)

A
  1. CVP/right atrium
  2. Right ventricle
  3. Pulmonary artery
  4. Wedge
97
Q

HEMODYNAMIC MONITORING
What does the abbreviation
PCWP stand for?
P485

A

Pulmonary Capillary Wedge Pressure

98
Q

HEMODYNAMIC MONITORING
Give other names for PCWP.
P485

A

Wedge or wedge pressure, pulmonary

artery occlusion pressure (PAOP)

99
Q

HEMODYNAMIC MONITORING
What is it?
P485 (picture)

A

Pulmonary capillary pressure after
balloon occlusion of the pulmonary
artery, which is equal to left atrial
pressure because there are no valves
in the pulmonary system
Left atrial pressure is essentially equal to
left ventricular end diastolic pressure
(LVEDP): left heart preload, and,
thus, intravascular volume status.

100
Q

HEMODYNAMIC MONITORING
What is the primary use of
the PCWP?
P486

A

As an indirect measure of preload

intravascular volume

101
Q 
HEMODYNAMIC MONITORING
Has the usage of a Swan-
Ganz catheter been shown
to decrease mortality in ICU
patients?
P486
A

NO

102
Q

MECHANICAL VENTILATION
Define ventilation.
P486

A

Air through the lungs; monitored by

P(CO(2))

103
Q

MECHANICAL VENTILATION
Define oxygenation.
P486

A 
Oxygen delivery to the alveoli; monitored
by O(2) sats and P(O(2))
104
Q 
MECHANICAL VENTILATION
What can increase
ventilation to decrease
P(CO(2))?
P486
A

Increased respiratory rate (RR),
increased tidal volume (minute
ventilation)

105
Q

MECHANICAL VENTILATION
What is minute ventilation?
P486

A

Volume of gas ventilated through the

lungs (RR x tidal volume)

106
Q

MECHANICAL VENTILATION
Define tidal volume.
P486

A

Volume delivered with each breath;

should be 6 to 8 cc/kg on the ventilator

107
Q

MECHANICAL VENTILATION
Are ventilation and
oxygenation related?
P486

A

Basically no; you can have an O(2) sat of
100% and a P(CO(2)) of 150; O(2) sats do not tell
you anything about the P(CO(2)) (key point!)

108
Q 
MECHANICAL VENTILATION
What can increase P(O(2))
(oxygenation) in the
ventilated patient?
P486
A 
Increased F(iO(2))
Increased PEEP
109
Q

MECHANICAL VENTILATION
What can decrease P(CO(2)) in
the ventilated patient?
P486

A

Increased RR
Increased tidal volume (i.e., increase
minute ventilation)

110
Q

MECHANICAL VENTILATION
Define the following modes:
IMV
P486

A 
Intermittent Mandatory Ventilation:
mode with intermittent mandatory
ventilations at a predetermined rate;
patients can also breathe on their own
above the mandatory rate without help
from the ventilator
111
Q

MECHANICAL VENTILATION
Define the following modes:
SIMV
P487

A 
Synchronous IMV: mode of IMV
that delivers the mandatory breath
synchronously with patient’s initiated
effort; if no breath is initiated, the
ventilator delivers the predetermined
mandatory breath
112
Q

MECHANICAL VENTILATION
Define the following modes:
A-C
P487

A

Assist-Control ventilation: mode in which
the ventilator delivers a breath when
the patient initiates a breath, or the
ventilator “assists” the patient to breathe;
if the patient does not initiate a breath,
the ventilator takes “control” and delivers
a breath at a predetermined rate
In contrast to IMV, all breaths are by the
ventilator

113
Q

MECHANICAL VENTILATION
Define the following modes:
CPAP
P487

A 
Continuous Positive Airway Pressure:
    positive pressure delivered continuously
    (during expiration and inspiration)
    by ventilator, but no volume
    breaths (patient breathes on own)
114
Q

MECHANICAL VENTILATION
Define the following modes:
Pressure support
P487

A 
Pressure is delivered only with an
    initiated breath; pressure support
    decreases the work of breathing by
    overcoming the resistance in the
    ventilator circuit
115
Q

MECHANICAL VENTILATION
Define the following modes:
APRV
P487

A

Airway Pressure Release Ventilation:
high airway pressure intermittently
released to a low airway pressure
(shorter period of time)

