Critical Care Flashcards
Definition of Sepsis
Temperature >38.3°C or <36°Ca Heart rate >90 beats/minutea Respiratory rate >20 breaths/minute or Paco2 <32 mm Hga WBC >12 × 103 cells/m3 or <4 × 103 cells/mm3a Altered mental status Hyperglycemia (BG >120 mg/dL without diabetes) Immature leukocytes (bands) >10% Significant edema or positive fluid balance (>20 mL/kg over 24 hours)
Definition of Severe Sepsis
SBP <90 mm Hg (or a >40–mm Hg drop) or MAP <70 mm Hg
Venous saturation (Svo2
) <70%
Need for mechanical ventilation
Hypoxemia (Pao2
/Fio2
<300)
CI >3.5
Lactate >1 mmol/L
Decreased capillary refill (press finger until turns white; time for
color to return is refill time and normally <2 seconds)
Mottling
Creatinine increase >0.5 mg/dL
Urine output <0.5 mL/kg/hour for ≥2 hours
Coagulopathy (INR >1.5 or aPTT >60 seconds)
Thrombocytopenia (platelet count <100,000/mm3
)
Ileus
Hyperbilirubinemia (total bilirubin >4 mg/dL)
Definition of Septic Shock
Persistent hypotension or a requirement for vasopressors after the
administration of an intravenous fluid bolus
SSC bundles (3 hours)
To be completed within 3 hours:
- Measure lactate
- Obtain blood cultures
- Administer broad spectrum antibiotics
- Administer 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or greater
SSC bundles (6 hours)
To be completed within 6 hours:
- Apply vasopressors to maintain MAP 65 mm Hg (that does not respond to initial fluid resuscitation)
- NE is the vasopressor of choice
- Epinephrine can be added or substituted for NE
- Vasopressin (0.03 unit/minute) can be added to NE
- Phenylephrine can be considered in patients with vasopressor induced serious tacharrhythmias or persistent hypotension
Risk factors for candidemia
- Recent abdominal surgery
- Chronic TPN
- Indwelling central venous catheters
- Recent tx w/ broad spectrum antibiotics
- Immunosuppressed
Preferred antifungal agents for Candida glabrata or krusei
Echinocandin
Calculate Anion Gap
[Na+] − [Cl− \+ HCO3 − ] Hypoalbuminemia decreases the AG by 2.5–3 mEq/L for every 1-g/dL decrease in serum albumin less than 4 g/dL.
Etiology of Metabolic Acidosis (Anion Gap)
MUDPILES Methanol Uremia DKA Propylene glycol Infection Lactic acidosis Ethylene glycol Salicylate
Drug able to administer through endotracheal tube during cardiac arrest
NAVEL Naloxone Atropine Vasopressin Epinephrine Lidocaine
When pursuing therapeutic hypothermia, what medications can combat complications such as shivering?
Sedatives (dexmetomidine, ketamine), anesthetics, analgesics (e.g. mepteridine, fentanyl, tramadol), dexamethasone, cloniddine, magnesium, ondansetron, buspirone, paralytics (avoided if possible)
What is the starting continuous infusion rate for lorazepam and a potential complication for prolonged infusion?
1 mg/hr, propylene glycol toxicity
What is the starting dose of continuous infusion for midazolam and a potential complication of prolonged infusion?
1 mg/hour and titrate to RASS goal
Midazolam may accumulate because of greater lipophilicity, especially in renal dysfunction
Titration dose for propofol?
Would you want to provide loading doses?
Monitoring parameters?
5 mcg/kg/min and titrate to RASS by 5 mcg/kg/min every 5 min, avoid loading doses due to hypotension and provides no analgesic properties
Prolonged infusions greater than 50 mcg/k/min may lead to PRIS
Monitoring:
BP, TG and calories provided from propofol (1 kcal/mL)
Titration schedule for dexmedetomidine?
Loading dose?
Monitoring parameters?
Maintenance dose of 0.2-0.7 mcg/kg/hour but evidence has shown up to 1.5 mcg/kg/hour. Loading doses are suggested for surgery but otherwise not due to bradycardia and hypotension
Monitoring:
Dose related bradycardia and hypotension
