Acute & Critical Care Medicine Flashcards
Define crystalloid
contains various concentrations of sodium and/or dextrose that pass freely between semipermeable membranes. most of the volume does not remain in the intravascular space (inside the blood vessels), but moves into the extravascular space or interstitial space
- less costly
- fewer adverse reactions
Define colloids
large molecules (typically protein or starch) dispersed in solutions that primarily remain in the intravascular space and increase oncotic pressure
- more expensive
- have not shown clear clinical benefit over crystalloids
What product is used when water is needed intracellularly
dextrose b/c it contains “free water”
What products are used for volume resuscitation in shock states
LR
normal saline
What products are used in patients with significant edema (e.g. cirrhosis)
albumin
list crystalloids
D5W
NS
LR
multiple electrolyte injection (plasma-Lyte a)
List colloids
albumin
define hyponatremia
Na < 135
hypotonic hypovolemia hyponatremia treatment
NaCl
hypotonic hypervolemic hyponatermia treatment
diuresis with fluid restriction
max rate of Na repletion
12 mEq/L over 24 hours
above this is associated with ODS (osmotic demyelination syndrome)
Define hypernatremia
Na > 145
associated with water deficit and hypertonicity
a drop of potassium of 1 mEq/L below 3.5 represents what
total body deficit of 100-400 mEq
how to administer potassium
- route
- rate
- max concentration
peripheral line
max rate < 10 mEq/L
max concentration of 10 mEq/100mL
Define hypophosphatemia
serum phosphate < 1 mg/dL
What does an APACHE 2 score tell you
determine patient prognosis and estimate ICU mortality risk
Vasopressor MOA
stimulate alpha receptors which cause vasoconstriction and increases systemic vascular resistance (SVR) which increases BP
epinephrine MOA
alpha-1, beta-1, beta-2 agonists
norepinephrine MOA
alpha-1 agonist > beta-1 agonist
phenylephrine MOA
alpha-1 agonist
vasopressin MOA
vasopressin receptor agonist
list vasopressors
dopamine epinephrine norepinephrine phenylephrine vasopressin
dopamine MOA
low dose 1-4 mcg/kg/min -dopamine-1 agonist medium dose 5-10 mcg/kg/min -beta-1 agonist high dose 10-20 mcg/kg/min -alpha-1 agonist
Define vesicants
cause tissue damage/necrosis with extravasation (leakage of drug from blood vessel into surrounding tissue)
how to administer vasopressors
via central line to avoid extravasation
how to treat vasopressor extravasation
phentolamine
phentolamine MOA
alpha-1 blocker that antagnoizes the effects of the vasopressor
list vasodilators
nitroglycerin
nitroprusside
nesiritide
nitroglycerin IV MOA
in low dose: venous vasodilator
in high dose: arterial vasodilator
nitroprusside MOA
mixed (equal) arterial and venous vasodilator
Boxed warning for nitroprusside
metabolism produces cyanide
inotropes MOA
increase contractility of the heart
list inotropes
dobutamine
milrinone
Dobutamine MOA
beta-1 agonist
increases HR and force of contraction, which increases CO
weak beta-2 (vasodilation) and alpha-1 agonist activity
Milrinone MOA
phosphodiesterase-3 inhibitor in cardiac and vascular tissue to produce inotropic effect with significant vasodilation
Define shock
hypoperfusion usually in the setting of hypotension defines as SBP <90 or MAP < 70
hypovolemic shock treatment
fluid resusciation: crystalloid
hemorrhage: PRBC, FFP
General principles for treating shock
fill the tank
-optimize preload with IV crystalloids bolus PRN
squeeze the pipes
-peripheral vasoconstrictor (alpha-1 agonist) to inc. SVR
kick the pump
-beta-1 agonist to inc. myocardial contractility and CO
Define distributive shock
low SVR
initially high CO followed by low or normal CO
what is the vasopressor of choice in septic shock
norepinephrine
Define acute decompensated heart failure
worsening symptoms of heart failure such as sudden weight gain, inability to lie flat without sob, decreasing functionality
Define cardiogenic shock
ADHF + hypotension + hypoperfusion
how to treat ADHF
volume overload -diuretics, IV vasodilators hypoperfusion (dec. renal function, ams, cool extremity) -inotropes (dobutamine, milrinone) -hypotensive: vasopressors
first-line opioids for analgesia in ICU
morphine
hydromorphone
fentanyl
how is agitation managed in ICU
benzodiazepines
hypnotics ( propofol, dexmedetomidine)
preferred sedation agent
non-benzodiazepines
- propofol
- dexmedetomidine
Brand name for dexmedetomidine
precedex
what is the only sedative approved for use in intubated and non-intuated patients
dexmedetomidine
SE of dexmedetomidine
hypo/hypertension
bradycardia
SE of propofol
hypotension
hypertriglyceridemia
propofol-related infusion syndrome (PRIS)
propofol brand name
diprivan
how many kcal does propofol provide
1.1 kcal/mL
what are the depolarizing NMBA
succinylcholine
what drug can be used in someone that is intubated to reduce secretions
glycopyrrolate
what are the non-depolarizing NMBAs
atracurium
cistracurium
rocuronium
vecuronium
