Day 5- Hyperglycemia, VTE prophylaxis, and Stress Ulcer Prophylaxis. Flashcards
Which hormone leads to your hyperglycemia in the ICU?
What are your current glycemia goals?
When do you get an A1C?
Cortisol.
140-180 most patients, 110-140 for cardiac surgery, ischemia cardiac and neurologic events.
BG>180 and not performed in the previous 3 months. Begin insulin treatment if BG >180.
What are your insulin guidelines for ICU?
What are your non pharmacologic prophylaxis for VTE in the ICU?
When is pharmacologic treatment CI’d?
Start if BG>180 of continuous drip of insulin. Transition to SQ and take lowest unit/hr of insulin in the last 6 hours and multiply by 17. Use 40% as basal insulin(given 1-2 hours before stopping infusion). Remainder as mealtime or correction.
Ambulation and mechanical prophylaxis.
INR >1.5(not on warfarin), Thrombocytopenia(<50K), TPA in the last 24 hours, Active gastric ulcer(or any other sign of bleeding).
What are your pharmacologic treatments for VTE?
Can you use non warfarin anticoagulants or aspirin?
What makes a bleed clinically important bleeding?
Low dose unfracionated Heparin(5000 units SQ BID or TID). Enoxaparin 40 mg sq qd, CrCl <30 requires dose adjustment. Fondaparinux CrCl <50 requires dose adjustment.
NO.
Spontaneous SBP decrease of at least 20, sitting SBP decrease of at least 10, HR increase of >20, Hemoglobin decrease of at least 2 and transfusion.
When is prophylaxis for ulcers recommended?
What are your pharmacological agents used for prophylaxis for ulcers?
Mechanical ventilation >48 hours, Coagulopathy(Platelets <50,000, INR >1.5, PTT >2 times the control value),Traumatic brain injury, multi trauma, sepsis, Acute renal failure, ISS >15, High dose steroid(250 mg hydrocortisone or equivalent).
PPI preferred(watch for Cdiff and pneumonia), H2RA second line requires dose adjustment, Cimetidine is least potent but most drug interactions. Famotidine is opposite, Can use sucralfate, antacids no longer recommended. Keep them on it until they are out of the ICU.
