Egyptian Board Critical Care flashcards

44 cards. Read the term and the definition here. The deck at the top of this page is optional.

ARDS Berlin definition

Acute onset within 1 week, bilateral opacities not fully explained by effusion or collapse, not primarily cardiogenic, and PaO2/FiO2 ≤ 300 on PEEP ≥ 5 cmH2O.

Driving pressure

Plateau pressure minus PEEP. Target ≤ 15 cmH2O in ARDS; elevated driving pressure reflects alveolar overdistension and is associated with higher mortality.

Rapid shallow breathing index

Respiratory rate divided by tidal volume in liters during spontaneous breathing. A value below 105 predicts successful extubation; higher values suggest weaning failure.

Auto-PEEP

Air trapping from incomplete exhalation, measured by end-expiratory hold. It raises intrathoracic pressure, impairs venous return, and can cause hypotension.

Septic shock definition

Sepsis with vasopressor requirement to maintain MAP ≥ 65 mmHg and lactate > 2 mmol/L despite adequate fluid resuscitation.

Passive leg raise test

Passive elevation of legs to 45° for 1–2 minutes. A rise in stroke volume or pulse pressure > 10% predicts fluid responsiveness without giving fluid.

Cardiac index formula

Cardiac output divided by body surface area. Normal 2.5–4.0 L/min/m2. Low index with high PCWP suggests cardiogenic shock.

Norepinephrine role

First-line vasopressor in septic shock. Alpha-1 and beta-1 effects raise MAP with modest cardiac stimulation; start early and titrate to MAP ≥ 65 mmHg.

SOFA score

Organ dysfunction score summing respiratory, coagulation, liver, cardiovascular, CNS, and renal components (0–4 each). A rise ≥ 2 defines sepsis.

Antibiotic time-out

Structured review at 48–72 hours to reassess indication, spectrum, dose, and duration. It supports de-escalation and reduces resistance and cost.

Procalcitonin use

Biomarker that rises in bacterial infection. A low or falling value can support stopping antibiotics, but it cannot rule out infection alone.

Source control

Drainage of abscess, debridement of necrotic tissue, or removal of infected devices. Delayed source control increases mortality in sepsis and septic shock.

Torsades de pointes

Polymorphic ventricular tachycardia with prolonged QT. Treat with IV magnesium, correct electrolytes, stop QT-prolonging drugs, and pace or use isoproterenol.

Beck triad

Hypotension, distended neck veins, and muffled heart sounds. Suggests cardiac tamponade; treat with pericardiocentesis and fluid bolus as a bridge.

Right ventricular infarction

Inferior MI with ST elevation in V4R. Avoid nitrates and preload reduction; give fluids and consider early revascularization.

CHA2DS2-VASc score

Stroke risk score in atrial fibrillation: congestive failure, hypertension, age ≥ 75 (2), diabetes, stroke (2), vascular disease, age 65–74, female sex.

Cerebral perfusion pressure

Mean arterial pressure minus intracranial pressure. Target 60–70 mmHg in traumatic brain injury; low CPP worsens ischemic injury.

Uncal herniation sign

Ipsilateral fixed dilated pupil from oculomotor nerve compression, with contralateral hemiparesis. Treat with hyperventilation, osmotic therapy, and neurosurgical consultation.

Status epilepticus

Continuous seizure ≥ 5 minutes or repeated seizures without recovery. Treat with benzodiazepine first, then second-line antiepileptic and anesthetic if refractory.

Nimodipine use

Calcium channel blocker given 60 mg every 4 hours for 21 days after subarachnoid hemorrhage to reduce delayed ischemic neurologic deficit from vasospasm.

Anion gap

Sodium minus chloride plus bicarbonate. Normal 8–12 mEq/L; correct upward by 2.5 for each 1 g/dL albumin below 4 g/dL.

Winter's formula

Expected PaCO2 = 1.5 × HCO3 + 8 ± 2. Used to detect a mixed acid-base disorder in metabolic acidosis.

Osmotic demyelination risk

Rapid correction of hyponatremia, typically > 8–10 mmol/L in 24 hours. Causes quadriparesis, dysarthria, and locked-in syndrome.

RRT indications

AEIOU: acidosis, electrolyte disturbance (potassium), intoxication, overload, uremia. Continuous therapy is preferred in hemodynamic instability.

DKA resolution criteria

Glucose < 200 mg/dL with two of: bicarbonate ≥ 15, venous pH > 7.3, anion gap ≤ 12. Ketones should be trending down.

Thyroid storm treatment order

Beta-blocker first, then thionamide, then iodine at least 1 hour later, plus glucocorticoid and supportive care. Iodine before thionamide worsens hormone release.

Adrenal crisis treatment

Hydrocortisone 100 mg IV immediately, then 50 mg every 6 hours. Give fluids and treat precipitating cause; do not wait for cortisol results.

Parkland formula

4 mL/kg per percent total body surface area of lactated Ringer's in first 24 hours from burn time; half in first 8 hours. Titrate to urine output.

Abdominal compartment syndrome

Intra-abdominal pressure > 20 mmHg with new organ dysfunction. Treat with decompression, drainage, and optimization of abdominal wall compliance.

Massive transfusion ratio

Balanced 1:1:1 plasma:platelets:packed red cells approximates whole blood and reduces coagulopathy in hemorrhagic shock.

Toxidrome recognition

Pattern of signs suggesting a drug class: anticholinergic, cholinergic, opioid, sympathomimetic, sedative-hypnotic, or serotonin syndrome. Guides empiric treatment.

N-acetylcysteine for acetaminophen

Antidote for acetaminophen overdose. Dosing based on Rumack-Matthew nomogram at 4 hours; give if hepatotoxicity or timing unknown.

Hyperbaric oxygen indications

Carbon monoxide poisoning with syncope, neurologic deficit, COHb > 25%, or pregnancy with COHb > 15%. Also used for decompression sickness and gas gangrene.

RSI medications

Pretreat if indicated, induce with ketamine, etomidate, or propofol, and paralyze with rocuronium 1.2 mg/kg or succinylcholine 1.5 mg/kg.

Defibrillation energy

Biphasic 120–200 J per manufacturer, monophasic 360 J. Resume CPR immediately for 2 minutes after shock.

Cricothyrotomy indication

Cannot intubate and cannot ventilate after failed attempts and rescue device. Perform surgical cricothyrotomy as the final airway rescue.

Capacity assessment

Patient can communicate a choice, understand information, appreciate consequences, and reason about options. If yes, consent or refusal is valid.

Brain death criteria

Established cause, unresponsive coma, absent brainstem reflexes, positive apnea test, and exclusion of sedation, hypothermia, and metabolic confounders.

Withholding versus withdrawing

Ethically equivalent; both allow proportionate care aligned with patient values. Withdrawal is not euthanasia when the goal is comfort.

ICU triage principle

Prioritize patients by short-term survival benefit and severity scores, not age or social worth. Use transparent, consistent criteria during scarcity.

CAM-ICU

Bedside delirium screen assessing acute onset, inattention, altered consciousness, and disorganized thinking. Positive screen prompts non-pharmacologic bundle.

RASS scale

Richmond Agitation-Sedation Scale from −5 (unarousable) to +4 (combative). Target −2 to 0 for light sedation in most ICU patients.

VAP prevention bundle

Head of bed 30–45°, oral care, daily sedation interruption, spontaneous breathing trials, and avoiding unnecessary circuit changes reduce ventilator-associated pneumonia.

Refeeding syndrome

Metabolic shift after restarting nutrition in malnourished patients: hypophosphatemia, hypokalemia, hypomagnesemia. Start low calories and replace thiamine first.