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Questions and Answers

What does the Monro-Kellie doctrine state?

There is a fixed, constant space within the cranium: 80% is occupied by the brain, 10% by CSF, 10% by blood.

What is the normal serum K+ value?

3.5-5.0

What is the normal serum Na+ value?

136-142

What is the normal serum Cl- value?

<p>96-106</p> Signup and view all the answers

What is the normal serum Ca++ (total) value?

<p>8.2-10.2</p> Signup and view all the answers

What is the normal serum CO2 value?

<p>22-28</p> Signup and view all the answers

What is the normal serum BUN value?

<p>8 to 23</p> Signup and view all the answers

What is the normal serum creatinine value?

<p>0.6-1.2</p> Signup and view all the answers

What are the normal arterial and venous lactate values?

<p>Arterial: 0.5-1.6, Venous: 0.4-2.0</p> Signup and view all the answers

What is the normal amylase value?

<p>27-131</p> Signup and view all the answers

What is the normal lipase value?

<p>31-186</p> Signup and view all the answers

What are the normal creatine kinase levels?

<p>40-150</p> Signup and view all the answers

What is the normal INR level?

<p>0.8-1.2</p> Signup and view all the answers

What is the first vent setting to titrate if the patient becomes hypoxic?

<p>PEEP</p> Signup and view all the answers

What are some ways to troubleshoot a vented patient with dynamic hyperinflation (Auto-PEEP)?

<p>Lower the rate; shorten the inspiratory time to increase the i:e ratio, keep the Vt in 6-8 mL/kg range.</p> Signup and view all the answers

How do you determine tidal volume for your patient?

<p>4-8 mL/kg of ideal body weight.</p> Signup and view all the answers

What are the four types of hypoxia?

<p>Hypoxemic, Stagnant, Anemic, Cytotoxic.</p> Signup and view all the answers

What is systemic vascular resistance (SVR)?

<p>The amount of afterload the left ventricle must overcome to eject blood.</p> Signup and view all the answers

What is a normal right atrial pressure?

<p>2-6 mmHg.</p> Signup and view all the answers

What is a normal pulmonary artery pressure?

<p>15-25 mmHg systolic; 0-8 mmHg diastolic.</p> Signup and view all the answers

What is a normal pulmonary capillary wedge pressure?

<p>6-12 mmHg.</p> Signup and view all the answers

Where should an arterial line be transduced?

<p>Level of the phlebostatic axis.</p> Signup and view all the answers

What does a pulmonary capillary wedge pressure (PCWP) measure?

<p>Left ventricular filling.</p> Signup and view all the answers

The patient with hypotension and a PCWP > 15 is in:

<p>Cardiogenic shock.</p> Signup and view all the answers

Norepinephrine produces vasoconstriction chiefly through stimulation of ______ receptors?

<p>Alpha</p> Signup and view all the answers

Phenylephrine produces vasoconstriction exclusively through ________ stimulation.

<p>Alpha</p> Signup and view all the answers

Dopamine acts to increase blood pressure due to:

<p>Vasoconstriction and positive inotropy.</p> Signup and view all the answers

Epinephrine stimulates _______ and _______ receptors.

<p>Alpha and Beta</p> Signup and view all the answers

Which vasopressor causes vasoconstriction and renal water retention?

<p>Vasopressin.</p> Signup and view all the answers

What is the most common cause of nontraumatic subarachnoid hemorrhage?

<p>Ruptured cerebral aneurysm.</p> Signup and view all the answers

What type of hemorrhage occurs when a vessel traversing between the brain and skull is damaged?

<p>Subdural hematoma.</p> Signup and view all the answers

Which vessel is damaged in an epidural hematoma?

<p>Middle meningeal artery.</p> Signup and view all the answers

Which type of intracranial hemorrhage presents with a blow to the head, followed by a brief loss of consciousness, followed by a lucid interval with subsequent neurologic deterioration?

<p>Epidural hematoma.</p> Signup and view all the answers

Which type of head bleed is typically associated with an acute onset of a 'thunderclap' headache?

<p>Subarachnoid Hemorrhage.</p> Signup and view all the answers

What is a normal pH?

