Day 4- ACLS, IV line and intro to CC patient, Shock Flashcards
What is ACLS?
Do you shock an asystole?
What drugs can you give in ACLS?
It’s Advanced Cardiac Life Support. AHA makes these guidelines.
NO. Give CPR every 2 minutes.
Epi, Amiodarone, Epi, Amiodarone then nothing but Epi. Epinephrine every 3-5 minutes
What are your reversible causes of ACLS? Your H’s and T’s.
What does a V-Fib look like and what happens?
What does V-tac look like?
Hypovolemia, Hypoxia, Hydrogen ion(acidosis), Hypo/hyperkalemia, Hypothermia, Tension pnuemothorax, tamponade(cardiac), toxins, thrombosis(pulmonary an coronoary).
Deadly, blood does not pump(no pulse), Chaotic EKG(all over the place). Shockable.
May or may not have a pulse, really rapid pulses, no QRS complex( Rate >100 x 3 beats). Shockable.
What does Torsades Du Pointes look like?
Do you shock PEA?
When is Amiodarone indicated?
Can’t shock it, Rate >150 BPM, Treatment is magnesium push every 5 minutes. Morphology on EKG changes with each beat.
NO. Defined organized rhythm without a pulse.
VF or pulseless VT, Other arrythmias.
When is Calcium indicated in ACLS?
What treats symptomatic bradycardia vs what treats symptomatic tachycardia?
What is the difference between brady and tachycardia?
Reversing Hyperkalemia.
Atropine. Adenosine(wide complex). Patients will feel chest pressure, must give as RAPID PUSH with y sited 20 mL NS immediately after. 10 second half life.
Bradycardia <50 bpm, Tachy is >150.
What are the 3 principal reasons patients get admitted to the ICU?
What are your routes of administration in the ICU?
What is hypotension cut offs?
Patient, Monitoring, and Nursing related.
Oral, Intranasal, Peripheral line IV(watch for extravasation), Central line IV(more common in ICU vs rest of hospital, non tunneled catheters, PICC, tunneled catheter/implantable ports), Intraosseous access, chest tube, foley catheter, in brain.
MAP <65, systolic <90. CO = HR x SV. SV is directly related to pre load and inversly to after load.
What drugs are preferred in a central line?
What port usually requires heparin when not in use?
What is your MAP equation?
Vasopressors, TPN, IV KCL(>10 Eq/hr).
Tunneled catheter/implantable ports.
((2xDBP)+SBP))/3
What does APACHE 2 score?
What does SOFA score?
What are the most common types of shock?
Severity of illness, higher the score the worse the outcome. Should be completed in the 1st 24 hours of ICU admission.
helps score sepsis and septic shock, Higher score means worse mortality.
Hypovolemic shock(bleeding, dehydration,, Cardiogenic shock(heart disease, MI, septal defects,etc), Distributive shock(septic. Shock is low bp + multi organ failure.
Do high lactate levels show signs of tissue damage of hypoperfusion?
What happens to your organs in shock?
What is normal central venous pressure?
Yes.
Liver failure, pancreatitis, transolocation of gut bacteria, ischemic bowel, Encephalopathy(confusion, delirium), Acute respiratory failure, Acute renal failure( high Scr, low CrCl), DIC, TTP, Thrombocytopenia, anemia.
5-10.
When is tachypnea a symptom of shock?
What are signs of hypovolemic shock?
What are signs of cardiogenic shock?
> 22.
Dry skin and mucous, Normal /decreased JVD, Delayed capillary refill and increased SVR.
diffuse crackes on ascultation, increased JVD, heart murmur, elevated cardiac enzymes, elevated BNP, reduced ejection fraction, increased SVR.
What are signs of distributive shock?
What is SIRS criteria?
What are your old septic shock classifications?
Normal/decreased JVD, decreased SVR, with septic shock.
Must have 2 of Temp >38 or <36, HR >90, RR>22 or pCO2 <32, WBC >12 or <4.
Sepsis, Severe sepsis, Septic shock.
What are your 4 mainstays of shock treatment?
What is your quick SOFA?
How do you decide which fluid to use in resuscitation?
fluid resuscitation, vasopressors, inotropes, steroids.
RR >22 or equal to is 1 point, change in mental status is 1 point, < or equal to 100 SBP is 1 point.more than 1 identified as having sepsis.
Need intravascular and 5% albumin does it the most. NS and LR do a lot more intravascular than D5W. Don’t use dextrose. Guidelines recommend 9% NS or IV LR or IV plasmalyte.
Do you give albumin to someone with a TBI?
How do you dose fluid resuscitation?
What is next after fluid resuscitation?
NO!!!!
BOLUS!!! Primary goal is 65 MAP. 30 mL/kG in the first 3 hours.
maintenance is 25-30 ml/kg/day. If patient doesn’t respond start vasopressor.
What vasopressor therapy is recommended in septic shock?
What is vasopressor therapy in cardiogenic shock?
How do you dose vasopressors?
Nor-Epi is 1st line. Vasopressin can be added if MAP doesn’t reach 65. Add EPI or steroids if not reaching. Dobutamine is last line. Phenylphrine only recommended if NE was attempted but caused arrythmia, salvage therapy when all others failed. Dopamine not recommended due to increased risk of arrythmia.
Nor-epi 1st line with severe hypotension(less than 70). Moderate(70-100) dopamine or dobutamine can be used. Epinephrine not used.
IV continuous drops and can be titrated every 1-5 minutes.
