Crit Care Flashcards
How does dobutamine work?
B1 agonist
Increases HR and force of contraction
Which increases cardiac output
Administration note for IVIG?
Use slower infusions rate for renal and CV disease
Dopamine dosing? 3 bullets
- Dopamine stimulates different receptors depending on dose
- Low renal dosing: 1-4 mcg/kg/min: Dope 1 agonist
- Medium: 5-10 mcg/kg/min Beta 1 agonist
- High: 10-20 mch/kg/min: Alpha 1 agonist
How does the CNS control functions of the body? 2 main systems
- Through the peripheral nervous system
- SOmatic nervous system
- autonomic nervous system
Cyklokapron?
Tranexamic acid
Hemostatic
Nitroprusside: Thiocyanate/cyanide roxicity risk is increased when what?
PAtients have renal or hepatic impairment
One alpha 1 agonist?
Phenylephrine
What is first line for hypovolemic shock?
IV crystalloids
In pts with hypovolemic chock that is not caused by hemorrhage
Common causes of Hypokalemia?
Underlying causes usually, meds, amphotericin and insulin
What is the vasopressor of choice in septic shock?
NE
How is hypovolemic hyponatremia treated?
Sodium chloride containing products IV
When is albumin particularly useful?
WHen there is significant edema (cirrhosis)
How does precedex work?
A2 adrenergic agonist
What 3 things do vasopresssors cause
- Vasoconstriction
- Increased SVR
- which increases BP
Pancuronium?
Long acting agent
Nitroglycerin or NTG uses?
During MI or uncontrolled hypertension but efficacy is limited to 24-48 hours due to tachyphylaxis (tolerance)
Haldol
Haloperidol
What can be used to treat SIADH and hypervolemic hyponatremia?
arginine vasopressin receptor antagonists (AVP)
The somatic nervous system controls muscle moves by?
- By sending signals through neurons to release
- Acetylcholine Ach to act on nicotinic receptors
Injectable anesthetics? 2
Bupivacaine, ropivicaine
Albuminar, Albutein, Alburx
Albumin 5% and 25%
Benzos role in sedation two times?
Seizure patients
and
Alcohol withdrawal patients
Warning for Samsca?
Hepatotoxicity
Precedex?
Dexmedetomidine
Special note for dobutmaine?
Way turn pink due to oxidation but potency is not lost
Epinephrine concentration used for IV push
0.1 mg/ml 1:10,000 ration strength
When should vasopressor solutions not be used?
If they are discolored or contain a precipitate
Common ICU conditions
Pain?
IV pioids
morphine and fentanyl first line
How does phentolamine work?
Alpha 1 antagonist
What is the safe way to correct sodium?
12 meq/L over 24 hours
More rapidly can cause osmotic demethylation syndrome (ODS)
or central pontine myelonolysis
can cause paralysis, seizure and death
SEs of Samsca? 4
Thirst, nausea, dry mouth, polyuria
SEs of Diprivan
Hypotension, apnea, hypertg, green urine/hair/nail beds, propofol related infusion syndrome (PRIS) can be fatal
Increasd time with foley catheter does one?
Increase chance of bladder infection
General principles for treating shock 3
1. Fill the tank
1. Optimize preload with IV crystalloids bolus as needed 2. Squeeze the pipes 1. Peripheral vasocontrictors (a1agonists) to increase systemic vascular resistance 3. Kick the pump 1. B1 agonist to increase myocardial contractility and cardiac output
How is agitation managed in the ICU?
WIth BZDs: lorazepam or midazolam
What 3 things have PPIs been associated with?
Bone fracture, C Diff, Nosocomial Pneumonia
treatment for sepsis and septic shock?
Broad spectrum abx and IV fluid resucitation with IV crystalloids
Nitropress, Nipride MOA?
Equal venous and arterial vasodilation
When is dextrose used pertaining to fluids
when water is needed intracellularly
These products contain free water
What do inotropes do?
Increase contractility of the heart
How long should a pt be treated with Samsca?
Talvaptan AVP
limited to less than <=30 days due to hepatotoxicity
What type of sedation is preferred?
Light sedation
When is hypophosphetemia life threatening?
<1mg/dL
What do Epi and NE do? Leads to what 3 things?
Stimulate multiple receptors including alpha 1 and beta 1, b2
WHich leads to increased vaso constriction HR and BP
What has to be present to characterize acute decompensated heart failure to cardiogenic shock?
Hypoperfusion and hypotension
How is hypervolemic hyponatremia treated?
Duiretics and fluid
Monitoring for Etomidate?
Adrenal insufficiency
Xylocaine?
Lidocaine
How are vasopressors given?
Through IV central line
Versed?
Midazolam
How is vesication with vasopressors treated?
Phentoloamine
Acute decompensated HF and cardiogenic shock
What is it?
Acute decompensated heart failure
rapid decline in health, wt gain, worseing of symptoms
Colloids 3
Albumin
Dextran
Hydoxyethyl startch
Boxed warnings for Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
2
- Acute renal dysfunction, usually within 7 days, more likley with products stabalized by sucrose
- THrombosis
Warning for Nitroprusside?
Increase Inctracranial pressure
SEs of Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
10
- HA
- Nausea
- diarrhea
- injection site rxn
- infusion rxn, facial flushing, chest pain, tightness, fever, chills, hypotension- slow/stop infusion
Increased time on ventilator increases risk of infection what is a common pathogen?
Pseudomonas they like moist air
If nitroprusside is hat color?
Blue indicated cyanide formation dont use
Treating with IVIG can do what?
impair response to vaccines
How is isovolemic hyponatremia caused?
COmmonly caused by Syndrome of Inappropriate antidiuretic hormone
SIADH
How is hypoperfusion characterized? 3 things
- Decreased renal function
- ALtered mental status
- or cold extremities
What is succinylcholine typically reserved for?
Intubation
What special care needs to be taken with NMBA?? 3
- Ensure eye lubrication
- Airway suction
- Protect the skin
Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
IVIG
What should pts be treated with if they have both volume overload and hypoperfusion
Both sets of agents
Loops, but avoid vasodilators
Risk factors to develop Stress ulcers? 2
Mechanical ventilation and coagulopathy
3 SEs of Nitroprusside?
- HA
- Tachycardia
- Thiocyanate/cyanide toxicity (Increase risk in renal and hepatic impairment
What is needed for potassium?
Mg must be corrected
When should BBs be stopped in patients with ADHF?
If hypotension or hypoperfusion is present
Example of beta 1 agonist?
Dobutamine