Critical Care Flashcards
What is sepsis?
SIRS and known source of infection.
What are the SIRS criteria?
Meet 2 of:
1) T > 38 or < 36
2) P > 90
3) RR > 20
4) PaCO2 < 32 mmHg
5) WBC > 12,000 or < 4,000
6) > 10% bands
What is severe sepsis?
Sepsis with end-organ dysfunction (e.g. ARF, altered mental status, ARDS) with hypotension that responds to fluids.
What is septic shock?
Sepsis with hypotension that is refractory to fluid resuscitation.
What is the hemodynamics profile of hypovolemic shock?
Decreased PCWP
Decreased CO
Increased SVR
What is the hemodynamics profile of cardiogenic shock?
Increased PCWP
Decreased CO
Increased SVR
What is the hemodynamics profile of distributive shock?
Decreased or normal PCWP
Increased CO
Decreased SVR
What are the risks of a Swan-Ganz catheter?
Infection Arrhythmias (2/2 irritation of endocardium)
Action of dobutamine?
Strong stimulation of B1.
Mild stimulation of B2.
Used in cardiogenic shock.
Action of isoproterenol?
Strong stimulation of B1.
Mild stimulation of B2.
Used in cardiogenic shock w/ bradycardia.
Action of milrinone?
PDE inhibitor –> increased AMP –> ionotropic effects on heart, vasodilation.
Used in HF and cardiogenic shock.
Action of low-dose dopamine (1-3 ug/kg/min)?
Stimulation of dopamine (dilates renal vasculature).
Mild B1 stimulation.
Used in renal insufficiency.
Action of med-dose dopamine (5-10 ug/kg/min)?
Stimulation of dopamine.
Moderate stimulation of B1.
Mild stimulation of A1 (vasoconstriction).
Used in cardiogenic shock.
Action of high-dose dopamine (10-20 ug/kg/min)?
Strong stimulation of dopamine, B1, A1.
Used in cardiogenic or septic shock.
Action of norepinephrine?
Strong stimulation of A1.
Moderate stimulation of B1.
Used in septic shock.
Action of epinephrine?
Strong stimulation of B1, A1.
Moderate stimulation of B2.
Used in anaphylaxis, septic shock, cardiopulmonary arrest.
Action of phenylephrine?
Strong stimulation of A1.
Used in septic, neurogenic shock, anesthesia-induced hypotension.
Action of sodium nitroprusside?
Venodilation and arterial dilation.
Used in low CO w/ high BP.
What is PS mechanical ventilation?
PS = pressure support.
Pt-initiated breath triggers boost of pressure.
What is AC mechanical ventilation?
AC = assist-controlled.
Preset VT is given at preset freq/min.
Pt-initiated breath receives preset VT.
What is IMV?
IMV = intermittent mandatory ventilation.
PS mode, w/ AC mode as backup.
What is CPAP?
CPAP = continuous positive airway pressure.
No variation with breathing cycle.
Pt breathes on own.
What is PEEP?
PEEP = positive end-expiratory pressure.
Provided to keep alveoli open.
Pt breathes on own.
