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Antibiotic Dosing in Renal Replacement Therapy

Source: Critical Care Review

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Stats Reference Table

Type 1 Error: rejecting null when null is TRUE.

Type 2 Error: rejecting null when null is FALSE.

Lower p value results in less type 1 error, more type 2 error.

MRI evolution of Cerebral Abscess

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Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

 

 

Pulmonary Artery Catheter Waveforms and Normal Values

As the PAC is inserted, the following waveforms can be observed.

1. When the catheters enters the RA, a CVP tracing is seen – characterized by a and v waves.img_1652

 

 

 

 

 

 

 

 

 

2. As the catheter enters the RV, a sharp increase in systolic pressure is noted.img_1653

3. As the catheter is advanced to the pulmonary artery, an increment in diastolic pressure is seen as well as the presence of a dichromatic notch. img_1654

4. When the catheter is advanced further into the pulmonary artery, and wedged – a sine wave that oscillates with respiration is seen. img_1655

THE RA WAVEFORM:

The RA waveform is characterized by presence of 2 waves: a wave (contraction of the RA) and the v wave (passive filling of the RA).

The x descent represents RA relaxation, which is interrupted by the c wave which represents closure of the tricuspid valve.

The y descent follows the v wave, which signals the opening of the tricuspid valve and exit of blood from the RA to the RV.

img_1656

OVERDAMPING:

The wave below illustrates flushing of the catheter – which results in high pressures in the transducer (1). Flushing stops, and results in fall in pressures and an overshoot (2), and a return to normal waveform.

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The wave below – overshooting is absent, and the waveform is flattened, which is found in an overdamped waveform. Overdamping can be caused by a kinked catheter, air bubbles, fibrin clot.

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CATHETER WHIP.

The graph below illustrate catheter whip – where ventrcicular contractions are transmitted to the PAC.

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OVERWEDGING:

The arrow indicates when the balloon is inflated. There is a sustained increment in pressure reading.

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ACUTE MITRAL INSUFFICIENCY

Prominent v waves represent blood that enters the LA during ventricular systole due to an incompetent mitral valve.

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TRICUSPID REGURGITATION

Broad c-v waves can be seen.

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RV INFARCTION

Marked acute dilatation of the RV occurs. Acute dilatation is limited by the pericardium. Deep x and y descents, resembling the letter W is seen.

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MEASURED HEMODYNAMICS VARIABLES:

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DERIVED HEMODYNAMICS VARIABLES

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OXYGEN TRANSPORT VARIABLES

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Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

Formulae: Acid-base disorders

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Reference:

Criner, G., Barnette, R. and D’Alonzo, G. (2010). Critical Care Study Guide. Dordrecht: Springer.

Pediatric GCS (Glasgow Coma Scale)

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References

Garvin, R. and Mangat, H. (2017). Emergency Neurological Life Support: Severe Traumatic Brain Injury. Neurocritical Care, 27(S1), pp.159-169.

Checklist: Vascular Work-up for TBI

Don’t forget to assess cerebral vasculature in TBI patients

Imaging with CTA MRA MRV or DSA should be considered in these patients:

1. Penetrating injury

2. Fracture over venous sinus

3. Neurologic deficit unexplained by head CT

4. C-spine injuries such as severe flex ion/ext injury or Fx through transverse foramen

5. Petrous bone fracture

6. LeFort II or II facial fractures

Suspected cause of injury s.a. Aneurysms rupture

7. Near hanging, seat belt abrasions of neck, anterior neck soft tissue swelling (?blunt injury to carotid / vertebral arteries?)

REFERENCE:

ENLS 2017