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hospital medicine > critical care medicine > Flashcards

critical care medicine Flashcards

1
Q

What are the 6 aspects of high quality care in the ICU

A
  • adherence to hand hygiene and infectious precautions
  • good interdisciplinary communication
  • good pt and family communication
  • interuption of sedation to assess readiness to extubate
  • frequent monitering for delerium
  • early mobilization of pts
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2
Q

pain, agitation and delerium are all risks for….. and therefore it is critical to manage these aspects

A

Post ICU syndrome

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3
Q

What is post ICU syndrome

A

characterized by weakness, cog dysfunction, and PTSD

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4
Q

What goal should be assessed first

A

analgesic goals

once this is done, target sedation to pt needs

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5
Q

what is the 1st line tx of nonneuropathic pain in ICU patients

A

IV opioids with nonopioid analgesics (tylenol and NSAIDs) as adjuncts

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6
Q

what are the IV opioid agents MC used in the ICU

A
  • fentanyl
  • hydromorphone
  • morphine
  • methadone
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7
Q

what should you give an ICU patient who has delerium with a normal QTc

A

PO Quetapine
IV or PO Haldol

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8
Q

what should you give a pt in the ICU who has delerium and QTc prolongation

A
  • PO zyprexa
  • SC Zyprexa
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9
Q

what should you give an ICU patient who is agitated and in need of prolonged sedation but does NOT have delerium

A

Dexmedetomidine

  • If this doesnt work add propofol
  • If they become hypotensive at any time during this consider BZD
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10
Q

Im not learningh this but yall are welcome to

A
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11
Q

In the ICU (bolus/continuous) dosing of medication is preferred

A

Bolus

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12
Q

What must you monitor for when treating patients in the ICU for pain

A
  • hypotension
  • depressed respiratory drive
  • constipation
  • urinary retention
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13
Q

what are the SE of opioid analgesics on the GI

A
  • reduced gut transit
  • ileus
  • urinary retention
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14
Q

How do you taper opioids? why is this important

A
  • infusions should not be decreased more than 25% daily
  • rapid tapering leads to withdrawal in pts who have been on high doses of opioids for more than 1 week
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15
Q

What is the first thing to do in management of a patient with agitation and anxiety in the ICU

A

mitigation attempts without the use of sedatives by attempting to address reversible causes

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16
Q

what are reversible causes of agitation/anxiety in the ICU

A
  • pain
  • hypoxemia
  • hypotension
  • disruption of sleep/wake cycle
  • substance withdrawal
17
Q

research shows (light/deep) sedation has better outcomes and leads to shorter hospital stays

in pts who are agitated/anxious

A

light

18
Q

what are the MC sedatives used in the ICU

A
  • BZDs
  • propofol
  • Dexmedetomidine
19
Q

what is the agent of choice for brief procedural sedation or short term mechanical ventilation (<1-3 days)

A

Propofol!

20
Q

what is the more cost effective way to do sedation that is expected to last longer than a few days

A

BZDs

21
Q

() is a water soluble primarily a-2 receptor agonist.

These are especially useful for (short/long) term sedation

A

Dexmedetomidine

short

22
Q

What are the pros of Dexmedetomidine

A
  • very little depressent effect
  • some analgesic properties
  • permit ventilator weaning w/o full discontinuation of drug!
23
Q

What is the timeline for ventilator acquired pneumonia

A

developes in patients more than 48-72 hours after endotracheal intubation

24
Q

what s/s would you see that could indicate ventilator assocaited pneumoani

A
  • fever
  • change in resp secretions
  • leukocytosis
  • change in O2 requirement
  • new/persisiten infiltrate on CXR
25
Q

T/F you should start ABX immediatly once VAP is suspected

A

FALSE! got ya

a lower respiratory tract sample should be obtained for culture PRIOR TO initiation of ABX

obtained via bronchoscopy or lavage/suction

26
Q

what are strategies used to prevent VAP

A
  • elevate bed 30-45 deg to prevent aspiration
  • continuous aspiration of subglottic secretions
  • silver coated endotracheal tubes (reduces bacteria and niofilm formation)
  • decontamination of oropharynx w chorhexidine wash may decease the burden of microbes
27
Q

what are postulated mechanisms for stress ulcer bleeding

A
  • excessive acid secretion
  • mucosal ischemia
  • impaired mucus production
28
Q

What can we give to reduce the risk of GI bleeding in stress ulcers

A
  • H2 blockers
  • PPIs

increase gastric pH

29
Q

what patients are at high risk of overt GI bleeding and should undergo prophylaxis for stress ulcer bleeds?

A
  • respiratory failure (mech ventilation >48hrs)
  • coagulopathy (INR >1.5 or platelet count <50k)
  • 2+ of the following:

stop prophylaxis once risks resolve

30
Q

Therapeutic hypothermia is MC used in…

A
  • post out-of-hospital cardiac arrest patients who remain comatose after return of spontaneous circultion
  • used in infants who have suffered asphyxia/anoxia
31
Q

what is the goal of therapeutic hypothermia

A

prevent or diminish hypoxic ischemic encephalopathy and other organ dysfunction

32
Q

what is HIE (hepatic ischemic encephalopathy)

A

acute global brain injury 2/2 critical reduction of blood flow and therefore oxygen/nutrients

33
Q

what are the 3 phases of therapeutic hypothermai

A
  1. induction
  2. maintenance
  3. rewarming
34
Q

what is the process of therapeutic hypothermia induction

A
  • internal thermometer probe is inserted usualy w foley
  • internal cooling w infusion of cooled NS
  • external cooling w blanket/ice packs

A RAPID induction!!!

35
Q

what must you watch for during the maintenance phase of therapeutic hypothermia

A
  • hypotension
  • hypokalemia
  • shivering
36
Q

what is the process of rewarming in therapeutic hypothermia

A
  • done over 8-24 hrs w cooling device and/or infusion of warmed saline

is this supposed to be “warming” device? idk

37
Q

what is the temperature goal for therapeutic hypothermia

A

32-34

provides most benefit while avoiding adverse effects

38
Q

how long does therapeutic hypothermia last

A

should be initiated ASAP and lasts 12-24 hrs at least.

time starts AFTER reaching goal temp.

hospital medicine (6 decks)

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