Surgical ICU UPDATED ACTUAL Exam
Questions and CORRECT Answers
name some causes of isotonic fluid loss - CORRECT ANSWER - hemorrhage
GI losses [suctioning, NVD]
burns, ileus, bowel obstruction [third spacing]
excessive diuretics
all of these can result in hypovolemic shock
T/F: 2 types of intraoperative monitoring measures for fluid volume are static and dynamic
measures - CORRECT ANSWER - true
3 methods of static measurements of fluid volume - CORRECT ANSWER - -BP and HR
-Central venous pressure
-Urine output
3 methods of dynamic measurements of fluid volume - CORRECT ANSWER --
respiratory variations of arterial pressure waveform
-stroke volume estimates
-lab values
CO is the volume of blood pumped by the heart per minute [liters/minute]. What is the normal
range - CORRECT ANSWER - 4-8 L/min
measurement method for CO - CORRECT ANSWER - pulmonary artery catheter [swan-
ganz catheter]
postop goal for CO - CORRECT ANSWER - maintain within 20% of baseline
,cardiac index - CORRECT ANSWER - CO / BSA aka cardiac output adjusted for body
surface area
cardiac index is an indicator for what - CORRECT ANSWER - fluid responsiveness
normal cardiac index range [liters/min/m^2] - CORRECT ANSWER - 2.5-4.0 L/min/m^2
average pressure during cardiac cycle - CORRECT ANSWER - mean arterial pressure
normal range MAP - CORRECT ANSWER - 70-100 mmHg
post-op target for MAP - CORRECT ANSWER - >65 mmHg [except should be higher for
cerebral/cardiac surgery]
how is mean arterial pressure measured - CORRECT ANSWER - arterial line ==>
continuous waveform analysis
central venous pressure measures the pressure WHERE - CORRECT ANSWER - in the
right atrium
therefore, what does central venous pressure indicate - CORRECT ANSWER - preload
normal central venous pressure - CORRECT ANSWER - 2-6 mmHg
3 access points for central venous pressure - CORRECT ANSWER - internal jugular
subclavian
femoral
, hypovolemic shock - CORRECT ANSWER - inadequate circulating volume most often
caused by bleeding
name 3 reliable, early indicators of hypovolemic shock - CORRECT ANSWER - 1.
capillary refill > 4 seconds
2. oliguria [low urine output]
3. thirst
which 3 indicators of hypovolemic shock indicates a more severe case - CORRECT
ANSWER - thirst ==> means that pt has lost 20-30% of blood volume
is heart rate [tachycardia] correlated to hypovolemia - CORRECT ANSWER - no
Name 3 initial steps in resuscitating a patient with hypovolemic shock - CORRECT
ANSWER - 1. adequate airway [intubate, ventilate]
2. direct pressure for external bleeding
3. warmed crystalloids
if the pt is still bleeding and the blood loss estimate reaches 1.5 L [30% of blood volume], what
should you do - CORRECT ANSWER - switch warmed crystalloids to PRBC &
resuscitate to brachial systolic pressure of 80 mmHg or radial pulse
why do you only resuscitate to 80 mmHg - CORRECT ANSWER - "permissive
hypotension" allows you to perfuse just enough without causing additional bleeding
cardiogenic shock - CORRECT ANSWER - Normal circulating blood volume but reduced
cardiac output due to low cardiac contractility
Questions and CORRECT Answers
name some causes of isotonic fluid loss - CORRECT ANSWER - hemorrhage
GI losses [suctioning, NVD]
burns, ileus, bowel obstruction [third spacing]
excessive diuretics
all of these can result in hypovolemic shock
T/F: 2 types of intraoperative monitoring measures for fluid volume are static and dynamic
measures - CORRECT ANSWER - true
3 methods of static measurements of fluid volume - CORRECT ANSWER - -BP and HR
-Central venous pressure
-Urine output
3 methods of dynamic measurements of fluid volume - CORRECT ANSWER --
respiratory variations of arterial pressure waveform
-stroke volume estimates
-lab values
CO is the volume of blood pumped by the heart per minute [liters/minute]. What is the normal
range - CORRECT ANSWER - 4-8 L/min
measurement method for CO - CORRECT ANSWER - pulmonary artery catheter [swan-
ganz catheter]
postop goal for CO - CORRECT ANSWER - maintain within 20% of baseline
,cardiac index - CORRECT ANSWER - CO / BSA aka cardiac output adjusted for body
surface area
cardiac index is an indicator for what - CORRECT ANSWER - fluid responsiveness
normal cardiac index range [liters/min/m^2] - CORRECT ANSWER - 2.5-4.0 L/min/m^2
average pressure during cardiac cycle - CORRECT ANSWER - mean arterial pressure
normal range MAP - CORRECT ANSWER - 70-100 mmHg
post-op target for MAP - CORRECT ANSWER - >65 mmHg [except should be higher for
cerebral/cardiac surgery]
how is mean arterial pressure measured - CORRECT ANSWER - arterial line ==>
continuous waveform analysis
central venous pressure measures the pressure WHERE - CORRECT ANSWER - in the
right atrium
therefore, what does central venous pressure indicate - CORRECT ANSWER - preload
normal central venous pressure - CORRECT ANSWER - 2-6 mmHg
3 access points for central venous pressure - CORRECT ANSWER - internal jugular
subclavian
femoral
, hypovolemic shock - CORRECT ANSWER - inadequate circulating volume most often
caused by bleeding
name 3 reliable, early indicators of hypovolemic shock - CORRECT ANSWER - 1.
capillary refill > 4 seconds
2. oliguria [low urine output]
3. thirst
which 3 indicators of hypovolemic shock indicates a more severe case - CORRECT
ANSWER - thirst ==> means that pt has lost 20-30% of blood volume
is heart rate [tachycardia] correlated to hypovolemia - CORRECT ANSWER - no
Name 3 initial steps in resuscitating a patient with hypovolemic shock - CORRECT
ANSWER - 1. adequate airway [intubate, ventilate]
2. direct pressure for external bleeding
3. warmed crystalloids
if the pt is still bleeding and the blood loss estimate reaches 1.5 L [30% of blood volume], what
should you do - CORRECT ANSWER - switch warmed crystalloids to PRBC &
resuscitate to brachial systolic pressure of 80 mmHg or radial pulse
why do you only resuscitate to 80 mmHg - CORRECT ANSWER - "permissive
hypotension" allows you to perfuse just enough without causing additional bleeding
cardiogenic shock - CORRECT ANSWER - Normal circulating blood volume but reduced
cardiac output due to low cardiac contractility