<p>7.35-7.45.</p> Signup and view all the answers

What is a normal PaCO2?

<p>35-45 mmHg.</p> Signup and view all the answers

What is a normal HCO3 (bicarbonate) level?

<p>22-26 mEq/L.</p> Signup and view all the answers

What is a normal base excess range?

<p>-2 to +2 mEq/L.</p> Signup and view all the answers

Respiratory acidosis is corrected primarily through:

<p>Minute volume.</p> Signup and view all the answers

The IABP reduces afterload and improves myocardial oxygenation through what mechanism?

<p>Counterpulsation.</p> Signup and view all the answers

The IABP balloon inflates during __________.

<p>Diastole.</p> Signup and view all the answers

The IABP balloon deflates during _________.

<p>Systole.</p> Signup and view all the answers

The coronary arteries are perfused by the IABP during _____.

<p>Diastole.</p> Signup and view all the answers

Timing of the IABP is based on either _____ or ______.

<p>EKG</p> Signup and view all the answers

In the IABP EKG trigger, the balloon is timed to inflate with the:

<p>R wave</p> Signup and view all the answers

In the IABP a-line trigger, the balloon is timed to inflate with the:

<p>Dicrotic notch</p> Signup and view all the answers

What does the dicrotic notch on an arterial line waveform signify?

<p>Closure of the aortic valve.</p> Signup and view all the answers

In the treatment of hypertensive emergencies, BP should be lowered by ____% of the MAP.

<p>25%</p> Signup and view all the answers

What is the normal fetal heart rate?

<p>120-160.</p> Signup and view all the answers

What is the dose for tPA in an ischemic stroke?

<p>0.9mg/kg max dose 90mg, 10% given as bolus, 90% given over one hour.</p> Signup and view all the answers

In a patient with poor ventilator compliance, we expect that the __________ will increase.

<p>Pressures</p> Signup and view all the answers

What does Poiseuille's Law state?

<p>Flow exponentially increases with increased tube diameter.</p> Signup and view all the answers

What is dead space?

<p>Space within the respiratory system that does not participate in gas exchange.</p> Signup and view all the answers

What is alveolar dead space?

<p>Alveoli that are ventilated but not perfused.</p> Signup and view all the answers

What is Fick's Law?

<p>The rate of diffusion is directly proportional to the difference in partial pressure and the surface area of the membrane. It is inversely proportional to the thickness of the membrane.</p> Signup and view all the answers

How does ARDS appear on chest imaging?

<p>Ground glass opacities.</p> Signup and view all the answers

What x-ray finding is found in epiglottitis?

<p>Thumbprint Sign.</p> Signup and view all the answers

What x-ray finding is found in croup?

<p>Steeple Sign.</p> Signup and view all the answers

The helicopter's ELT transmits at what frequency?

<p>121.5</p> Signup and view all the answers

The ELT is activated when it senses how much force?

<p>4 G's.</p> Signup and view all the answers

What is HELLP syndrome?

<p>Hemolysis, Elevated LFT's, Low Platelets: Type of preeclamptic pathology that may lead to hemorrhage; manifests as N/V and RUQ pain; Lab findings yield elevated ALT/AST, low platelets, and hemolytic anemia.</p> Signup and view all the answers

Which medication is given for active seizures in eclampsia or for seizure prophylaxis in ill preeclamptic patients?

<p>Magnesium Sulfate (5-6 grams over 10 min).</p> Signup and view all the answers

What medication is contraindicated in pancreatitis?

<p>Morphine.</p> Signup and view all the answers

What are treatment modalities for esophageal varices?

<p>Do not insert OG/NG tube due to risk of rupture; gastroenterologist can place bands on varices. If ruptured, place Blakemore tube to tamponade bleeding until patient can be taken emergently to GI lab for cauterization of bleeding varices.</p> Signup and view all the answers

What is the formula for cerebral perfusion pressure?

<p>MAP - ICP.</p> Signup and view all the answers

What is normal intracranial pressure?

<p>Normal ICP is typically around 7-15 mmHg.</p> Signup and view all the answers

What does the Monro-Kellie doctrine state?

