EDIC Part I flashcards

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

KDIGO AKI stage 3

Creatinine ≥3.0 times baseline, or ≥4.0 mg/dL, or initiation of renal replacement therapy, or urine output below 0.3 mL/kg/h for 24 hours, or anuria for 12 hours.

Fractional excretion of urea

Calculated as (urine urea × plasma creatinine)/(plasma urea × urine creatinine) × 100. Values below 35% suggest a prerenal cause, especially in patients taking loop diuretics.

Hepatorenal syndrome treatment

Terlipressin plus albumin is the standard pharmacological approach in cirrhosis with ascites. It reverses splanchnic vasodilation and improves renal perfusion; liver transplantation is definitive.

ARDS Berlin oxygenation categories

With PEEP of at least 5 cmH2O, PaO2/FiO2 of 201 to 300 is mild, 101 to 200 is moderate, and 100 or less is severe. Onset must be within one week.

ROX index

Ratio of SpO2/FiO2 to respiratory rate, used to predict high-flow nasal oxygen failure. Values below about 3.85 at 2, 6 and 12 hours suggest escalating respiratory support.

Prone positioning ARDS

Sessions of at least 16 hours per day improve survival in moderate to severe ARDS with PaO2/FiO2 under 150. Complications include pressure injury, tube dislodgement and transient desaturation.

Malignant hyperthermia antidote

Dantrolene 2.5 mg/kg intravenously, repeated until symptoms abate, with cessation of triggering volatile agents and succinylcholine, active cooling, and treatment of hyperkalaemia and acidosis.

Local anaesthetic systemic toxicity

Intravenous 20% lipid emulsion at 1.5 mL/kg bolus followed by infusion, airway support and seizure control. Avoid vasopressin, calcium channel blockers and beta-blockers.

Revised Cardiac Risk Index

Six predictors: ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery. Each adds one point.

Cardiac tamponade triad

Beck triad of hypotension, distended neck veins and muffled heart sounds, often with pulsus paradoxus and electrical alternans. Pericardiocentesis is the definitive treatment.

Dynamic fluid responsiveness indices

Pulse pressure variation and stroke volume variation predict fluid responsiveness in mechanically ventilated patients with sinus rhythm, but are unreliable in spontaneous breathing, arrhythmia or low tidal volumes.

Number needed to treat

Reciprocal of the absolute risk reduction. An NNT of 20 means 20 patients must be treated for one additional patient to benefit over the study period.

Likelihood ratio positive

Sensitivity divided by one minus specificity. It indicates how much a positive test raises the probability of disease; values above 10 are strongly informative.

Intention-to-treat analysis

Analysing participants in the group to which they were randomised, regardless of adherence. It preserves prognostic balance and avoids attrition bias, at the cost of underestimating efficacy.

Decision-making capacity

The ability to understand relevant information, appreciate its consequences, reason about options and communicate a choice. It is assessed for each specific decision.

Substituted judgement standard

Decision made by a surrogate based on what the patient would have chosen, using prior statements, values and advance directives. Best interests applies when wishes are unknown.

Refeeding syndrome

Potentially fatal shift of phosphate, potassium and magnesium into cells after reintroduction of nutrition in malnourished patients. Start feeding low, give thiamine and monitor electrolytes.

ICU-acquired weakness

Clinically detected weakness in critically ill patients, with Medical Research Council sum score below 48 of 60. It prolongs ventilation and is associated with higher mortality.

Post-intensive care syndrome

New or worsening physical, cognitive or psychological impairment persisting after critical illness and hospital discharge. Screening and multidisciplinary follow-up improve recognition.

Adrenal crisis treatment

Immediate hydrocortisone 100 mg intravenously followed by 50 mg every six hours, with isotonic fluid resuscitation. Do not delay treatment for confirmatory cortisol results.

Diabetic ketoacidosis potassium rule

Total body potassium is depleted. Replace potassium when serum level is below 5.5 mmol/L, and hold insulin if potassium is below 3.3 mmol/L to avoid arrhythmia.

Quality-adjusted life year

A health outcome measure combining survival duration with utility weights from 0 (death) to 1 (perfect health). Used in cost-utility analysis and resource allocation decisions.

Incremental cost-effectiveness ratio

Difference in cost between intervention and control divided by difference in effect, often expressed per quality-adjusted life year. Compared against a willingness-to-pay threshold.

qSOFA criteria

Respiratory rate 22/min or more, altered mentation, and systolic blood pressure 100 mmHg or less. Two or more criteria identify patients with suspected infection at higher mortality risk.

Ventilator-associated pneumonia

Pneumonia developing after at least 48 hours of mechanical ventilation, with new infiltrate, fever, purulent secretions and leukocytosis. Treat with culture-directed antibiotics.

Cerebral perfusion pressure

Mean arterial pressure minus intracranial pressure. Targets of 60 to 70 mmHg are used in traumatic brain injury to maintain cerebral blood flow.

Monro-Kellie doctrine

The skull is a fixed container holding brain, blood and cerebrospinal fluid. An increase in one component raises intracranial pressure unless another volume decreases.

Propofol infusion syndrome

Rare complication of prolonged high-dose propofol infusion, causing metabolic acidosis, rhabdomyolysis, hyperkalaemia, arrhythmia and cardiac failure. Discontinue the drug immediately.

Heparin-induced thrombocytopenia

Immune-mediated platelet fall, usually more than 50%, with paradoxically increased thrombosis risk. Stop heparin and start a non-heparin anticoagulant such as argatroban.

Septic shock haemodynamics

Vasopressor requirement to maintain mean arterial pressure of at least 65 mmHg, with lactate above 2 mmol/L despite adequate fluid resuscitation. Noradrenaline is first-line.

Glasgow Coma Scale components

Eye opening 1 to 4, verbal response 1 to 5, motor response 1 to 6, total 3 to 15. Scores of 8 or less generally prompt airway protection.

Status epilepticus first line

Benzodiazepines such as lorazepam or midazolam are given first. Second-line agents include levetiracetam, valproate or phenytoin, with anaesthetic doses and EEG monitoring if refractory.