acute and critical care medicine Flashcards
what fluids are crystalloids
D5W
NS
LR
plasmalyte
what fluids are colloids
albumin
dextran
pros of crystalloids
less costly
fewer AE
does not sit in intravascular space
when is albumin used
edema not for serum albumin
hyponatremia state
<135
symptomatic when <120
3 diff state
hypotonic hypovolemic
cause is diuretic and sodium wasting
tx is correct cause and add IV NS
hypotonic hypervolemic hyponatremia
caused by fluid overload, cirrhosis, HF etc
tx is diuresis with fluid restriction
hypotonic isovolemic hyponatremia
cause - SIADH syndrome of inappropriate antidiuretic hormone
what is ODS
when treating hyponatremia aggressively it causes paralysis
should not be more than >12meq opver 24 hours
tx with stopping SIADH drugs , diuresis ore restricting fluids
what are AVP
arginine vasopressin receptor antagonist
used for SIADH or hypervolemic hyponatremia
tolvaptan
samsca
llimited to 30 days due to hepatoxic
hypernatremia
Na> 145 meq
with water defecit and hypertonicity
hypovolemic hypernatremia
caused by dehydration
tx with fluids
hypervolemic hypernatremia
intake of hypertonic fluids
tx with diuresis
isovolemic hypernatremia
caused by diabetes can decrease antidiuretic hormone
tx with desmopressin
hypokalemia
K<3.5
manage underlying cause- metabolic alkalosis, diuresis, meds
tx with oral K
what dose 1 drop of K below 3.5 mean
body defecit of 100-400 meq
how to tx potassium
check phos first if more than 2.5 use oral supplements if less than 2.5 phos then add Kphos
serum potassium instruction tx
<3.5 to 3.3 40 meq
3.0-3.2 60meq
2.6-2.9 80 meq
<2.6meq 100meq
monitoring of K
if <3.2 recheck immediatley and am check
if more than 3.2 check am
IV K recommendations
peripheral line max infusion rate 10meq/hr
max 10meq/100ml
IV push and undiluted can be fatal
resistant K level through tx
check mg,
if both hypo tx mg first
magnesium
hypo< 1.3
hyper is during renal insufficiency
when is IV MG recommended
when MG <1 with symptoms
MGSO4
or without symptoms IV or IM
when is MG oral recommende
when MG is between 1-1.5
MGO for 5 days
phosphorus
hyper due to CKD
Hypo is severe and symptomatic when <1
hypo can be caused by phospahte binding drugs alcohol intake and hyperparathyroidism
when is IV phos recommended
<1
VTE prophylaxis
for inpatient
IVIG
warning for thrombosis
HA, N/V/D
for Myasthenia gravis, multiple sclerosis, GBS
ICU meds that target SNS
vasopressors
vasodilators
ionotropes
what are some vasopressors
dopamine
epinephrine
norep
vasopressin
** all should be through central line
MOA of dopamine
low dose- D1 agonist 1-4
medium dose- Beta 1 agonist
high dose- alpha 1 agonist 10-20mcg/kg/min
can cause vesicant, arrythmia, tachycardia, necrosis,
MOA of epinephrine
A1 B1 B2 agonist
arrythmia, tachy, hyperglycemia
MOA Norep
A1>B1
phenylephrine MOA
A1
vasopressin
AVP vasopressin receptor agonist
how to treat extravastion caused by Alpha agonists
phentolamine
what are vasodilators used in ICU
nitroglycerin
nitroprusside (nitropress)
ionotrpoes in icu
dobutamine B1
PDE3 inhibitor milrinone
types of shocks
Hypovolemic
distributive
cardiofenic
obstructive
how to tx hypovolemic shock
fluid resuscitation with crystalloids for hypo shock not with hemorrhage
vasopressors will not work without effective intravascular volume
distributive
when there is low SVR
septic anaphylactic and neurologic are ex of distributive
septic shock
SOFA >2
alterered mental status
SBP<100
RR>22
what are some contra indications of nitro
PDe5 inhibitors
HA Tachycardia
SBP <90
high dose nitro is for
arterial vasodilation
target MAP for treating shock
> 65
MAP= (2XDBP)+ SBP /3
most common causes of ICU infections
Mechanical ventilation- psudomonas
foley catheter
how to maintain MAP
vasoconstrictors and crystalloid fluids
cardiogeneic shock
HF with worsening symptoms
how to tx
avoid NSAIDS
avoid BB if Hypotension
cardiogenic shock with volume overload
IV diuretics
vasodilators
cardiogenic shock with hypoperfusion
inotropes
vasopressors
cardiogenic shock with volume overload and hypoperfusion
combination of
IV diuretics
vasodilators
inotropes
vasopressors
tx hypoperfusion if Bp is adequate
ionotrope with vasodilator
if not add vaso constrictors
what are some non benzo sedation
prpofol
dexmedetomidine (precedex) preferred
RASS scale
richmond agitation and sedation scale
stress ulcers
H2raas and PPIs
when is a risk for stress ulcer
mechanical ventilation >48 hours
coagulopathy
sepsis
TIA
major burns
AKI
high dose steroids
anesthtics
local- lidocaine
inhaled - desflurane
secoflurane
inj- bupivacaine
ropivacaine
neuromuscular blocking agents
causes paralysis
succinylcholine- depolarizing
cistra”curium” - non depolarizing
hat is a depolizing NMBA good for
short acting `
