Canvas Exam 3 - Critical Care and Medical-Surgical Review

A comprehensive vocabulary review deck containing 179 terms covering mechanical ventilation, trauma resuscitation, shock classifications, neurological emergencies, cardiology, and gastrointestinal disorders for Exam 3.

Acute Respiratory Distress Syndrome (ARDS)

hypoxemia due to alveolar damage

s/s of ARDS

refractory hypoxemia, pulmonary infiltrates, and normal cardiac function.

ABGs of a pt in respiratory failure

PaO2 <60, PaCO2 >50, pH <7.35, O2 sat <90%

Normal Minute Ventilation

6-8 L/min

Assist-Control vent

deliver set tidal volume for each breath

Peak Inspiratory Pressure (PIP)

Reflects upper airway resistance and compliance.

Plateau Pressure (Pplat)

A mechanical ventilation pressure parameter that best reflects overall alveolar and pulmonary compliance.

Elevated Peak Inspiratory Pressure (PIP > 30)

Clinical causes to troubleshoot when PIP exceeds $30\,cmH_2O$: secretions, pneumothorax, bronchospasm, equipment failure, endotracheal tube displacement, and patient biting on the tube.

Elevated Plateau Pressure (Pplat > 30)

Complications suspected when plateau pressure rises above $30\,cmH_2O$: alveolar overdistention and barotrauma.

Ventilator Ventilation Adjustments

Parameters evaluated and manipulated to adjust ventilation on a mechanical ventilator: $pH/PaCO_2$, tidal volume (TV), and respiratory rate (RR).

Ventilator Oxygenation Adjustments

Parameters evaluated and manipulated to adjust arterial oxygenation on a mechanical ventilator: $PaO_2/\text{Sat}$, $\text{FiO}_2$, and PEEP.

ARDS Pharmacotherapy

Medications indicated for patient management during ARDS: rocuronium (paralytic), propofol (sedative), and fentanyl (analgesic).

Prone Positioning

A therapeutic positioning technique utilized to recruit collapsed alveoli and improve alveolar compliance in ARDS.

Continuous Positive Airway Pressure (CPAP)

A non-invasive positive pressure modality best suited for patients with obstructive sleep apnea or cardiogenic pulmonary edema needing oxygenation correction.

Bilevel Positive Airway Pressure (BiPAP)

A non-invasive positive pressure modality best suited for patients with COPD who require correction of both oxygenation and ventilation.

Inspiratory Positive Airway Pressure (iPAP)

The pressure setting on a BiPAP machine that controls and assists patient ventilation.

Expiratory Positive Airway Pressure (ePAP)

The pressure setting on a BiPAP machine that recruits alveoli and controls oxygenation.

Severe Hypocapnia (PCO2 of 10)

A clinical finding indicating poor systemic perfusion, severe hypocapnia, or poor cardiac stability.

Hypercapnia (PCO2 of 55)

A clinical finding indicating alveolar hypoventilation and excessive $CO_2$ retention.

Shark Fin Waveform

A characteristic capnography waveform shape indicating bronchospasms or expiratory airflow obstruction.

Trauma Golden Hour

The critical post-injury window occurring within 2 hours, representing the second peak of trauma mortality.

Primary Survey (Trauma)

The systematic initial assessment protocol in trauma: A (airway with C-spine immobilization), B (breathing), C (circulation), D (disability), and E (exposure and evaluation).

Tension Pneumothorax Emergency Interventions

Emergency procedures performed for a trauma patient presenting with absent breath sounds and hypotension: needle decompression, finger thoracotomy, and chest tube placement.

Flail Chest

A severe chest wall injury characterized by paradoxical movement of a thoracic segment during respiration.

Immediate Trauma Resuscitation Priorities

The immediate circulatory resuscitation interventions for severe trauma: placing two large-bore IVs, infusing warmed Lactated Ringer's (LR), and initiating massive transfusion protocol.

AVPU Scale

A rapid assessment mnemonic used to determine neurological responsiveness: Alert (A), response to Voice (V), response to Pain (P), and Unresponsive (U).

