Neurologic
Propofol has ___ effects but not ___ effects
Senior Residents: name 3 side effects of propofol
thought to potentiate γ-aminobutyric acid (GABA) receptors resulting in amnesia but not analgesia
Side effects: bradycardia, hyperlipidemia, propofol infusion syndrome (bradycardia, rhabdomyolysis, hyperlipidemia, hepatomegaly, and renal failure)
What is the duration of oral Lasix?
Senior Residents: what is the duration of IV Lasix?
Onset: 5 min (IV) 30 - 60 min (oral)
Duration: ~2 hours (IV) 6-8 hours (oral)
Primarily inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal and distal renal tubules, interfering with the chloride-binding cotransport system
What is the % of O2 in air?
Senior Residents: What % of the airway is dead space?
21%
20-30% of the airway
What is the glucose target is used in the ICU?
Senior residents: What is the name of the trial that established this?
< 180
the NICE-SUGAR trial
ATLS was founded by an orthopedic surgeon in what state?
Nabraska!
Dexmedetomidine (Precedex) acts on what receptors?
Senior Residents: What is the onset of action and duration of action?
Dexmedetomidine is a centrally acting α2-adrenoreceptor agonist that binds to receptors within the locus ceruleus to provide sedation and anxiolysis and receptors in the spinal cord to provide for analgesia
onset of action between 5 and 15 minutes and a duration of action between 60 and 120 minutes
What is the first line vasopressor in patients with aortic stenosis and why?
Senior Residents: What vasopressor and MAP goal should be used in neurogenic shock?
phenylephrine - Alpha 1 agonist causing peripheral vasoconstriction (no ionotropy) since afterload is set with stenotic valve. Don't want to increase myocardial O2 demand
Norepinephrine, MAP goal 85 - 90
What is the name of the criteria to diagnose ARDS?
Senior Residents: What are the criteria?
Berlin Criteria
bilateral infiltrates on chest radiograph or CT scan, a PaO2/FiO2 ratio <300, an inciting factor within 7 days prior to the diagnosis, and a rule-out of hydrostatic edema as a cause of the bilateral infiltrates
What are emergent indications for dialysis?
Senior Residents: At what pH level is dialysis typically indicated?
Acidosis, Electrolyte abnormalities, Intoxication, Overload, Uremia
Generally, treatment is deferred unless the pH drops below 7.1, at which point there is risk for serious metabolic effects such as left ventricular depression and hemodynamic instability
Name the City, State, or Hospital where the first surgical ICU was established
The first surgical intensive care unit (ICU), specifically a postoperative neurosurgical unit, was established at Johns Hopkins Hospital in 1928 by Dr. Walter Dandy.
Baltimore, Maryland
What is the treatment for delirium?
Senior Resident: When sedative infusions are necessary, what should be used in delirious patient's?
limiting circadian rhythm abnormalities and maintaining normal sleep-wake cycles by opening blinds or shades during the day and turning off lights at night, reducing ancillary and unnecessary noises or noxious stimuli, avoiding the use of restraints when safe, mobilizing the patient, providing the patient with their eyeglasses or hearing aids if needed, and having family or friends help to reorient and reassure the patient
When sedative infusions are necessary, dexmedetomidine has been found to decrease the rate of delirium by more than 20% when compared to using midazolam
When does the heart undergo concentric hypertrophy vs eccentric hypertrophy?
Senior residents: why?
Concentric hypertrophy develops in pressure overload, eccentric hypertrophy develops in volume overload
Hypertrophy develops when the rate of myocardial protein synthesis exceeds that of protein degradation. In pressure overload, synthesis rates increase while in volume overload degradation rate decreases.
In VC/AC ventilation what are the two parameters that affect oxygenation? ventilation?
Senior Residents: What is the difference between VC/AC and SIMV
Oxygenation: FiO2, PEEP
Ventilation: Respiratory Rate, Tital Volume
SIMV adds a fifth parameter, pressure support, extra breaths are given a set pressure but not supported with full tital volume
What are the indications for stress ulcer prophylaxis in the ICU?
Senior Resident: Name 2 risks of PPIs
Mechanical ventilation >48 hours, Coagulopathy (plt<50,000 or INR >1.5), Traumatic brain injury, Significant burn injury (>20 % TBSA Partial + Full Thickness), History of previous gastrointestinal hemorrhage
Decreased gastric emptying, increased risk of nosocomial pneumonia and Cdiff, nutritional deficiency (B12, Mg, Iron)
Within 3 years what year was the Glasgow Coma Scale (GCS) developed at the University of Glasgow?
The Glasgow Coma Scale (GCS) originated at the University of Glasgow in Scotland. It was developed in 1974 by neurosurgery professors Graham Teasdale and Bryan Jennett.
Primary and secondary brain injuries are the two phases during which neuronal injury occurs. What are secondary brain injuries?
Secondary brain injury is a consequence of pathologic and physiologic alterations after the initial injury. Examples of causes of secondary brain injury resulting in further neuronal injury and death include ischemia, hypoxia, hypotension, cerebral edema, acidosis, and elevated intracranial pressure.
What is the oxygen delivery equation?
Oxygen Delivery = (Cardiac Output [CO])(Hemoglobin * 1.3 * Oxygen Saturation + 0.003 Partial Pressure of Dissolved Oxygen)
What are the two modes of ECMO?
Senior Resents: What is the difference between the two modes?
Veno-venous (VV) and veno-arterial (VA) ECMO (Extracorporeal Membrane Oxygenation)
VV ECMO provides respiratory support by oxygenating the blood and removing carbon dioxide, VA ECMO provides both respiratory and circulatory support, assisting both the heart and lungs
What is the formula for free water deficit in hypernatremia?
Senior Residents: What % is used for body water in male and female?
Free H2O Deficit = (%Body water x Kg)[(Serum Na/140) – 1]
male 50%
Female 60%
Insulin was first isolated and used to treat diabetes in what anamal in 1921?
OR
The first human insulin injection was in 1922 with insulin derived from what animal?
Dog
Cow
What is the preferred paralytic in patients with renal and liver failure?
Senior Residents: Why?
Cisatracurium
it undergoes a non-enzymatic degradation process called Hofmann elimination
For patients with accessory pathways (WPW) what are first line medications for Afib?
Senior Residents: What is the timeframe for cardioversion where you should start to worry about clot or need to anticoagulated?
Ca channel blockers, beta blockers, amiodarone, and digoxin are contraindicated due to the risk that suppression of the atrioventricular node will worsen tachycardia though the accessory pathway. Ibutilide or procainamide are recommended.
12 hrs (48 hours was historically used)
The treatment of ARDS in the ARDSNet trial involved several goals termed lung protective ventilation. Name 2 of those goals.
Senior Residents: Name 5 goals
What are the optimal nutritional requirements of a critically ill patient? (kcal/kg/day)
Senior Residents: What is the protein requirement?
optimal nutrition requirements for the critically ill patient are roughly 25 to 30 kcal/kg/day
1.2–2 g/kg/day of protein
The first successful blood transfusion took place in 1667 in France and involved the transfusion of blood from what animal to a 15-year-old boy who was suffering from fever?
Sheep
The first successful transfusion of human blood was performed in 1818 to a woman suffering post-partum hemorrhage saving her life