Acute care Flashcards
Sepsis What is it and what is the treatment
When an infection causes a dysregulated immune response that leads to organ failure
Treatment is antibiotic therapy and treating the underlying cause
Sepsis shock what is it and the treatment
Sepsis with hypotension and decreased vascular tone
Treatment is fluids, norepinephrine, could add on vasopressin, dobutamine (inotrope, for patient with low cardiac output)
If patient is refractory use corticosteroids
Respiratory failure
Really common to see in the ICU and caused by obstructed airway, failure to protect airway, hypoventilation
Acute respiratory distress syndrome what is it and treatment
Life threatening respiratory failure characterized by inflammation of the lungs
Risk factors are sepsis, pneumonia, trauma, aspiration
usually requires mechanical ventilation with sedation (succ) and potentially an NMBA
FAST HUGS BID
Feeding
Analgesic
Sedation
Thromboprophylaxis
HOB elevation
stress ulcer prophylaxis
Glycemic control
Spontaneous awakening trial
Bowel regemin
Indwelling catheters
Delerium assessment
Analgesic Treatment and assessment
Analgesic is given to patient to help with their pain being experienced
in the hospital the most common analgesics are morphine and fentanyl
Can also use non-opioid treatment to decrease the opioid requirement (acetaminophen or gabapentin if neuropathic pain)
Assessment: always talk to the patient which is the gold standard. If communication with the patient is not feasible use BSP and CPOT
Sedation treatment and assessment
Used for agitation (anxiety +motor restlessness)
Tends to be caused by pain, MV, delirium, hypotension, withdrawal
Its important to start with nonpharm options: adequate sleep, eye and hearing accomidations, adequate analgesic control
If patient is still agitated we will give them Propofol or Dexmed last line use is benzos due to increased risk of delirium
Assess sedation with RASS and SAS
What are the RASS and SAS assessments used for
to discriminate between different levels of sedation
What are CPOT and BSP assessment used for
when we are unable to talk with the patient we will use these to assess how their analgesic is working
what is BIS monitoring indicated for
BIS is used for those on deep sedation or NMBA treatments
Thromboprophylaxis treatment and monitoring
Should be given to all patients who are in ICU and immobile, mechanically ventilated
Treat with LMWH or UFH - No renal dose adjustment for UFH but must dose adjust for enoxaparin
Monitor bleeding, thrombocytopenia
Stress ulcer prophylaxis
For all patients on mechanical ventilation, coagulopathy, chronic liver disease, and shock
Risk factors: shock, coagulopathy, chronic liver disease, NSAIDS, anticoagulants
Give patient H2 or PPI either or can be first line
Glycemic control
For diabetics and non-diabetic patients
Target glucose : 144-180
Start insulin is glucose is above 180 - use regular insulin and monitor blood glucose levels
Spontaneous awakening trial
Used to assess sedation of the patient
doing SAT routinely will make sure we are doing the least amount of sedation possible
Delirium
want to focus on doing nonpharm first
adequate sedation and analgesia, good sleep, mobility, communicating with the patient even when sedated, vision and hearing checks
2 types : hyperactive which means they are hallucinating and violent
or Hypoactive where they are confused and overly sedated
If they are hypoactive delirium then we want to back off on the sedation
if they are hyperactive delirium focus on nonpharm and and patient continues to have significant stress and hallucinations we can treat with haloperidol or atypical antisychotics
Always monitor QTC as these cause prolongation and assess ICDSC and CAM-iCU
what are ICDSC and CAM-ICU used for
these are used to assess the patients delirium
Succinylcholine use, AE, and mechanism
Binds to Ach receptor and causes depolarizationn thus blocking the ability of muscles to contract
Used for rapid sequence intubation (placement of tube)
AE: hyperkalemia, deep muscle pain, APNEA
Contraindicated in major burns, crush injury, and upper motor neuron disease (like ALS)
NMBAs use, AE, and mechanism, monitoring
competitively block the action of Ach (do not activate receptors) - these cause paralysis
Used for mechanical ventilation for those with acute respiratory distress syndrome, RSI, manage increased ICP, muscle relaxation in operative setting, decreased oxygen consumption, therapeutic hypothermia
AE: Paralysis of respiratory muscle, muscle weakness, do not provide analgesic, sedative, or anxiolytic effect ( MAKE SURE PATIENT HAS ADEQUATE DOSES OF EVERYTHING ELSE BEFORE GIVING THIS BECAUSE IF YOU DON’T THEY WILL LITERALLY NOT BE ABLE TO MOVE AND IN THE WORST PAIN OF THEIR DANG LIFE)
Efficacy point is based on clinical indication
Toxicity point - use peripheral nerve stimulation - on the wrist of the patient and count the amount of jerks the patient does responding to shock from the device - our goal is a 1/4 or 2/4 because we want to ensure we are giving enough paralysis but not too much to the point where it is over done
Definition of pain
unpleasant sensory and emotional experience associated with actual or potential tissue damage
Definition of agitation
condition characterized by apprehension, increased motor activity, and autonomic arousal may be manifested by fearful withdrawal
state of anxiety accompanied by motor restlessness
Definition of delirium
Syndrome characterized by acute cerebral dysfunction with a change or fluctuation in baseline mental status, inattention, and either disorganized thinking and altered level of consciousness