Glasgow Coma Scale (GCS)

A standardized neurological scale scored from 3 to 15 (recorded as 0-15 in text) assessing level of consciousness through eye opening, verbal response, and motor response.

Exposure and Environmental Control (Step E)

The primary survey step requiring complete removal of clothing, inspection of posterior surfaces, and active prevention of hypothermia.

Secondary Survey (Trauma)

The secondary assessment phase comprising a full set of vitals, facilitating family presence, pain medication administration, history gathering, head-to-toe examination, and identification of all injuries.

Deterioration During Secondary Survey

The mandatory clinical protocol to immediately stop the secondary survey and return to the primary survey if a patient becomes unstable.

Trauma Diamond

The lethal tetrad of interrelated physiological derangements in trauma: coagulopathy, acidosis, hypothermia, and hypocalcemia.

Hypothermia in Trauma

A dangerous physiological state that inhibits the coagulation cascade and worsens active bleeding.

Primary Indicator of Blood Loss

Tachycardia, which is the earliest and most sensitive physiological indicator of acute blood loss.

Hemorrhagic Shock Clinical Findings

The characteristic physiological response to significant blood loss: elevated HR, elevated RR, decreased BP, decreased urine output, and decreased hemoglobin/hematocrit (H/H).

Massive Transfusion Protocol (MTP)

A balanced blood component resuscitation protocol delivered in a 1:1:1 ratio of packed red blood cells (PRBCs), platelets, and fresh frozen plasma.

Tranexamic Acid (TXA)

An antifibrinolytic medication that prevents clot breakdown by inhibiting fibrinolysis to reduce traumatic hemorrhage; must be administered within 3 hours of injury.

Calcium Replacement (Transfusion)

The electrolyte replacement required after infusing 2 to 4 units of PRBCs to counteract citrate-mediated hypocalcemia.

Goal Urine Output

The target clinical parameter indicating adequate renal and systemic perfusion: $0.5\,mL/kg/hr$.

Goal Mean Arterial Pressure (MAP)

The standard perfusion target for critically ill and resuscitated patients: $>65\,mmHg$.

Mean Arterial Pressure (MAP) Formula

The formula used to calculate mean arterial pressure: $\frac{2 \times \text{Diastolic} + \text{Systolic}}{3}$ ($Dx2 + S / 3$).

Pelvic Binder

A circumferential stabilization device applied immediately to an unstable pelvic fracture to reduce pelvic volume and stop massive retroperitoneal bleeding.

FAST Exam

Focused Assessment with Sonography in Trauma; a bedside ultrasound exam used to rapidly identify free fluid or air in the pericardial and peritoneal cavities.

Etiology of Traumatic Shock

The single most common cause of shock in trauma patients: hypovolemia secondary to acute blood loss.

Exsanguination

Severe, fatal blood loss defined as a 40% loss of total blood volume (approximately $2\,L$).

Tension Pneumothorax Presentation

The classic clinical constellation of absent breath sounds on the affected side, tracheal deviation away from the affected side, hypotension, and restlessness/anxiety.

Thoracentesis

A procedural aspiration of fluid from the pleural space used to treat pleural effusion.

Traumatic Cardiac Arrest Management

The fundamental clinical focus during traumatic cardiac arrest: identifying and reversing or treating the underlying cause.

Reversible Hs in Trauma

Potentially reversible arrest etiologies: hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, and hypothermia.

Reversible Ts in Trauma

Potentially reversible arrest etiologies: tension pneumothorax, cardiac tamponade, toxins, thrombosis, and thromboembolism.

Pericardiocentesis

An emergency needle aspiration of fluid from the pericardial sac used to relieve cardiac tamponade.

Blood Shunting (Shock)

A compensatory physiological response during shock where blood is diverted from peripheral beds to preserve vital central organ perfusion.

Multiple Organ Dysfunction Syndrome (MODS)

A progressive organ failure state suspected when a patient develops hypotension, oliguria, elevated BUN/Cr, hyperkalemia, and elevated liver function tests.