<p>There is a fixed, constant space within the cranium: 80% is occupied by the brain, 10% by CSF, 10% by blood.</p> Signup and view all the answers

What is the normal serum K+ value?

<p>3.5-5.0</p> Signup and view all the answers

What is the normal serum Na+ value?

<p>136-142</p> Signup and view all the answers

What is the normal serum Cl- value?

<p>96-106</p> Signup and view all the answers

What is the normal serum Ca++ (total) value?

<p>8.2-10.2</p> Signup and view all the answers

What is the normal serum CO2 value?

<p>22-28</p> Signup and view all the answers

What is the normal serum BUN value?

<p>8 to 23</p> Signup and view all the answers

What is the normal serum Creatinine value?

<p>0.6-1.2</p> Signup and view all the answers

What are the normal arterial and venous lactate values?

<p>Arterial: 0.5-1.6, Venous: 0.4-2.0</p> Signup and view all the answers

What is the normal amylase value?

<p>27-131</p> Signup and view all the answers

What is the normal lipase value?

<p>31-186</p> Signup and view all the answers

What are normal creatine kinase levels?

<p>40-150</p> Signup and view all the answers

What is the normal INR level?

<p>0.8-1.2</p> Signup and view all the answers

What is the first vent setting to titrate if the patient becomes hypoxic?

<p>PEEP</p> Signup and view all the answers

What are some ways to troubleshoot a vented patient with dynamic hyperinflation (Auto-PEEP)?

<p>Lower the rate; shorten the inspiratory time to increase the I:E ratio; keep the Vt in 6-8 mL/kg range.</p> Signup and view all the answers

How do you determine tidal volume for your patient?

<p>4-8 mL/kg of ideal body weight</p> Signup and view all the answers

What are the four types of hypoxia?

<p>Hypoxemic, Stagnant, Anemic, Cytotoxic</p> Signup and view all the answers

What is systemic vascular resistance (SVR)?

<p>The amount of afterload the left ventricle must overcome to eject blood.</p> Signup and view all the answers

What is a normal right atrial pressure?

<p>2-6 mmHg</p> Signup and view all the answers

What is a normal pulmonary artery pressure?

<p>15-25 mmHg systolic; 0-8 mmHg diastolic</p> Signup and view all the answers

What is a normal pulmonary capillary wedge pressure?

<p>6-12 mmHg</p> Signup and view all the answers

Where should an arterial line be transduced?

<p>Level of the phlebostatic axis</p> Signup and view all the answers

What does a pulmonary capillary wedge pressure (PCWP) measure?

<p>Left ventricular filling</p> Signup and view all the answers

The patient with hypotension and a PCWP > 15 is in:

<p>Cardiogenic shock</p> Signup and view all the answers

Norepinephrine produces vasoconstriction chiefly through stimulation of ______ receptors?

<p>Alpha</p> Signup and view all the answers

Phenylephrine produces vasoconstriction exclusively through ________ stimulation.

<p>Alpha</p> Signup and view all the answers

Dopamine acts to increase blood pressure due to:

<p>Vasoconstriction and positive inotropy</p> Signup and view all the answers

Epinephrine stimulates _______ and _______ receptors.

<p>Alpha and Beta</p> Signup and view all the answers

Which vasopressor causes vasoconstriction and renal water retention?

<p>Vasopressin</p> Signup and view all the answers

What is the most common cause of nontraumatic subarachnoid hemorrhage?

<p>Ruptured cerebral aneurysm</p> Signup and view all the answers

What type of hemorrhage occurs when a vessel traversing between the brain and skull is damaged?

<p>Subdural hematoma</p> Signup and view all the answers

Which vessel is damaged in an epidural hematoma?

<p>Middle meningeal artery</p> Signup and view all the answers

Which type of intracranial hemorrhage classically presents with a blow to the head, followed by a brief loss of consciousness, followed by a lucid interval with subsequent neurologic deterioration?

<p>Epidural hematoma</p> Signup and view all the answers

Which type of head bleed is typically associated with an acute onset of a 'thunderclap' headache?

<p>Subarachnoid Hemorrhage</p> Signup and view all the answers

What is a normal pH?

<p>7.35-7.45</p> Signup and view all the answers

What is a normal PaCO2?

