Approach to Critically Ill patients and vent support for Dummies
You are under cardiac arrest for stealing my heart
Don't Be Nervous
ARDS you feelin lucky?
Intern Facts/Semi Facts
100
What is the definition of shock

Presence of multisystem end organ hypoperfusion

100

This is the most reasonable first line vasopressor used in cardiogenic shock

Norepinephrine (associated with fever adverse events) i.e. lower lactate levels

100

Osmotic Demyelination Syndrome, previously known as Central Pontine Myelinolysis is best avoided by correcting hyponatremia no more than how much in the first 24 and 48 hours?

8

15

100

The natural history of ARDS is marked by 3 phases, name them

Exudative, proliferative, and fibrotic

100

This intern enjoys anime, Manchester united football, and got loopholed out of a greencard

Manvith

200

Name the 4 types of respiratory failure

I Acute hypoxemic Respiratory Failure

II Hypercapnic Respiratory Failure

III Lung Atelectasis

IV Metabolic Demands

200

This is the shock you should give ASAP when VF or VT is recognized

200J

Biphasic waveform

200

What makes up the clinical triad of Wernicke's Disease?

Ophthalmoplegia, Ataxia, and global confusion

200

A 2013 trial demonstrated a significant reduction in 28 day mortality with what positioning for patients with severe ARDS

Prone

200

This intern hasn't seen Peaky Blinders (despite an obvious reason to do so) and doesn’t like scrubs that show too much ankle

Shelby

300

These variables are used to calculate the SOFA score

PaO2, FiO2, respiratory support

Platelets

Billirubin

MAP

GCS

Creatinine or urine output

300

This is the initial dose of amiodarone that you can give if No ROSC is achieved in a patient that has V fib or pulseless V tach

300mg

300

Current guidelines recommend targeted temperature management (TTM) for cardiac arrest patients who have no meaningful response to verbal commands after return of spontaneous circulation between …and…degrees C for at least 24 hours

33-36

300

True or false: Patients with ARDS arising from direct lung injury (including PNA, aspiration, pulmonary contusion) are less likely to die compared to ARDS 2/2 surgery and trauma patients

False, patients with direct lung injury are more likely to die 2/2 ARDS

300

This intern gestures a lot with their hands when they talk, knows the highways you grew up around better than you, and has a fuzzy coat

Omar

400

These are the criteria for determining if your patient is ready to be extubated

Underlying process is improved

Awake, minimal sedation

FIO2 <0.5

PEEP <8.0 cm H2O

Stable hemodynamics

Minimal secretions/good cough

400

This sleep disorder and this cardiac arrhythmia are associated with increased sudden cardiac death risk

OSA

A fib

400

CAR-T therapy is associated with significant side effects including CRS or cytokine release syndrome causing hypotension, fever and hypoxia as well as possible multiorgan dysfunction. CRS occurs in...% to …% of CAR-T treated patients.

80-100%

400

Which 2 etiologies of ARDS make up a combined 40-60% of cases

PNA and sepsis

400

This baritone intern likes pineapple on their pizza

Sami

500

These values constitute passing a spontaneous breathing test

RR < 35

SBP 90 to 180 mmHg

HR change of <20%

500

This is the clinical presentation of cardiogenic shock

Persistent hypotension (SBP <90) or MAP <60-65mmHg unresponsive to volume replacement or by use of vasopressors needed to maintain SBP >90mmHg

Accompanied by clinical features of peripheral hypoperfusion (i.e. arterial lactate >2)

500

A very elevated serum level (>33 micrograms/L) of this biochemical marker within the first 3-5 days after resuscitation following cardiac arrest is indicative of brain damage and predicts a poor outcome.

Neuron-specific Enolase (NSE)

500

Regarding evidence based recommendations for ARDS therapies, what is the only recommended therapy based on strong clinical evidence from randomized clinical trials. Hint, its a vent setting.

Low tidal volume mechanical ventilation

500

This intern has batman themed art in their home that my wife won't let me get for ours.

Abby

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