2014 Critical care Clinical Assessment
- 1.Baroreceptor-mediated vascular compensation by increasing vascular tone can sustain a constant blood pressure in a patient losing as much as what percent (%) of blood volume before being associated with a drop in mean arterial pressure (MAP)?
- A.
14%
- B.
16%
- C.
18%
- D.
20%
- 2.Which of the following are considered 'flow parameters'?
- A.
SV, CVP, CO
- B.
CI, DO2, PaOP
- C.
SVI, CI, DO2
- D.
CVP, HR, urine output
- 3.ScvO2 is affected by:
- A.
Hemoglobin changes (bleeding, hemodilution)
- B.
Cardiac output changes (preload, afterload, contractility, heart rate)
- C.
Metabolic demand (fever, shivering, stress, muscle activity)
- D.
Oxygenation (Sp02, Pa02)
- E.
All of the above
- 4.What is the clinical utility of ScvO2?
- A.
Reveals occult tissue hypoxia
- B.
Determines the balance of oxygen delivery and consumption
- C.
Helps determine the adequacy of cardiac output
- D.
Helps determine whether blood transfusion is needed when used in conjunction with hemobglobin/hematocrit levels
- E.
All of the above
- 5.Literature supports that Systolic Blood Pressure, CVP and HR show a considerable lack of sensitivity and specificity as predictors of fluid responsiveness.
- A.
True
- B.
False
- 6.Which of the following is not at sign of SIRS?
- A.
Tachycardia
- B.
Tachypnea
- C.
Elevated lactate
- D.
Temperature (elevated or abnormally low)
- E.
WBC (elevated or abnormally low)
- 7.In the original EGDT study by Manny Rivers, et al., what was the key differences between the control and treatment arm protocols? (select all that apply)
- A.
Scv02 endpoint >70%
- B.
CVP endpoint 8-12mm Hg
- C.
MAP endpoint >65 and
- D.
Urine Output endpoint >0.5 ml/kg/hr
- 8.When giving epinephrine, a clinician might expect to see what happen with parameter using the CardioFlo Sensor?
- A.
Increase CO and SV
- B.
Decrease CO and SV
- C.
Increase SV and Stroke Volume Variation (SVV)
- D.
Decrease SV and SVV
- 9.Compliance has an inverse effect on pulse pressure.
- A.
True
- B.
False
- 10.Pulse Pressure is proportional to what?
- A.
Heart Rate
- B.
Stroke Volume
- C.
Cardiac Output
- D.
ScvO2
- 11.A hypovolemic patient may show an elevated SVV (>10%).
- A.
True
- B.
False
- 12.If an elevated SVV does not respond to fluid, it may indicate that?
- A.
The patient had a bad day
- B.
The patient needs a colloid
- C.
The patient’s ventricle is failing
- D.
The patient should be removed from mechanical ventilation
- 13.A 44 year old trauma patient comes into the emergency room after a motor vehicle accident. The patient has tachycardia, hypotension, a firm abdomen, and an abdominal tap is positive for blood. The patient is sent to the operating room for an exploratory laparotomy. Anesthesia starts a radial arterial line with a CardioFlo sensor and a 14/14ga. Double lumen central line. Parameters show: H/RB/PSp02CVPSVSW11070/40 (55)9923522% Anesthesia gives 2 units of packed red blood cells (PRC ), and 1000cc Normal Saline after which: H/RB/PSp02CVPSVSW10090/60 (75)9974518%Given this information, what do YOU think the next step would be?
- A.
IV infusion to maintenance (TKO) drip only and cont. monitoring
- B.
Continue to give volume (blood or crystalloid)
- C.
Start the patient on an inotrope (increase contractility)
- D.
Give the patient Lasix (diuretic)
- E.
Open up the latest People magazine and keep up with the Kardashians.
- 14.Entering Height and Weight in to a Vigileo monitor using a CardioFlo sensor are important because:
- A.
They account for the effects of age
- B.
It supports Boulain's principle of the "taller the better"
- C.
Height and weight correlate with the length and width of the aorta
- D.
CardioFlo does not require the entry of height and weight
- 15.How is Stroke Volume Variation (SVV) calculated?
- A.
SVmin - SVmean / SVmax
- B.
SVmax-SVmin / SVmean
- C.
SVmax - SVmin / SVmax
- D.
SVmax—Svmin / 60 sec.
- 16.A 67 year old male is having a Total Hip Revision procedure. The patient has history of diabetes and a strong family history of coronary artery disease. The patient has received cardiology clearance. Anesthesia starts a radial arterial line with the FloTrac system and a 14/14ga double lumen central line. One hour into the procedure the patient experiences significant blood loss after removal of the old implant and suffers a splitting of the femur which now requires wires. Parameters show: H/RB/PSp02CVPSVSW98100/60 (75)9944518% After infusion of 2 units of packed red blood cells (PRC) and 750 cc of Normal Saline after which:H/RB/PSp02CVPSVSW10095/58 (70)9973518% Given what YOU know, the best answer is:
- A.
IV infusion maintenance drip (TKO) and continue monitoring
- B.
Continue to give volume (blood or crystalloid)
- C.
Start the patient on an inotrope
- D.
Give the patient Lasix (diuretic)
- E.
Grab a guitar and sing the blues
- 17.The administration of vasopressors will always result in an increase in SV
- A.
True
- B.
False
- 18.In the presence of arrhythmia the SVV will be inaccurate
- A.
True
- B.
False
- 19.In the presence of arrhythmia, the SV/CO will be accurate
- A.
True
- B.
False
- 20.Pulmonary Hypertension may result in elevated CVP readings
- A.
True
- B.
False
- 21.Underdamped arterial waveforms will underestimate SV/CO
- A.
True
- B.
False
- 22.Overdamped arterial waveforms will underestimate SV/CO
- A.
True
- B.
False
- 23.Pulmonary Hypertension will increase SV and decrease SVV
- A.
True
- B.
False
- 24.PGDT refers to:
- A.
Post-operative goal directed therapy
- B.
Premimum goal directed therapy
- C.
Peri-operative goal directed therapy
- D.
Peri-operative goal designated time
- 25.The best references (peer review journal articles) to utilize with OR customers for PGDT are
- A.
Benes, Ramsingh, Hamilton
- B.
Benes, Hamilton, McGee
- C.
McGee, Ramsingh, Benes
- D.
McGee, Manecke, Ramsingh
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