Palliative in Pulm/crit

ICU

100

Most common type of delirium in the ICU

Mixed delirium 

200

Six steps of the SPIKES model of communication

Setting

Perception

Invitation

Knowledge

Emotion/empathy

Strategy/summary

300

Medications that need to be stopped in a patient with hypercalcemia (3)

Thiazide, Digoxin, Lithium Ca supplements theophylline, tamoxifen, Vitamin A and D

400

Management bowel obstruction when surgery is not an option (3)

Analgesics, Octreotide, anticholinergics, GI decompression,  glucocorticoids, antiemetics (haldol)

500

Variables of Provent score (Prognosis of prolonged MV) 

-Age >50

-Hemodialysis

-Thrombocytopenia

-Vasopressors

Validated at day 14 and 21 of MV.

0--> 15 %mortality, 3  --> 97% mortality

Pulm

100

Receptors involve in Dyspnea sensation (3)

Chemoreceptors peripheral (carotid bodies and aortic arch)  and central (located in the medulla) PH / CO2 

Upper airway receptors: Innervated by the trigeminal nerve (Fan) 

Chest wall Mechanoreceptors

Pulmonary receptors:  via the vagus nerve:

●Pulmonary stretch receptors,  activated by increase in tension in the walls of airways,(hyperinflation). Slowly adapting receptors

●Irritant receptors:  Stimulated by mechanical stimuli, or inhalation of irritants. Rapidly adapting 

●  Juxta pulmonary capillary receptors (c fibers) stimulated by mechanical and chemical factors. 

200

Percentage of VC at which PEG should be place in ALS patients

PEG should be placed when vital capacity (VC) falls to 50 percent of predicted. There is increased morbidity of the procedure as respiratory function declines.

300

 Mechanisms by which supplemental oxygen may reduce dyspnea (3)

Reversal of hypoxemia

Reduced PA pressure, dynamic hyperinflation and ventilatory muscle fatigue

Stimulation of facial, nasal, or pharyngeal receptors

Increased capacity for exercise training

Placebo effect

400

Mechanisms by which opioids may reduce dyspnea (3)

Analgesia - reduce pain-induced respiratory drive

Anxiolytic effects

Vasodilation (improved cardiac function, decreasing preload)

Decreased metabolic and ventilatory requirements

Reduced medullary sensitivity and response to hypercarbia or hypoxia

Blunted afferent transmission from pulmonary mechanoreceptor to the CNS

Alteration of neurotransmission within medullary respiratory center

Cortical sedation (suppression of respiratory awareness)

500

Elements of DECAF score (COPD in hospital mortality) 

Dyspnea, 

Eosinopenia, 

Consolidation, 

Acidemia 

Fibrillation (atrial)

Crystal Ball

100

Survival after withdrawal of dialysis (ambulatory)

7 to 10 days

200

Average 5 year survival in dialysis patients

50%

Life expectancy 25% of non renal pts 

25% Die after decision to D/C dialysis

300

90 day mortality rate for cancer related hypercalcemia

75%

400

Minimal performing status to tolerate chemotherapy

ECOG PS 2

0: Fully active. 1: Ambulatory light work. 2: Self-care, Up >50% of waking hrs 3: Bed or chair>50% of waking hrs 4: Completely disabled; confined to bed or chair.

500

Minimal life expectancy needed to recommend Surgery for spinal cord compression due to metastatic cancer

Greater than 3 months.

Meds

100

Opioid receptors in the respiratory system

 mu-opioid receptors

200

Opioid for ICU patients with renal failure

 Fentanyl

300

Opioid that is least associated with respiratory depression

Buprenorphine

Partial mu agonist: It has a ceiling effect on respiratory depression

400

AB initially discovered as psychotropic with antidepressant effects.

Linezolid

500

First test needed when admitting patient with methadone use

ECG

Associated with prolonged QT and torsade. QT >500 msec in up to 10% of pts.