Distributive Shock

A broad classification of shock caused by widespread loss of vascular tone and abnormal systemic vasodilation.

Neurogenic Shock

A form of distributive shock caused by spinal cord injury that presents uniquely with hypotension, bradycardia, and warm, dry skin.

Neurogenic Shock Management

The protocol for treating neurogenic shock: spinal stabilization, isotonic fluids, norepinephrine, and atropine if $HR < 60\,bpm$.

SIRS Criteria

Systemic Inflammatory Response Syndrome criteria (requiring $\ge 2/4$): $HR > 90$, $T > 100^\circ F\text{ or } > 38^\circ C$, $RR > 20$, and $WBC > 12\text{ or } < 4$.

Septic Shock Manifestations

Clinical and laboratory markers of septic shock: $MAP < 65\,mmHg$, lactate $> 2\,mmol/L$, procalcitonin $> 2\,ng/mL$, WBC left shift, and metabolic acidosis.

Sepsis Treatment Bundle

The structured clinical protocol: blood cultures, broad-spectrum antibiotics (piperacillin/tazobactam), fluid boluses ($30\,ml/kg$), vasopressors (norepinephrine, vasopressin, epinephrine), and hydrocortisone.

Disseminated Intravascular Coagulation (DIC)

A severe acquired hematological disorder causing widespread microvascular thrombosis and consumptive bleeding, commonly complicating septic shock.

DIC Diagnostic Signs and Labs

Indicators of DIC: bleeding at 2 or more sites, purpura, tachypnea, D-dimer $> 0.05$, PT/INR $> 12/1$, PTT $> 35$, platelets $< 50$, and fibrinogen $< 150$.

Cryoprecipitate

A plasma-derived blood component indicated specifically to replace low fibrinogen levels in conditions such as DIC.

Anaphylactic Shock Presentation

Clinical features: rash or hives, wheezing, stridor, hypotension, tachycardia, tachypnea, and shortness of breath.

Angioedema

Severe localized submucosal or subcutaneous edema involving the airway, tongue, and face that requires strict monitoring during anaphylaxis.

First-Line Anaphylaxis Treatment

The immediate first-line intervention: intramuscular epinephrine 1:1000 given at a dose of $0.3\text{ to }0.5\,mg$.

Secondary Anaphylaxis Medications

Adjunctive pharmacotherapy: methylprednisolone, oxygen, IV fluids, diphenhydramine, and famotidine.

Hypovolemic Shock Presentation

Clinical features resulting from severe intravascular volume depletion: increased HR and RR, decreased BP, cool, pale, clammy skin, and confusion.

Cardiogenic Shock Presentation

Clinical features resulting from cardiac pump failure: increased HR and RR, decreased BP, cool, pale, clammy skin, arrhythmias, chest pain, pink frothy sputum, and decreased LOC.

Cardiogenic Shock Etiologies

The primary clinical causes of pump failure: acute myocardial infarction (MI), advanced heart failure, and severe valve disorders.

Cardiogenic Shock Fluid Bolus

A fluid challenge strictly limited to small volumes ($250\,ml$) to prevent exacerbation of acute pulmonary edema.

Cardiogenic Shock Pharmacotherapy

Vasoactive and inotropic drugs used to support circulation: milrinone, dobutamine, dopamine (medium range), and sodium nitroprusside.

Milrinone

A phosphodiesterase-3 (PDE3) inhibitor that acts as a positive inotrope and vasodilator without increasing myocardial oxygen consumption or heart rate.

Sodium Nitroprusside

A direct-acting vasodilator that decreases cardiac afterload through venous and arterial dilation.

Dobutamine

A direct beta-1 adrenergic agonist that increases myocardial contractility and enhances forward stroke volume.

Dopamine (Medium Dose)

An inotropic agent given at medium dose ranges to improve contractility that cannot be administered concurrently with beta blockers.

Glucagon (Antidote)

The primary pharmacological reversal agent and treatment for severe beta blocker toxicity/overdose.