<p>35-45 mmHg</p> Signup and view all the answers

What is a normal HCO3 (bicarbonate) level?

<p>22-26 mEq/L</p> Signup and view all the answers

What is a normal base excess range?

<p>-2 to +2 mEq/L</p> Signup and view all the answers

Respiratory acidosis is corrected primarily through:

<p>Minute volume</p> Signup and view all the answers

The IABP reduces afterload and improves myocardial oxygenation through what mechanism?

<p>Counterpulsation</p> Signup and view all the answers

The IABP balloon inflates during __________.

<p>Diastole</p> Signup and view all the answers

The IABP balloon deflates during _________.

<p>Systole</p> Signup and view all the answers

The coronary arteries are perfused by the IABP during _____.

<p>Diastole</p> Signup and view all the answers

Timing of the IABP is based on either _____ or ______.

<p>EKG or arterial line waveform</p> Signup and view all the answers

In the IABP EKG trigger, the balloon is timed to inflate with the:

<p>R wave</p> Signup and view all the answers

In the IABP a-line trigger, the balloon is timed to inflate with the:

<p>Dicrotic notch</p> Signup and view all the answers

What does the dicrotic notch on an arterial line waveform signify?

<p>Closure of the aortic valve</p> Signup and view all the answers

In the treatment of hypertensive emergencies, BP should be lowered by ____% of the MAP.

<p>25%</p> Signup and view all the answers

What is a normal fetal heart rate?

<p>120-160</p> Signup and view all the answers

What is the dose for tPA in an ischemic stroke?

<p>0.9 mg/kg max dose 90 mg, 10% given as bolus, 90% given over one hour</p> Signup and view all the answers

In a patient with poor ventilator compliance, we expect that the __________ will increase.

<p>Pressures</p> Signup and view all the answers

What does Poiseuille's Law state?

<p>Flow exponentially increases with increased tube diameter</p> Signup and view all the answers

What is dead space?

<p>Space within the respiratory system that does not participate in gas exchange</p> Signup and view all the answers

What is alveolar dead space?

<p>Alveoli that are ventilated but not perfused</p> Signup and view all the answers

What is Fick's Law?

<p>The rate of diffusion is directly proportional to the difference in partial pressure and the surface area of the membrane. It is inversely proportional to the thickness of the membrane.</p> Signup and view all the answers

How does ARDS appear on chest imaging?

<p>Ground glass opacities</p> Signup and view all the answers

What x-ray finding is found in epiglottitis?

<p>Thumbprint Sign</p> Signup and view all the answers

What x-ray finding is found in croup?

<p>Steeple Sign</p> Signup and view all the answers

The helicopter's ELT transmits at what frequency?

<p>121.5</p> Signup and view all the answers

The ELT is activated when it senses how much force?

<p>4 G's</p> Signup and view all the answers

What is HELLP syndrome?

<p>Hemolysis, Elevated LFT's, Low Platelets: Type of preeclamptic pathology that may lead to hemorrhage; manifests as N/V and RUQ pain; lab findings yield elevated ALT/AST, low platelets, and hemolytic anemia.</p> Signup and view all the answers

Which medication is given for active seizures in eclampsia or for seizure prophylaxis in ill preeclamptic patients?

<p>Magnesium Sulfate (5-6 grams over 10 min)</p> Signup and view all the answers

What medication is contraindicated in pancreatitis?

<p>Morphine</p> Signup and view all the answers

What are treatment modalities for esophageal varices?

<p>Do not insert OG/NG tube due to risk of rupture; gastroenterologist can place bands on varices. If ruptured, place Blakemore tube to tamponade bleeding until patient can be taken emergently to GI lab for cauterization of bleeding varices.</p> Signup and view all the answers

What is the formula for cerebral perfusion pressure?

<p>MAP - ICP</p> Signup and view all the answers

What is normal intracranial pressure?

<p>Normal range not provided.</p> Signup and view all the answers

Study Notes

Monro-Kellie Doctrine

  • The Monro-Kellie doctrine states that the cranium is a fixed, constant space occupied by the brain, CSF, and blood.

