Crashing Patients Flashcards
what’s a good needle size for IV access, esp for an actively bleeding patient?
18 gauge (green)
definition of sepsis
infection + (Greater than 2 SOFA)
sepsis related organn failure: hypotension, low Pao2 fio2)
goal MAP
above 65 for most normal adults
how much fulids to give for resuscitaiton from sepsis induced hypoperfusion?
30 ml/kg (roughly 2 L within first 3 hours)
good way to measure perfusion in sepsis/infection
UOP!
nml lactate
<2
good pressor to use on the floor when things are getting bad?
DOPAMINE (good since it can be given via peripheral line until patient can be transferred to ICU)
norepi can also be given through central line
FLUIDS ARE THE KEY TO ALL TYPES OF SHOCK except….
cardiovascular shock due to LV pump failure
Additional special ICU things to present for patients
highlights of last 24 hours Is and Os ventilator settings neuro exam usually harder to do(level of sedation, pupils, gag, motor function) drain output, types of lines
systems based A/P
Most important labs for ICU patient
CBC
chem
ABG with lactate
Goals of mechanical ventilation (5)
maintain airway oxygenation ventilation acid base (high CO2/renal failure, may need to blow off as an example) decrease energy consumption
What does positive pressure ventilation help with?
adding POSITIVE PRESSURE via endotracheal tube at the lips to create a POSITIVE PRESSURE so air flows from lip/endotracheal tube into lungs
air flows from POSITIVE -> NEGATIVE pressure
How is PPV different from NIPPV aka bipap
NIPPV doesn’t require an endotracheal tube
used when there is no absolute cardiac/respiratory shock as an alternative to intubation
Main utility for CPAP
provides PEEP (increases positive pressure) to allow cycles of inspiration and expiration to continue while IMPROVING HYPOXIA
expiratory and inspiratory remain the same
CPAP vs BIPAP
CPAP - expiratory and inspiratory have less of a difference; good for HYPOXIC FAILURE
BIPAP - huge difference between inspiration (IPAP) and expiration pressure (EPAP); therefore this increases TIDAL VOLUME; big tidal volumes are good for blowing off CO2; good for HYPERCAPNIC FAILURE