Furosemide (Preload Reduction)

A potent loop diuretic administered to promote diuresis and reduce cardiac preload in heart failure and cardiogenic shock.

Obstructive Shock Etiologies

Mechanical conditions that obstruct blood flow: tension pneumothorax, cardiac tamponade, and massive pulmonary emboli.

Obstructive (Cardiogenic) Shock Signs

Diagnostic manifestations: Beck's triad (hypotension, JVD, muffled heart sounds), pulsus paradoxus (decreased BP with each inhalation), decreased LOC, oliguria, and tachycardia.

Tension Pneumothorax Obstructive Signs

Specific physical signs distinguishing this form of obstructive shock: diminished breath sounds and contralateral tracheal deviation.

Beck's Triad

A classic triad of clinical signs diagnostic of cardiac tamponade: hypotension, jugular venous distention (JVD), and muffled heart sounds.

Cardiac Tamponade Treatment

Emergency procedural drainage of pericardial fluid performed via pericardiocentesis.

Pulmonary Embolism Pharmacotherapy

Emergency thrombolytic and anticoagulant therapies: alteplase or tenecteplase, followed by heparin.

Thrombolytic Monitoring Protocol

Essential post-administration nursing surveillance: neurological checks every 15 minutes and continuous monitoring for angioedema.

C2-C3 Spinal Cord Injury

The most fatal spinal cord injury level, which leads directly to immediate respiratory arrest.

C3-C5 Spinal Cord Injury

The cervical spinal cord region that innervates the diaphragm via the phrenic nerve; injury here necessitates mechanical intubation.

T6 Spinal Cord Injury Threshold

The anatomical spinal level at or above which individuals are at risk of developing autonomic dysreflexia.

Autonomic Dysreflexia Presentation

A hypertensive crisis manifested by $BP > 300\,mmHg$, severe headache, bradycardia, facial flushing above the lesion, and pallor below the lesion.

Autonomic Dysreflexia Treatment

Emergency interventions: raising head of bed (HOB), eliminating noxious stimuli (tight clothing, kinked urinary catheter, fecal impaction), and administering labetalol or sodium nitroprusside.

Priapism (Spinal Trauma)

A persistent, painful penile erection in a spinal trauma patient signaling the return of spinal reflexes.

Urinary Retention Catheterization Threshold

A post-void residual or retained bladder volume exceeding $300\,ml$ that warrants intermittent catheterization.

Neurological Patient Priority

Airway maintenance, which is always the absolute highest clinical priority in neurological patients.

Early Signs of Increased ICP

Early neurological indicators of elevated ICP: deterioration in level of consciousness (LOC), pupillary dysfunction, irritability, and restlessness.

Late Signs of Increased ICP

Advanced neurological signs of elevated ICP: Cushing's triad (bradycardia, hypertension with widened pulse pressure, irregular respirations) and projectile vomiting.

GCS Intubation Criterion

A Glasgow Coma Scale score of less than 8 ($<8$), which requires immediate airway protection and endotracheal intubation.

Monro-Kellie Doctrine

The principle that the rigid skull contains fixed volumes of brain tissue (80%), blood (10%), and CSF (10%), meaning an increase in one component necessitates a compensatory decrease in another.

Vascular ICP Management (Hyperventilation)

Mechanical ventilation adjustment titrating $PaCO_2$ to $30-35\,mmHg$ to induce cerebral vasoconstriction and decrease intracranial volume.

Extreme Hypocapnia Risk (PaCO2 < 30)

Severe cerebral vasoconstriction leading to profoundly decreased cerebral perfusion and secondary ischemic brain injury.

Ventriculostomy Transducer Positioning

Leveling the transducer to the Foramen of Monro or tragus of the ear with the head of the bed at $30^\circ$ and the head aligned neutral in midline.

Ventriculostomy ICP Component

Cerebrospinal fluid (CSF), which is the specific cranial compartment regulated and drained by a ventriculostomy.

Osmotic Therapies for Brain Swelling

Hyperosmolar agents used to draw water out of edematous brain tissue: mannitol and 3% hypertonic normal saline.