Normal Serum Values

  • Potassium (K+): 3.5-5.0 mEq/L
  • Sodium (Na+): 136-142 mEq/L
  • Chloride (Cl-): 96-106 mEq/L
  • Calcium (Ca++): 8.2-10.2 mg/dL
  • Carbon Dioxide (CO2): 22-28 mEq/L
  • Blood Urea Nitrogen (BUN): 8 to 23 mg/dL
  • Creatinine: 0.6-1.2 mg/dL
  • Lactate: Arterial: 0.5-1.6 mmol/L, Venous: 0.4-2.0 mmol/L
  • Amylase: 27-131 U/L
  • Lipase: 31-186 U/L
  • Creatine Kinase (CK): 40-150 U/L
  • International Normalized Ratio (INR): 0.8-1.2

Ventilator Management

  • Positive End-Expiratory Pressure (PEEP): The first vent setting to adjust if the patient becomes hypoxic.
  • Dynamic Hyperinflation: Can be managed by lowering the rate, shortening the inspiratory time (increasing the i:e ratio), and keeping the tidal volume (Vt) in the 6-8 mL/kg range.
  • Tidal Volume (Vt): Determine Vt using 4-8 mL/kg of ideal body weight.
  • Types of Hypoxia: Hypoxemic, Stagnant, Anemic, Cytotoxic

Hemodynamics

  • Systemic Vascular Resistance (SVR): Measures the afterload the left ventricle must overcome to eject blood.
  • Right Atrial Pressure: Normal range is 2-6 mmHg.
  • Pulmonary Artery Pressure: Normal range is 15-25 mmHg systolic; 0-8 mmHg diastolic.
  • Pulmonary Capillary Wedge Pressure (PCWP): Normal range is 6-12 mmHg; measures left ventricular filling pressure.
  • Cardiogenic Shock: Present in patients with hypotension and a PCWP > 15 mmHg.
  • Arterial Line Transduction: Transduce an arterial line at the level of the phlebostatic axis.

Vasopressors

  • Norepinephrine: Primarily produces vasoconstriction through alpha receptor stimulation.
  • Phenylephrine: Exclusively produces vasoconstriction through alpha receptor stimulation.
  • Dopamine: Increases blood pressure via vasoconstriction and positive inotropy.
  • Epinephrine: Stimulates both alpha and beta receptors.
  • Vasopressin: Causes vasoconstriction and renal water retention.

Intracranial Hemorrhage

  • Subarachnoid Hemorrhage (SAH): Most commonly caused by a ruptured cerebral aneurysm.
  • Subdural Hematoma: Occurs when a vessel traversing between the brain and skull is damaged.
  • Epidural Hematoma: Occurs when the middle meningeal artery is damaged.
  • Epidural Hematoma Presentation: Classically presents following a head injury, with brief loss of consciousness, followed by a lucid interval, and subsequent neurologic deterioration.
  • Subarachnoid Hemorrhage Presentation: Typically associated with an abrupt onset of a "thunderclap" headache.

Acid-Base Balance

  • Normal pH: 7.35-7.45
  • Normal PaCO2: 35-45 mmHg
  • Normal HCO3 (Bicarbonate): 22-26 mEq/L
  • Normal Base Excess: -2 to +2 mEq/L
  • Respiratory Acidosis Correction: Primarily corrected through minute volume (ventilation).

Intra-Aortic Balloon Pump (IABP)

  • Mechanism of Action: Reduces afterload and improves myocardial oxygenation via counterpulsation.
  • Balloon Inflation: Occurs during diastole.
  • Balloon Deflation: Occurs during systole.
  • Coronary Artery Perfusion: Occurs during diastole.
  • IABP Timing: Based on EKG or arterial line waveform.
  • EKG Trigger: Balloon inflates with the R wave.
  • A-line Trigger: Balloon inflates with the dicrotic notch.
  • Dicrotic Notch: Signifies closure of the aortic valve.

Hypertensive Emergencies

  • Blood Pressure Reduction: Should be lowered by 25% of the mean arterial pressure (MAP).

Fetal Heart Rate

  • Normal Fetal Heart Rate: 120-160 beats per minute.

