Pulmonary
Ventilators
ICU
ICU 2
Get at me bro
100
Light's Criteria
- Pleural fluid protein / serum protein > 0.5
- Pleural fluid LDH / serum LDH > 0.6
- Pleural fluid LDH > 2/3 the upper limit of normal serum LDH
100
This landmark trial showed reduced mortality using 6 mL/kg predicted body weight tidal volumes and limiting plateau pressure to ≤30 cm H₂O.
ARDSNet ARMA trial
100
1st Pressor of choice on ALL types of shock?
Levophed babyyyy
100
How many types of shock do you know? Name 4
Distributive, Cardiogenic, Hypovolemic, Obstructive
100
You are in the ICU and levophed extravastes into a peripheral line while you were preparing to get a central line. Which medication you using?
Phentolamine (Alpha antagonist)
200
How to calculate P/F ratio.
Calculate it Fio2: 50%, Po2 120
240
200
What is SBT? Explain, what ventilator mode must the patient be on (2). What would make a patient fail SBT? (give me 3 reasons)
Spontaneous Breathing Trial
- CPAP 5
- Low pressure support, often around PS 5–8 with PEEP 5 (BIPAP)
They fail when tachypneic, hypotensive, mentation not there, PEEP >5-8 varies per institution
200
Why don't we use Dopamine anymore? What is the main side effect
Very pro arrhythmogenic
200
Pressor of choice in Cardiogenic shock (1)
Pressor contraindicated in Cardiogenic shock (1) and its mechanism of action then explain why contraindicated...
Levophed
Phenylephrine (alpha 1 agonist), increases afterload
200
Name the trial landmark trial that proved that proning patients on severe ARDS reduces mortality?
PROSEVA
300
ARDS diagnostic criteria (Berlin)
- Timing: onset within 1 week of a known clinical insult or new/worsening respiratory symptoms.
- Imaging: bilateral opacities on CXR or CT
- Origin of edema: respiratory failure not fully explained by cardiac failure or fluid overload
- Hypoxemia with PEEP/CPAP ≥5 cm H₂O:
- Mild: 200 < P/F ≤ 300
- Moderate: 100 < P/F ≤ 200
- Severe: P/F ≤ 100
300
What maneuver you need to do to be able to measure Plateau Pressure? Explain in your own words what is it?
End INSPIRATORY hold
Its the pressure experienced in the alveoli, that is why ARDSNet trial aims for low PP, to avoid its side effects (barotrauma)
300
How does NICOM calculate the SVV? (Which cardiology concept is applied here?) What is SVV? What other variables does NICOM provide?
:)
300
Distributive shock
300
Gold standard tool/intervention to measure hemodynamics in the ICU
Swan-Ganz catheter
400
Severe CAP dx criteria
Mention at least 6
400
What is Auto-Peep? Explain to me
Intrinsic PEEP caused by incomplete exhalation. Basically the next ventilator breath starts before the patient has fully emptied the previous breath...
Patient starts stacking air inside!... We wont talk about how to treat it for now and how to recognize it, that is for my vent lecture :P
400
TYPE OF SHOCK?
Distributive (septic vs anaphylactic vs neurogenic)
400
Which type of shock is this and why?
Hemorrhagic, look at CVP!
400
Indications to intubate a patient? (4)
Its usually a combination of things but can only be 1 if it is severe enough and you can't solve it with other interventions (BIPAP not enough or contraindicated)
Can’t oxygenate (requires high Fio2 >50%), can’t ventilate (not moving enough air), can’t protect (AMS, drug overdose), or can’t keep going (patient will get tired).
500
How many lobes in the right lung?
3 :)
500
Which patient is ready to be extubated and why? (give me 3 reasons at least)
The one on the left, FIo2 equal or less than 50%, Peep 5, breathing over the vent (has respiratory drive)
500
What is the max dose of LEVOPHED?? Usual pimp question in the ICU
Tricky question, it is weight based.
0.5 mcg/kg/min to 1 mcg/kg/min
500
How does a hemosphere work? What does a patient need to have IN them to be able to use a hemosphere?
uses A-Line wave form to calculate hemodynamics indexes via a mathematical algorithm (this means that if your A-Line wave form is trash you cant rely on the hemosphere).
A patient needs an arterial Line!
500
Where is this? Name the country
Peru! :)