Move to the Beat
Name a medication commonly given in the ICU for delirium that can cause a prolonged QT interval.
Acceptable answers are
What is: Haldol, Seroquel, Risperidone?
A pt was transfused 4 units of PRBC. What electrolyte do you anticipate replacing?
What is Calcium?
Interpret the following ABG:
pH 7.55/ CO2 22/ PaO2 83/ HCO3 14
What is uncompensated respiratory alkalosis?
A 58 yo is admitted with septic shock. The shock is resolved and off pressors. He becomes confused and tries to get OOB. What type of screening should you assess?
What is CAM assessment for delirium?
Which of the following complications should be aggressively treated to prevent worsening of cerebral edema and infarct expansion after an acute ischemic stroke?
A. Hypernatremia
B. Fever
C. Hypokalemia
D. Hypoglycemia
What is B - Fever?
Fever, hyponatremia, and hyperglycemia have all been associated with worsening infarcts and neurological outcomes.
A temporary pacer is in place and you notice pacing spikes inappropriately during all phases of the cardiac cycle. What action would you take?
What is decrease the sensitivity (mV)?
With these lab values, what is the diagnosis?
Anion gap 10, urine ketones negative, serum K 4.3, BG 1050
What is Hyperosmolar Hyperglycemic Non-Ketotic Syndrome (HHS)?
A 90kg pt with ARDS is intubated. Vent settings are APVCMV - Rate 12/ Vt 900/ PEEP 20/ FiO2 100%. SpO2 is 91%, plateau pressure is 38, and VS are stable. What intervention is needed to this pt's vent settings?
What is decrease the tidal volume?
Recommended Vt in ARDS is 4-6 mL/kg.
You perform a dynamic response test on the arterial line and the waveform is overdamped. Which intervention is appropriate to address the issue?
A. Remove the add-on tubing.
B. Assess for kinking of the catheter/tubing system.
C. Flush the line to remove pinpoint air bubbles.
D. Compare with a cuff pressure going forward.
What is B - Assess for kinking of the catheter/tubing system?
A & C cause an underdamped waveform.
Pt with CHF exacerbation has a Swan in place and is showing signs of sepsis. Which of the findings below is of greatest concern?
A. SvO2 48%
B. CVP 3
C. SvO2 75%
D. CVP 10
What is A - SvO2 48%?
Pt's invasive hemodynamics are: CVP 6, PAD 10, CO 5, CI 2.7, SVR 1700. What medication would bring down the abnormal value into the desired range?
A. Lasix
B. Dobutamine
C. Lidocaine
D. Nitroprusside
What is D - Nitroprusside?
Type 1 DM is admitted with BG 472. ABG pH 7.14/ CO2 35/ PaO2 90/ HCO3 4. What is the interpretation?
What is metabolic acidosis?
A pt admitted with pulmonary contusions and ARDS is on the vent and the settings are APVCMV - Rate 12/Vt 350/PEEP 10/FiO2 60%.
ABG is pH 7.20/ CO2 65/ PaO2 80/ HCO3 22.
What vent changes would you anticipate?
What is increase RR?
What physical assessment findings would be expected in the setting of thrombocytopenia?
What is petechiae?
Which finding distinguishes neurogenic shock from other forms of distributive shock?
A. BP 80/45 (MAP 57)
B. HR 45
C. SVR 1400
D. CO 3 L/min
What is B - HR 45?
A pt with severe mitral insufficiency is prone to which dysrhythmias.
What is atrial fibrillation?
Which of the following is common lab finding in a pt with diabetes insipidus (DI):
A. Decreased serum osmolality
B. Decreased serum Na
C. Elevated urine specific gravity
D. Elevated serum osmolality
What is D. elevated serum osmolality?
68 yo male with COPD has SOB and ABG results are:
pH 7.22/ CO2 74/ PaO2 103/ HCO3 30
What is partially compensated respiratory acidosis?
Pt admitted 2 days ago with L-sided intraventricular hemorrhage is showing signs of an extension of the initial hemorrhage. Which of the below supports this concern?
A. L pupil > R and non-reactive with RUE posturing
B. L hand grasp weakness with numbness/tingling
C. R pupil > L and non-reactive with LUE posturing
D. 8/10 headache pain unrelieved by Tylenol
What is A - L pupil > R and non-reactive with RUE posturing?
Pharmacologic therapy, used for the treatment of pulmonary hypertension, requires close monitoring for which of the following complications?
A. infection
B. left ventricular failure
C. hypotension
D. pedal edema
What is C - hypotension?
Pulmonary hypertension is treated with dilators which have systemic effect in reduction of arterial blood pressure.
What are the beneficial hemodynamic effects of intra-aortic balloon therapy?
A. It increases the myocardial oxygen supply during diastole.
B. It increases the ventricular filling volume during systole.
C. It increases coronary artery perfusion during systole.
D. It increases the left ventricular diastolic pressure during diastole.
What is A - It increases the myocardial oxygen supply during diastole?
Your pt is suspected to have Disseminated Intravascular Coagulation (DIC). What 3 lab values would you want to know and would they be elevated or decreased?
What are: Decreased PLTs, Decreased Fibrinogen, Increased D-Dimer
Which of the following factors would decrease the release of oxygen from hemoglobin at the tissue level?
A. Temp of 39
B. PaCO2 of 55
C. Arterial pH of 7.30
D. Massive transfusion of stored, banked blood
What is D - Massive transfusion of stored, banked blood?
A pt is suspected of having a R-sided tension pneumothorax. What are 2 assessment findings you would expect?
What are tracheal deviation to the L and absent breath sounds over the pneumothorax?
A pt is admitted with DKA. Serum glucose was 510, pH 7.28, PaCO2 24, HCO3 9. Insulin gtt was started at 5 units/hr after loading dose and NS started. One hour later, serum glucose was 490. What intervention to the insulin gtt is indicated?
What is increase the insulin drip?
Goal is to decrease the serum glucose by 50-100 per hour.