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22 Cards in this Set
- Front
- Back
PbtO2 levels that correlate to severe brain hypoxia |
<15mm Hg |
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(Based on K. Lee's Algorithm) What are the variables to treat with brain hypoxia and a metabolically stressed brain (PbtO2 <15 and LPR >40) |
Address the following: CO, Hb, SaO2, intravascular volume, then optimize CPP |
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How do you improve CO in brain hypoxia? |
IV milrinone or IV dobutamine |
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Best parameters to monitor when addressing intravascular volume |
CVP, SVV, GEDVI, PAWP |
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Ideal CVP / PAWP for adequate intravascular volume? |
CVP 8-12 PAWP 10-14 |
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Ideal SVV showing adequate intravascular volume? |
SVV <10% |
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Ideal GEDVI showing adequate intravascular volume |
GEDVI 600-800 |
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How do you optimize CPP? |
Increase MAP, decrease ICP, normalize PbtO2 to >20mm Hg
Increase MAP by utilizing levophed and dopamine |
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Define the Lindegaard ratio? |
Mean TCD velocity of MCA divided by mean TCD velocity of ipsilateral, extracranial ICA |
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What is the normal Lindegaard ratio? |
<1.7, values >2.0 indicates higher risk f VSP
Institution-dependent, some say <1.5 is noraml |
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Lindegaard ratio for hyperemia, mild, mod, severe VSP? |
Hypermedia 1.5-2.5 Mild 2.5-3.5 Mod 3.5-4.5 Severe >4.5 |
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Interventions to decrease risk of contrast-induced nephropathy (CIN) - name 3 |
NS 1ml/kg/h x 12h NaHCO3 3ml/kg/h x 12h N-acetylcysteine 600mg IV prior then 600 mg PO BID x 2d |
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3 perfusion maps provided by CTP |
MTT CBV CBV |
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CTP findings in vasospasm / DCI |
MTT prolonged CBF reduced CBV normal or increased if autoregulation intact; reduced with infarction / ischemia |
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CTP showing a window of opportunity to intervene in DCI |
When MTT is increased and CBF is reduced, and CBV shows either normal or incresaed blood flow |
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What is hyperdynamic therapy? |
Increased cardiac index without significantly increasing BP |
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Parameters for hypovolemia |
CVP 0-3 Anemia Hb <7 Low PAWP <10 GEDVI <680 SVV >13% SVI <40 ml/m2 Low UO <0.5ml/kg/h |
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Normal cardiac output? |
5-8 L/min |
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Normal cardiac index? |
3-5 L/min/m2 |
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Name 4 agents used in intra-arterial therapy of vasospasm |
Papaverine Nicardipine Verapamil Milrinone |
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What happens to FENa in CSW vs SIADH? |
FENa is low (<1%) in CSW and high (>1%) in SIADH |
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What happens to serum uric acid levels in CSW and SIADH? |
Serum UA level is low for both CSW and SIADH |