ICU Flashcards
Precedex
Max Dose:
1.5mcg/kg/hr
Hypercapnic respiratory failure is defined as….
Hypercapnic respiratory failure is defined as an increase in arterial carbon dioxide (CO2) (PaCO)> 45 mmHg with a pH < 7.35 due to respiratory pump failure and/or increased CO2 production.
Hypoxemic respiratory failure is defined as…
Hypoxemic respiratory failure is defined as SaO2 < 88% or a PaO2 < 60 mmHg with a normal or decreased partial pressure of carbon dioxide (PaCO2).
Normal PaO2 values =
Normal PaO2 values = 80-100 mmHg
Normal bicarb level =
Normal bicarb level = 22-28
AVAPS stands for…
Average Volume Assured Pressure Support (AVAPS)
Non-invasive positive pressure ventilation (NIPPV) includes
CPAP
BiPAP
AVAPS
NIPPV appropriate for HF w pulmonary edema?
CPAP
NIPPV appropriate for COPD exacerbation?
BiPAP
With BiPAP, the difference between IPAP and EPAP is called __________.
With BiPAP, the difference between IPAP and EPAP is called pressure support.
Normal CVP
8-12mmHg
Initial treatment for patients with suspected sepsis or septic shock includes initiation of fluid administration (_____mL/kg recommended) within the first hour and completion within three hours of initial presentation.
Initial treatment for patients with suspected sepsis or septic shock includes initiation of fluid administration (30 mL/kg recommended) within the first hour and completion within three hours of initial presentation.
Fluid boluses are preferred to treat hypotension before initiating vasopressors and should be continued until blood pressure and tissue perfusion is adequate or if patients are nonresponsive to fluid resuscitation. Multiple randomized trials and meta-analyses has provided no evidence of significant difference in mortality between albumin and crystalloid solutions in managing sepsis or septic shock.
Normal PA systolic < ____ mmHg
Normal PA diastolic < ____ mmHg
Normal PA systolic < 25 mmHg
Normal PA diastolic < 10 mmHg
Norepinephrine (Levophed)
MOA
Primarily agonistic at alpha1 and beta1 receptors, with little-to-no beta2 or alpha2 activity.
< 3 mcg/min - the beta1 effects may be more pronounced and increase cardiac output.
> 3 mcg/min - the alpha1 effects may predominate.
Three E’s in norepinephrine = 3mcg cut off
Normal Cardiac Index (CI)
2.5-4.0 L/min/M^2
Why Norepinephrine (Levophed) infusion should be through large-bore peripheral IV cath or CVC?
It is highly recommended to infuse norepinephrine through large-bore peripheral intravenous catheters or central venous catheters. Ideally, the peripheral infusion should be in the upper extremity, preferably through an antecubital vein, as this provides the least risk of ischemia secondary to extravasation. If possible, lower extremity veins should be avoided as occlusive vascular diseases are more likely to occur in the lower extremities. Extravasation into local tissue can cause significant ischemia and subsequent necrosis. Should extravasation be suspected, the infusion should stop immediately. An attempt should be made to remove (drawback) any of the injected medication. If continuing the infusion is necessary, it should be restarted at a different site, ideally in a different extremity. The local area should then be infiltrated with phentolamine.
Genenral rule > 10mcg/min you should place a CVC.
Normal PCWP < ___mmHg
< 12mmHg
Epinephrine (Adrenalin)
MOA?
a1, a2, b1, b2 agonist
Lose Dose (< 10mcg/min)– more b1/b2 effect
High Dose (>10mcg/min)- more a1/a2 effect
Epinephrine increases systemic vascular resistance, heart rate, cardiac output, and blood pressure.
10 letters in epinephrine = 10mcg cut off
Epinephrine
Cardiac Arrest Dose?
1mg Q3-5min
Ephedrine
Indirect and Direct Sympathomimetic
Ephedrine, a stereoisomer to better-known pseudoephedrine, is a sympathomimetic amine with unique effects due to its indirect mechanism than other sympathomimetic agents like pseudoephedrine and phenylephrine.
Ephedrine acts as both a direct and indirect sympathomimetic. It binds directly to both alpha and beta receptors; however, its primary mode of action is indirectly achieved by inhibiting neuronal norepinephrine reuptake and displacing more norepinephrine from storage vesicles. This action allows norepinephrine to remain in the synapse longer to bind postsynaptic alpha and beta receptors.
Ephedrine’s indirect mechanism results in a sustained or even increased heart rate due to norepinephrine’s ability to bind alpha and beta receptors, whereas more direct sympathomimetics like phenylephrine results in reflex bradycardia. While the indirect effect is most profound on arterial blood pressure, the direct vasoconstricting action functions more on the venous system. It is, therefore, effective in elevating central venous pressure when the patient is challenged with fluids.
Stimulation of alpha-1-adrenergic smooth muscle receptors within vasculature results in a rise in systemic vascular resistance and, consequently, systolic and diastolic blood pressure. Direct stimulation of beta-1 receptors by ephedrine and norepinephrine increases cardiac chronotropy and inotropy.
Finally, beta-2-adrenergic receptor stimulation in the lungs results in bronchodilation with ephedrine administration, though it is not as pronounced as its cardiovascular effects.
ACLS guidelines define high quality chest compressions as achieving ETCO2 pressures of at least ____-____ mmHg.
When ROSC occurs, the patients ETCO2 will increase to >____ mmHg.
ACLS guidelines define high quality chest compressions as achieving ETCO2 pressures of at least 10-20 mmHg.
When ROSC occurs, the patients ETCO2 will increase to > 40 mmHg.
Cardiac Arrest:
First dose Amiodarone
Second dose Amiodarone
300mg Amiodarone
150mg Amiodarone
Cardiac Arrest:
First dose Lidocaine
Second dose Lidocaine
1-1.5mg/kg
0.5-0.75mg/kg
Shock energy for defibrillation in cardiac arrest (biphasic)
120-200J
Rhythm?
V Fib
Rhythm?
V Tach
Types of Breaths
Mandatory
Assisted
Spontaneous
Difference between AC and SIMV
