ABIM Critical Care flashcards
ABIM Critical Care · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Berlin ARDS criteria
- Acute onset within 1 week, bilateral opacities on imaging, PaO2/FiO2 ≤300 with PEEP ≥5 cmH2O, and respiratory failure not fully explained by cardiac failure or fluid overload.
- Lung-protective ventilation
- Strategy using tidal volume 6 mL/kg predicted body weight and plateau pressure ≤30 cmH2O to reduce ventilator-induced lung injury and mortality in ARDS.
- Auto-PEEP
- Air trapping causing positive end-expiratory pressure due to incomplete exhalation; detected by flow not returning to zero; managed by reducing rate and increasing expiratory time.
- Rapid shallow breathing index
- Respiratory rate divided by tidal volume in liters; a value <105 predicts successful extubation, while higher values suggest weaning failure.
- Cardiogenic shock criteria
- Systolic blood pressure <90 mmHg or vasopressors needed, cardiac index <2.2 L/min/m2, PCWP >15 mmHg, and evidence of end-organ hypoperfusion.
- Septic shock definition
- Sepsis with vasopressor requirement to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite adequate fluid resuscitation.
- Pulse pressure variation
- Difference between systolic and diastolic pressure during a respiratory cycle; >13% in mechanically ventilated patients predicts fluid responsiveness.
- Glasgow Coma Scale
- Neurologic assessment scoring eye (1-4), verbal (1-5), and motor (1-6) responses; total ≤8 indicates severe coma and need for airway protection.
- Cerebral perfusion pressure
- Calculated as mean arterial pressure minus intracranial pressure; target 60-70 mmHg in traumatic brain injury to maintain cerebral blood flow.
- Status epilepticus management
- First-line benzodiazepines; if persistent, fosphenytoin, valproate, or levetiracetam; refractory requires continuous infusion of midazolam or propofol.
- KDIGO AKI criteria
- Increase in serum creatinine ≥0.3 mg/dL within 48 hours, or ≥1.5 times baseline within 7 days, or urine output <0.5 mL/kg/h for 6 hours.
- Fractional excretion of sodium
- Formula: (urine Na × plasma Cr) / (plasma Na × urine Cr) × 100; <1% suggests prerenal etiology, >2% suggests intrinsic renal disease.
- Hyperkalemia emergency treatment
- IV calcium for cardiac membrane stabilization, insulin with glucose and beta-agonists to shift potassium intracellularly, bicarbonate if acidemic, then dialysis or binders.
- Anion gap calculation
- Sodium minus (chloride plus bicarbonate); normal 8-12 mmol/L; elevated in lactic acidosis, ketoacidosis, renal failure, and toxin ingestion.
- Sepsis-3 definition
- Life-threatening organ dysfunction caused by dysregulated host response to infection; organ dysfunction defined as increase in SOFA score ≥2.
- Early sepsis resuscitation bundle
- Within 3 hours: measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.
- Ventilator-associated pneumonia
- Pneumonia occurring >48 hours after endotracheal intubation; common pathogens include Pseudomonas, MRSA, and gram-negative bacilli; treat with appropriate antibiotics.
- Diabetic ketoacidosis diagnosis
- Glucose >250 mg/dL, arterial pH <7.3, bicarbonate <18 mEq/L, anion gap >10, and ketonemia; treated with IV fluids, insulin infusion, and potassium replacement.
- Thyroid storm treatment
- Beta-blocker for heart rate control, thionamide to block hormone synthesis, iodine after thionamide to block release, and glucocorticoids for adrenal suppression.
- Adrenal crisis management
- IV hydrocortisone 100 mg followed by 50 mg every 6 hours; fluids and vasopressors for hypotension; treat precipitating cause.
- Spontaneous bacterial peritonitis
- Ascitic fluid polymorphonuclear cell count ≥250/mm3; treat with third-generation cephalosporin and albumin 1.5 g/kg on day 1 and 1 g/kg on day 3.
- Heparin-induced thrombocytopenia
- Immune-mediated platelet drop >50% or thrombosis after heparin exposure; stop heparin and start argatroban or bivalirudin.
- Massive transfusion protocol
- 1:1:1 ratio of packed red blood cells, plasma, and platelets; minimizes crystalloid use and addresses coagulopathy in hemorrhagic shock.
- Parkland burn formula
- 4 mL/kg/% total body surface area of lactated Ringer's in 24 hours; half given in first 8 hours, remainder over next 16 hours.
- Abdominal compartment syndrome
- Intra-abdominal pressure >20 mmHg with new organ dysfunction; treated with decompressive laparotomy and temporary abdominal closure.
- Acetaminophen toxicity treatment
- N-acetylcysteine within 8-10 hours of ingestion; use Rumack-Matthew nomogram to determine treatment threshold based on timed acetaminophen level.
- Toxic alcohol poisoning
- Methanol or ethylene glycol ingestion; treat with fomepizole or ethanol to block metabolism, and hemodialysis for severe acidosis or visual symptoms.
- Serotonin syndrome management
- Stop serotonergic agents, provide supportive care, benzodiazepines for agitation, and cyproheptadine for severe cases.
- Post-cardiac arrest care
- Targeted temperature management (32-36°C) for comatose survivors, maintain normoxia and normocapnia, and treat reversible causes.
- Central line insertion bundle
- Hand hygiene, maximal sterile barrier precautions, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity to prevent CLABSI.
- VAP prevention bundle
- Head of bed elevation 30-45°, daily sedation interruption, oral care with chlorhexidine, peptic ulcer prophylaxis, and avoiding unnecessary ventilator circuit changes.
- Surrogate decision-making
- Follow patient's advance directive or substituted judgment; if unknown, use best interests standard; document discussions and decisions.