CPGs Flashcards
Differences in peds
CNS: glucose >2.6 (neo), less susceptible to ICP (open sutures), more likely to have TBI with trauma, more likely to have SCIWORA due to flexible spine
CVS: SBP > 70 + (agex2), less able to increase stroke volume
Resp: need to pad for head, larger tongues, anterior larynx, floppy epiglottis, compliant chest wall, higher metabolism leads more quickly to hypoxia, smaller TV (6-8 ml/kg), reduced FRC, nose breathers
GI: liver is more exposed from rib cage
GU: less able to concentrate urine
Differences in bariatrics
CNS: more prone to HHS
CVS: increased CO (due to surface area), increased blood volume, decreased SVR?, more likely baseline HTN or underlying CAD
Resp: decreased FRC, increased RR, increased O2 consumption (faster for hypoxia), difficult airways
GI: potential for ACS
Differences in geriatrics
CNS: higher likelihood of subdural,
CVS: less cardiac reserve, higher baseline MAP, lower temp due to hypothyroid
Resp: decreased FRC
GU: decreased GFR (reduced Rx clearance)
Differences in maternity
CNS: consider eclampsia for seizures
CVS: increased blood volume, decreased SVR, increased HR (all lead to increased CO), cardiac murmurs, left axis deviation, increased plasma volumes (relatively low Hgb (110) and HCT), hypercoagulation (increased fibrinogen)
Resp: increased RR, respiratory alkalosis, increased PaO2 (105; goal > 70), decreased FRC, increase O2 consumption, landmark higher for needle thoracentesis
GI: higher risk of aspiration
GU: increase in GFR (CO)
Types of shock
Hypovolemic (fluid loss, blood loss)
Obstructive (failure to fill, outflow obstruction)
Cardiogenic (cardiomyopic, arrhythmia, mechanical)
Distributive (dx of exclusion)
Types of hypoxia
Hypoventilation (CO2 displaces O2) Decreased FiO2 Diffusion abnormalities VQ (ventilation without perfusion) Shunt (perfusion without ventilation) Venous admixture (decreased SaO2 requires significant diffusion to become saturated)
Burns (first 8 hrs)
- RL 3ml/kg/%TBSA, half over first 8 hrs
- MAP > 65
- HR < 130
- SpO2 > 92
- UO 30-50 ml/hr(unless electrical 50-100 ml/hr)
- consider hydroxycobalamine 5g IVP (70mg/kg)
Sepsis
- 30 ml/kg RL
- CVP 8-12 (- 1/2 PEEP) *PROCESS, ARISE, PROMISE state no mortality benefit to meeting target
- MAP > 65
- ScVO2 > 70*
- PaO2 > 80
- UO > 0.5 ml/kh/hr
- early antibiotics/cultures
- source control
STEMI
- ASA 160
- Tic 180 (preferred for PCI)
- clopidogrel 300 (TNK), 600 (PCI), 75 (>75 yrs)
- TNK if within 12 hrs onset
- nitrates
- heparin/enoxaparin
- statin
- BB
NSTEMI
- ASA 160
- tic 180 (unless bradycardic)
- clopidogrel 600
- heparin (if PCI in 48 hrs)/enoxaparin
- nitrates
- BB
- statin
DKA
- 10-20 ml/kg RL (over 1 hr)
- correct K if < 3.3
- add K if 3.3-5.3
- insulin bolus 0.1U/kg
- insulin infusion 0.1U/kg/hr
- add D10 when bg < 11.1
- D/C insulin when AG <12
TBI
- RASS -5 (propofol preferred)
- consider seizure prophylaxis (Dilantin 20 mg/kg)
- HTS 5 ml/kg for herniation
- MAP > 80, SBP <160-140 (labetalol 10, hydralazine 5)
- normothermia
- Hgb > 90; INR < 1.5
- PaO2 100-150; PaCO2 35-40
- Na 140-150
Indications for rescue PCI
- > 50% reduction in STE in 90 mins
- persistent pain
- hemodynamic instability
- arrhythmias
- cardiogenic shock/pulmonary edema
Types of shock
- hypovolemic
- obstructive
- cardiogenic
- distributive
Assessing fluid status
- JVP
- CVP 8-12 (-1/2 PEEP)
- passive leg raise (10 pt increase in MAP)
- pulse pressure variation (15% paralyzed with Vt > 8 ml/kg)
- ScVO2 < 70
- IVC collapsibility (50% in NSR with PPV)
- mucous membranes
- skin turgor
- Hct > 0.45
- Na > 145
- Hx
ARDS Berlin criteria
- illness within 7 days
- diffuse patchy infiltrates on CXR
- non-cardiogenic pulmonary edema
- P:F < 300 (PaO2 / 0.x)
Scores to know
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