Acute Care Medicine Flashcards
(33 cards)
Crystalloid Examples
Dextrose
Normal Saline
Lactated Ringers
Plasma-Lyte A
Colloids Example
Albumin (Albutein, AlbuRx)
Larger molecules that stay in the intravacular spaces
How fast should you correct sodium?
No more than 12 mEq/L/24 hours
*faster than this would cause osmotic demyelinolysis ===== paralysis and seizures
SIADH treatment
conivaptan or tolvaptan (arginine vasopression receptor antagonists)
Hypotonic hypovolemic hyponatremic treatment
Diuresis
***fluid overload, sodium is falsely low :(
Hypotonic hypovolemic hyponatremia
Correct cause (Diuretics, Vomiting/diarrhea, blood loss)
Hypertonic saline if Na < 120
What medications cause HYPOkalemia?
Insulin
Amphocerin B
What is the maxium rate of potassium through a peripheral line?
10 mEq/hr
With hypokalemia, what other labs do you want to check before treatment with potassium?
Magnesium!
A patient’s potassium dropped to 3.2. What amount of potassium replacement is recommended?
60 mEq PO or IV
3.3 -3.5 40 mEq PO or IV
3 - 3.2 60 mEq PO or IV
2.6 - 2.9 80 mEq IV
Octagam
IV immunoglobin (IgG)
**DO NOT SHAKE OR FREEZE
used for MS, myasthenia gravis, and Guillain-Barre syndrome
What should you treat extravasation of vasopressors with?
Phentolamine
What vasopressin’s MOA is dependent on the dose?
Dopamine
Low 1-4 mcg/kg = DA-1
5-10 mcg/kg = Beta-1
10-20 mcg/kg = alpha-1
What vasopressin is an agonist of beta-1, beta-2, and alpha 1?
Epinephrine (Adrenalin)
Counseling on Vasopressins
-ALL administered through central line!
-SE: arrhythmias, tachycardia, necrosis
-treat extravastion with phentolamine
What vassopressin causes hyperglycemia?
epinephrine
What vasodilator produces cyanide during its metabolism?
Nitroprusside (Nipride)
**requires light protections
**only use CLEAR solution, blue indicates cyanide production!
NE MOA
alpha-1 agonist > beta-1 agonist
1st line for hypovolemic shock
Crystalloids
**confirm it is not hemorrhagic!
What is a target MAP in septic shock?
MAP >/= 65
Treatment for septic shock
IV antibiotics
IV crystalloids (LR)
Vasopressin (if MAP < 65)
—-NE preferred
What would you used to treat a patient in acute decompensated HF with volume overload, altered mental status, and cool extremities?
Diuretics
Inotropes (Dobutamine, milrinone)
What sedation drugs are associated with improved ICU outcomes and LESS delirium?
Propofol
Dexmedetomidine (Precedex)
NOT benzodiazepines
Which sedative is approved for both intubated and non-intubated patients?
Dexmedetomidine (Precedex)
