Approach to Critically Ill patients and vent support for Dummies
Presence of multisystem end organ hypoperfusion
This is the most reasonable first line vasopressor used in cardiogenic shock
Norepinephrine (associated with fever adverse events) i.e. lower lactate levels
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
The natural history of ARDS is marked by 3 phases, name them
Exudative, proliferative, and fibrotic
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Manvith
Name the 4 types of respiratory failure
I Acute hypoxemic Respiratory Failure
II Hypercapnic Respiratory Failure
III Lung Atelectasis
IV Metabolic Demands
This is the shock you should give ASAP when VF or VT is recognized
200J
Biphasic waveform
What makes up the clinical triad of Wernicke's Disease?
Ophthalmoplegia, Ataxia, and global confusion
A 2013 trial demonstrated a significant reduction in 28 day mortality with what positioning for patients with severe ARDS
Prone
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
These variables are used to calculate the SOFA score
PaO2, FiO2, respiratory support
Platelets
Billirubin
MAP
GCS
Creatinine or urine output
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
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
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
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Omar
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
This sleep disorder and this cardiac arrhythmia are associated with increased sudden cardiac death risk
OSA
A fib
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%
Which 2 etiologies of ARDS make up a combined 40-60% of cases
PNA and sepsis
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Sami
These values constitute passing a spontaneous breathing test
RR < 35
SBP 90 to 180 mmHg
HR change of <20%
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)
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)
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
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Abby