116
Q

MECHANICAL VENTILATION
Define the following modes:
HFV
P487

A

High Frequency Ventilation: rapid rates

of ventilation with small tidal volumes

117
Q 
MECHANICAL VENTILATION
What are the effects of
positive pressure ventilation
in a patient with hypovolemia
or low lung compliance?
P487
A

Venous return and cardiac output are

decreased

118
Q

MECHANICAL VENTILATION
Define PEEP:
P487

A

Positive End Expiration Pressure:
positive pressure maintained at the end
of a breath; keeps alveoli open

119
Q

MECHANICAL VENTILATION
What is “physiologic PEEP”?
P488

A

PEEP of 5 cm H(2)O; thought to
approximate normal pressure in normal
nonintubated people caused by the
closed glottis

120
Q

MECHANICAL VENTILATION
What are the side effects of
increasing levels of PEEP?
P488

A

Barotrauma (injury to airway =
pneumothorax), decreased CO from
decreased preload

121
Q 
MECHANICAL VENTILATION
What are the typical initial
ventilator settings:
Mode?
P488
A

Intermittent mandatory ventilation

122
Q 
MECHANICAL VENTILATION
What are the typical initial
ventilator settings:
Tidal volume?
P488
A

6–8 ml/kg

123
Q 
MECHANICAL VENTILATION
What are the typical initial
ventilator settings:
Ventilator rate?
P488
A

10 breaths/min

124
Q 
MECHANICAL VENTILATION
What are the typical initial
ventilator settings:
F(iO(2))?
P488
A

100% and wean down

125
Q 
MECHANICAL VENTILATION
What are the typical initial
ventilator settings:
PEEP?
P488
A

5 cm H(2)O
From these parameters, change
according to blood-gas analysis

126
Q

MECHANICAL VENTILATION
What is a normal I:E (inspiratory
to expiratory time)?
P488

A

1:2

127
Q 
MECHANICAL VENTILATION
When would you use an
inverse I:E ratio (e.g., 2:1,
3:1, etc.)?
P488
A

To allow for longer inspiration in patients
with poor compliance, to allow for
“alveolar recruitment”

128
Q

MECHANICAL VENTILATION
When would you use a prolonged
I:E ratio (e.g., 1:4)?
P488

A

COPD, to allow time for complete

exhalation (prevents “breath stacking”)

129
Q 
MECHANICAL VENTILATION
What clinical situations
cause increased airway
resistance?
P488
A

Airway or endotracheal tube obstruction,
bronchospasm, ARDS, mucous plug,
CHF (pulmonary edema)

130
Q

MECHANICAL VENTILATION
What are the presumed
advantages of PEEP?
P488

A

Prevention of alveolar collapse and
atelectasis, improved gas exchange,
increased pulmonary compliance,
decreased shunt fraction

131
Q

MECHANICAL VENTILATION
What are the possible
disadvantages of PEEP?
P488

A 
Decreased cardiac output, especially in
the setting of hypovolemia; decreased gas
exchange; ↓ compliance with high levels
of PEEP, fluid retention, increased
intracranial pressure, barotrauma
132
Q 
MECHANICAL VENTILATION
What parameters must
be evaluated in deciding
if a patient is ready to be
extubated?
P489
A

Patient alert and able to protect airway,
gas exchange (P(aO(2)) >70, (P(aO(2)) 5 cc/kg), minute
ventilation ( < –20 cm H(2)O,
or more negative), F(iO(2)) ≤40%, PEEP 5,
PH >7.25, RR <105

133
Q 
MECHANICAL VENTILATION
What is the Rapid-Shallow
Breathing (a.k.a. Tobin)
index?
P489
A

Rate: Tidal volume ratio; Tobin index
105 is associated with successful
extubation (Think: Respiratory Therapist
= RT = Rate: Tidal volume)

134
Q 
MECHANICAL VENTILATION
What is a possible source of
fever in a patient with an NG
or nasal endotracheal tube?
P489
A

Sinusitis (diagnosed by sinus films/CT)

135
Q

MECHANICAL VENTILATION
What is the 3545 rule of
blood gas values?
P489

A

Normal values:
pH = 7.357.45
P(CO(2)) = 3545

136
Q 
MECHANICAL VENTILATION
Which medications can be
delivered via an
endotracheal tube?
P489
A 
Think “NAVEL”:
    Narcan
    Atropine
    Vasopressin
    Epinephrine
    Lidocaine
137
Q 
MECHANICAL VENTILATION
What conditions should you
think of with c peak airway
pressure and T urine
output?
P489
A
  1. Tension pneumothorax

2. Abdominal compartment syndrome

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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