Ischemic Stroke

  • Tissue Plasminogen Activator (tPA): Dose is 0.9mg/kg, maximum 90mg. 10% given as a bolus, 90% over one hour.

Ventilation and Physiology

  • Poor Ventilator Compliance: Leads to increased pressures.
  • Poiseuille's Law: Flow exponentially increases with increased tube diameter.
  • Dead Space: Space in the respiratory system that does not participate in gas exchange.
  • Alveolar Dead Space: Alveoli that are ventilated but not perfused.
  • Fick's Law: The rate of diffusion is directly proportional to the difference in partial pressure and the surface area of the membrane. It is inversely proportional to the thickness of the membrane.

Chest Imaging

  • ARDS: Chest imaging shows ground glass opacities.
  • Epiglottitis: X-ray shows a "thumbprint sign".
  • Croup: X-ray shows a "steeple sign".

Emergency Medical Services

  • Emergency Locator Transmitter (ELT): Transmits at 121.5 MHz frequency.
  • ELT Activation: Activated when it senses 4 G's of force.

Obstetrics

  • HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets. A type of preeclamptic pathology that may lead to hemorrhage; manifests as nausea/vomiting and right upper quadrant pain. Lab findings include elevated AST/ALT, low platelets, and hemolytic anemia.
  • Eclampsia: Magnesium sulfate (5-6 grams over 10 minutes) is given for active seizures or seizure prophylaxis.
  • Preeclampsia: Morphine is contraindicated.

Gastroenterology

  • Esophageal Varices: Do not insert OG/NG tube due to risk of rupture. Gastroenterologist can place bands on varices. If ruptured, place a Blakemore tube to tamponade bleeding until the patient can be taken to the GI lab for cauterization.

Cerebral Perfusion Pressure (CPP)

  • Formula: CPP = MAP - ICP
  • Normal Intracranial Pressure (ICP):

Monro-Kellie Doctrine

  • States that the skull is a closed space, containing brain tissue, cerebrospinal fluid, and blood.
  • The sum of these three components is relatively constant.
  • An increase in one component must be compensated for by a decrease in one of the other components.

Normal Serum Values

  • Potassium: 3.5-5.0 mEq/L
  • Sodium: 136-142 mEq/L
  • Chloride: 96-106 mEq/L
  • Calcium (total): 8.2-10.2 mg/dL
  • Carbon Dioxide: 22-28 mEq/L
  • Blood Urea Nitrogen (BUN): 8 to 23 mg/dL
  • Creatinine: 0.6-1.2 mg/dL
  • Lactate:
    • Arterial: 0.5-1.6 mmol/L
    • Venous: 0.4-2.0 mmol/L
  • Amylase: 27-131 IU/L
  • Lipase: 31-186 IU/L
  • Creatine Kinase: 40-150 IU/L
  • International Normalized Ratio (INR): 0.8-1.2

Mechanical Ventilation

  • Initial Vent Setting to Titrate for Hypoxia: Positive End-Expiratory Pressure (PEEP)
  • Dynamic Hyperinflation (Auto-PEEP) Troubleshooting:
    • Lower the rate.
    • Shorten the inspiratory time to increase the inspiratory to expiratory (I:E) ratio.
    • Maintain Tidal Volume (Vt) within 6-8 mL/kg range.
  • Tidal Volume Determination: 4-8 mL/kg of ideal body weight
  • Hypoxia Types:
    • Hypoxemic
    • Stagnant
    • Anemic
    • Cytotoxic

Hemodynamics and Cardiovascular Physiology

  • Systemic Vascular Resistance (SVR): Reflects the afterload the left ventricle must overcome to eject blood.
  • Normal Right Atrial Pressure: 2-6 mmHg
  • Normal Pulmonary Artery Pressure: 15-25 mmHg systolic, 0-8 mmHg diastolic
  • Normal Pulmonary Capillary Wedge Pressure (PCWP): 6-12 mmHg
  • Arterial Line Transduction Location: Level of the phlebostatic axis
  • PCWP Measurement: Reflects left ventricular filling pressure.
  • Cardiogenic Shock: Characterized by hypotension and a PCWP greater than 15 mmHg.

