What are potential causes of hyperthermia? (6)
- Hyperthermia: airway obstruction, external heat source
- Pyrexia (resetting of hypothalamus): infectious, inflammatory, neoplasia, drug-induced (opioids/ ketamine in cats)
What are causes of hypothermia? (6)
- infection/ inflammation
- renal failure
What are the signs of volume overload in the order which they occur clinically? (5)
tachypnea--> dyspnea--> auscultable crackles--> dull lung sounds--> cyanosis
What are causes of tachycardia? (7)
- pain/ anxiety
- atrial/ ventricular arrhythmias
- drug-induced (dopamine, ketamine)
What are causes of bradycardia? (7)
- increased vagal tone
- electrolytes (hyperK+)
- conduction disturbances
- drug-induced (alpha-2's, opioids)
- shock (cats)
Pulse quality is dictated by ___________, which is...
pulse pressure; the difference b/w systolic and diastolic BP
Strong, synchronous pulses can be indicative of... (2)
Snappy/ tall and narrow pulses can be indicative of... (3)
- [rapid fall off to diastolic pressure]
- hemodilutional anemia (IMHA)
- aortic regurg
Weak, thready pulses can be indicative of... (2)
- decompensated shock
What are causes of tachypnea? (7)
- pain/ stress
- compensation for metabolic acidosis
- CNS issues
- shock state
What are causes of bradypnea? (4)
- CNS disease (increased ICP, encephalitis)
- drug-induced (opioids, propofol)
- neuromuscular disease
What are causes of white/pale MMs? (3)
- peripheral vasoconstriction
What are causes of red/ injected MMs? (5)
- peripheral vasodilation
- hyperdynamic state
- CN poisoning
- CO poisoning
Cyanosis is reflective of...
severe hypoxemia (>5g/dL desaturated hemoglobin) [normal PCV is 45% therefore 45/3--> 15g/dL hemoglobin]
Prolonged CRT reflects...
decreased peripheral perfusion from vasoconstriction as a compensatory response to shock or in painful patients
Shortened CRT may reflect...
increased peripheral perfusion/ vasodilation [hyperdynamic stage of sepsis, CN toxicity, hyperthermia]
What are the levels of consciousness? Describe them.
- Alert- normal
- Dull/ obtunded- diminished interaction with surroundings, blunted response to stimuli
- Stuporous- only respond to noxious stimuli
- Comatose- don't response to any stimuli
What are potential causes of a change in level of consciousness? (8)
- increased ICP
- cardiovascular collapse
- severe anemia
- severe hypoxemia
- severe acidemia/ alkalemia
- organ dysfunction (renal, liver)
- systemic infection/ inflammation
- drug-induced (sedatives)
Dehydration less than ________ is subclinical/ undetectable.
Changes in body weight are largely a function of...
changes in total body water (best way to assess de/re/over hydration)
Development of edema/ effusion may suggest... (3)
overhydration, increased vascular permeability, decreased oncotic pressure
Urine output should be ________.
PCV/TP both decrease as a result of __________.
Increased in both PCV/TP reflects _________.
Decreased TP with a normal PCV can suggest... (2)
loss of protein or decreased consumption
What are limitations to using PCV/TP as an indicator of fluid balance? (4)
- slow to change in acute blood loss (no initial change until redistribution of body fluid or fluid administration)
- drop in PCV can lag behind drop in TP d/t splenic contraction
- dilutional effects of fluids can cause major changes
- TP does not always reflect oncotic pressure
Colloid osmotic pressure assesses...
adequacy of albumin to provide oncotic pressure and maintain intravascular volume
What are causes of decreased colloid osmotic pressure? (7)
- sepsis/ SIRS
- liver failure
- poor nutritional plane
- blood loss
- severe burns
How is colloid osmotic pressure measured?
colloid osmometer [used to help guide fluid therapy, need for oncotic support/ colloids when COP< 15]
You can discontinue colloid support when COP is _________ because...
>18; oncotic pressure is a driving force for albumin synthesis
What are potential causes of hypoglycemia in critically ill patients? (6)
- sepsis/SIRS (increased metabolic demand)
- Addison's (decreased glucocorticoid release)
- PSS (decreased glycogen stores)
- liver failure (decreased glycogen, gluconeogenesis)
- anorexia (young patients only)
What are causes of hyperglycemia? (3)
- diabetes/ DKA
- stress response
- secondary to critical illness
HypoK+ in an ICU patient is commonly secondary to...(2)
diuresis and/or decreased intake.
Causes of hyperkalemia. (4)
- urinary obstruction
- reperfusion injury
What are causes of changes in Cl- levels? (2)
GI losses, changes in free water
Causes of hypocalcemia. (4)
critical illness, eclampsia, addison's, pancreatitis
What are indications for monitoring arterial BP? (5)
- routine monitoring in ICU
- anesthetized patients
- determination of hypovolemia/ shock state
- monitoring resuscitation
- diagnosis and monitoring of systemic hypertension
What are the pros and cons of using Doppler to measure BP?
- Pros: inexpensive, auditory signal generated, validated and reasonably accurate
- Cons: only provides systolic BP, overestimate hypotension, underestimates hypertension, requires patient manipulation, operator dependecy
What are the pros and cons of using oscillometric devices to monitor BP?
- Pros: readily available, provides systolic/diastolic/mean BP, allows hands-off measurement
- Cons: affected by motion, overestimates hypotension, underestimates hypertension, operator dependency (cuff size and placement)
What is the gold standard for arterial BP?
What are the pros and cons of direct measurement of arterial BP?
- Pros: provides systolic, diastolic/mean BP, provides arterial waveform, close tracking of changes
- Cons: requires arterial catheter, requires monitor and pressure transducer, pressure tracings can be distorted (clots/ kinks/ inappropriate tubing)
What are normal values for arterial BP?
- Systolic 120-140
- Diastolic 70-90
- Mean 90-110
What are the limitations of monitoring BP as an indicator of perfusion? (5)
- BP is not an independent indicator of perfusion or cardiac output or blood volume
- insensitive- highly preserved in compensatory responses (BP is the last thing to go and the first thing to come back)
- variability, especially with indirect measurements
- must correlate findings to PE
- can be affected by other factors (pain, stress, etc)
What are indications for monitoring ECG? (5)
- unstable patients
- pulse deficits
- presence of arrhythmias
- guide resuscitation
- guide anti-arrhythmic therapy
What is the clinical significance of lactate?
- produced by tissues undergoing anaerobic metabolism
- marker for perfusion, O2 delivery, and O2 utilization
What are indications for measuring blood lactate? (4)
- patients with evident or suspected ischemia
- guide for fluid therapy
- help decide need for RBC transfusion
- failure to improve may have prognostic value
What are the limitations of measuring lactate for diagnostic/ prognostic evaluation? (4)
- measurement is a balance of production and clearance
- may become trapped in tissues if severely underperfused (falsely low levels)
- may be high in patients with adequate perfusion but with altered cellular utilization of O2
- elevations can be unrelated to perfusion (liver failure, sepsis, neoplasia)
____________ is a global marker of tissue perfusion; this value is obtained through...
- central venous saturation (SCVO2); central line in vena cava
- [used to guide therapy in shock resuscitation, guide decisions for blood transfusion]