Acute Medicine Flashcards
<p>Define Sepsis, Severe Sepsis & Septic Shock</p>
<p><u><strong>SEPSIS</strong></u></p>
<ul> <li>SIRS + Documented Infection + ≥ 1 of: <ul> <li><em>Altered Mental Status</em></li> <li><em>Oliguria</em></li> <li><em>Hypoxemia</em></li> <li><em>increase Lactate</em></li> </ul> </li> </ul>
<p><u><strong>SEVERE SEPSIS</strong></u></p>
<ul> <li>Sepsis + Organ Failure + SBP < 90mmHg but responds to fluids</li> </ul>
<p><u><strong>SEPTIC SHOCK</strong></u></p>
<ul> <li>Severe Sepsis not responding to fluids</li> </ul>
<p>SIRS criteria</p>
<p><strong>Presence of ≥ 2 of:</strong></p>
<p>–T > 38 or < 36</p>
<p>–HR > 90</p>
<p>–RR >20 or PaCO2 <32</p>
<p>–WBC >12 or <4 or >10% immature band forms</p>
<p>5 common causes of hyperkalemia</p>
“<ul> <li>Pseudohyperkalemia</li> </ul> <p style=""><em>i.e. drawn above a potassium containing IV</em></p> <p style=""><em>Hemolysis on transport</em></p> <ul> <li>Renal Failure</li> <li>Drugs (Digoxin, NSAIDs, ACE-I, K-sparing, succinylcholine)</li> <li>Acidotic</li> <li>Cell Death (Rhabdo, Burn, Crush, Tumor Lysis, True Hemolysis)</li> </ul>”
<p>Hyperkalemia: 5 changes on EKG</p>
<ul> <li>Tall peaked T waves (~5.5 – 6.5)</li> <li>Loss of p waves (~6.5 – 7.5)</li> <li>Wide QRS – usually K > 8</li> <li>Loss of PR</li> <li>Sine wave</li> </ul>
<p>How will your replace sodium in a 70kg man with a Serum Na of 120mmol/L</p>
<p>1.Determine Patients Normal Weight</p>
<p>2.Determine Na deficit and replace ½:</p>
<ul> <li><em>(140 – serum Na)/2 to replace</em></li> <li><em>Total replacement = Deficit x TBW = deficit x(wt X0.6)</em></li> </ul>
<p>3.Determine the rate of replacement</p>
<ul> <li><strong>(total replacement/(mmol/L of </strong><strong>infusate</strong><strong>))/#hours</strong></li> </ul>
<p></p>
<p><strong>Ex: 70kg, serum Na = 120</strong></p>
<p>1.Deficit = 10mmol, Replacement = 10 (70X0.6) = 420mmol</p>
<p>2.If rate of replacement of 0.5mmol/hr = (10mmol/0.5mmol/hr) = 20 hours</p>
<p>3.Rate: (420/0.153)/20 = 137cc/hr</p>
<p>–0.9% NS has 153mmol/L = 0.153</p>
<div><b><u>Mechanical Ventilation</u></b></div>
“<div>· Pulmonary contusion: low TV</div> <div>· Asthma/COPD:low TV, low RR</div> <div>· ARDS: high PEEP, low TV, lowest tolerated FiO2</div> <div>· Neonates: pressure controlled ventilation</div> <div>· Acidosis: high RR</div> <div>· Head Injury: avoid hypercapnea</div> <div><span>· </span><b><u><span>Complications:</span></u></b></div> <div><span>· </span><span>Volutrauma</span></div> <div><span>· </span><span>Barotrauma</span></div> <div><span>· </span><span>Ventilator associated pneumonia</span></div> <div><span>· </span><span>Hemodynamicinstability(high RR/PEEP → ↓ Venous return → ↓ CO → hypotension)</span></div>”
<div>How should ventilator settings be adjusted to address air trapping (auto-PEEP) in intubated patients with COPD?</div>
<div>Maximize the expiratory time by adjusting the inspiratory:expiratory (I:E) ratio to 1:3 or 1:4. Tidal volume should be reduced and the inspiratory flow rate increased (> 100 L/min).</div>
Hypoxia in vented pt
“<img></img>”
Causes of non cardiogenic pulm edema
ARDS<br></br>HAPE<br></br>Opioid OD<br></br>PE<br></br>Eclampsia<br></br>TRALI