Vasopressors

  • Norepinephrine: Primarily causes vasoconstriction through alpha receptor stimulation.
  • Phenylephrine: Produces vasoconstriction exclusively through alpha stimulation.
  • Dopamine: Increases blood pressure through vasoconstriction and positive inotropy.
  • Epinephrine: Stimulates both alpha and beta receptors.
  • Vasopressin: Causes vasoconstriction and renal water retention.

Intracranial Hemorrhage

  • Most Common Nontraumatic Subarachnoid Hemorrhage Cause: Ruptured cerebral aneurysm.
  • Subdural Hematoma: Occurs when a vessel traversing between the brain and skull is damaged.
  • Epidural Hematoma: Caused by damage to the middle meningeal artery.
  • Epidural Hematoma Presentation: Typically presents with a blow to the head, followed by a brief loss of consciousness, followed by a lucid interval with subsequent neurologic deterioration.
  • Subarachnoid Hemorrhage Presentation: Commonly associated with an acute onset of a "thunderclap" headache.

Acid-Base Balance

  • Normal pH: 7.35-7.45
  • Normal PaCO2: 35-45 mmHg
  • Normal HCO3 (Bicarbonate): 22-26 mEq/L
  • Normal Base Excess: -2 to +2 mEq/L
  • Respiratory Acidosis Correction: Primarily through minute volume (respiratory rate and tidal volume).

Intra-Aortic Balloon Pump (IABP)

  • Mechanism of Action: Reduces afterload and improves myocardial oxygenation through counterpulsation.
  • Inflation Timing: During diastole.
  • Deflation Timing: During systole.
  • Coronary Perfusion: During diastole.
  • Timing Determination: Based on either EKG or arterial line waveform.
  • EKG Trigger: Balloon inflation timed with the R wave.
  • Arterial Line Trigger: Balloon inflation timed with the dicrotic notch.
  • Dicrotic Notch Significance: Denotes closure of the aortic valve.

Hypertensive Emergencies

  • Blood Pressure Reduction Goal: Lower blood pressure by 25% of the mean arterial pressure (MAP).

Obstetrics

  • Normal Fetal Heart Rate: 120-160 bpm
  • tPA Dosing for Ischemic Stroke: 0.9 mg/kg, maximum dose 90 mg, 10% given as a bolus, 90% given over one hour.

Respiratory and Critical Care

  • Poor Ventilator Compliance: Increases pressure.
  • Poiseuille's Law: Flow through a tube is exponentially increased with increased tube diameter.
  • Dead Space: Space within the respiratory system that does not participate in gas exchange.
  • Alveolar Dead Space: Alveoli that are ventilated but not perfused.
  • Fick's Law: The rate of diffusion is directly proportional to the difference in partial pressure and the surface area of the membrane. It is inversely proportional to the thickness of the membrane.
  • ARDS on Chest Imaging: Characterized by ground-glass opacities.

Radiology

  • Epiglottitis X-Ray Finding: Thumbprint sign.
  • Croup X-Ray Finding: Steeple sign.

Aviation

  • Emergency Locator Transmitter (ELT) Frequency: 121.5 MHz.
  • ELT Activation Threshold: 4 G's of force.

Emergency Medicine

  • HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets; a preeclamptic pathology that can lead to hemorrhage. It presents with nausea/vomiting and right upper quadrant pain.
    • Lab findings: Elevated ALT/AST, low platelets, and hemolytic anemia.
  • Eclampsia Seizures/Prophylaxis Medication: Magnesium Sulfate (5-6 grams over 10 minutes).
  • Medication Contraindicated in Pancreatitis: Morphine.
  • Esophageal Varices Treatment:
    • Avoid insertion of OG/NG tubes due to rupture risk.
    • Gastroenterologist can place bands on varices.
    • If ruptured, place a Blakemore tube for tamponade until emergent GI lab transfer for cauterization.
  • Cerebral Perfusion Pressure (CPP) Formula: Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP).
  • Normal Intracranial Pressure: 0-15 mmHg.

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This quiz covers essential concepts related to the Monro-Kellie doctrine, normal serum values, and ventilator management techniques. Understanding these key topics is crucial for healthcare professionals working in critical care settings. Test your knowledge on these fundamental clinical principles.

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