ICU Flashcards
SCIP protocol for sepsis in a sending cholangitis
IV antibiotics within one hour
2 L bolus
Arterial line in central venous line
Levophed (norepinephrine) 2-20 micrograms per kilogram per minute
Vasopressin 0.03
–
If you still sick:
Hold the course twelve– twenty four hours! then ERCP
Or transit hepatic percutaneous
Treatment of delirium tremens
Ativan
Banana bag: thiamine, folic acid, 3 grams of magnesium sulfate Multivitamin
Status of exclusion of ARDS with cardiac failure
no more
What is normal I:E ratio and what do you change it to with ARDS
Normal :
Inspiratory:Expiratory
1:3
(this just feels natural when breathing) - yoga breath)
Recruitment manuver:
1:1 or even reverse 2:1
what is ECMO annula vessle
Adults: IJ - honking cannula
Kids: common carodtid!
what does APRV stand for
Airway pressure release ventilation
How does NO work as advanced ventilation technique
Dilated pulmonary vasculature (remember medical school study)
Alveoli then see more gas exchange
MAY help get off of vent
How do you ask to be someone for end-of-life
“taking off of support”
Morphine for anxiety
decrease fio2
Supportive measures for myoglobinemia
Sodium bicarb to alkalize the the urine
sodium bicarbonate 50 mEq/L.
pH greater than 7.5
Sodium 160
Consider manitol
what check be PCO to be to confirm endotracheal integration
Greater than 15×3 breaths
what other blood vessel contribute to anterior spinal cord
besides the artery of a Adamkowitz
DDx of high pressure alarm on the vent
check ETT Sucking check circuit machine Bag mask
Interthoracic:
PTX!
stiff lung
What is estimated distatance of ETT from incisors
22-24 cm
What does rising BU win indicate regarding fluid status
Indications of dehydration
What is rising creatinine and associated with
Decreased renal function
How well creatinine is being cleared
Noninvasive method of monitoring central venous fluid resuscitation status
Echocardiogram
Demonstrate hepatic vein collapse
Main algorithm to assess hypoxia
Perfusion versus ventilation
Perfusion:
MI!
Shock - bleeding / third space
PE (not getting blood to the gas exchange)
Ventilation:
ARDS
Emphysema
Shunt
Mechanical (pneumothorax)
Maximum size of the inferior vena cava to use standard IVC filter
28 millimeters
Algorithm for hyperkalemia
Cardiac monitor
D50 1 amp: 20 – 50 mL of 50% solution
Insulin 10 units
Calcium gluconate 10 mg and 10% solution over five minutes
Kayexalate 30 g PO / 50 g rectal enema
Sodium bicarb one amp q 10 minutes
Dialysis AEIOU Acidosis Electric light Uremia
A – Acidosis – metabolic acidosis with a pH 6.5 mEq/L or rapidly rising potassium levels; see previous postfor a review of the causes and management of hyperkalemia
I – Intoxications – use the mnemonic SLIME to remember the drugs and toxins that can be removed with dialysis: salicylates, lithium, isopropanol, methanol, ethylene glycol
O – Overload – volume overload refractory to diuresis
U – Uremia – elevated BUN with signs or symptoms of uremia, including pericarditis, neuropathy, uremic bleeding, or an otherwise unexplained decline in mental status (uremic encephalopathy)
If normal measures to correct potassium are not working what should you consider giving
Magnesium
SIADH
Basically concentrating urine to hold onto water
Increased antidiuretic hormone
Increase urine osmolality
Increase urine sodium
Decreased systemic sodium
Decreases systemic osmolality
Treatment is fluid restriction
Cerebral salt wasting
Decreased serum sodium
Increase serum osmolality
(lose fluid more than you lose sodium)
Decreased urine osmolality
Increase urine sodium
Diabetes insipidus
This is liters of urine per hour of dilute urine
Increase serum sodium
Increase serum osmolality
Decreased urine osmolality
Decreased urine sodium
Protective measures for intracranial hemorrhage
Headed at 30°
Permissive HYPOcapnea PCO2 35
Mannitol 1 g per kilogram Q6 six hours:
serum osmolality goal of 330
3% saline started 50 mL in our drip max with serum sodium goal 155
Paralyze
Barbiturate coma
ICP pressure goal less than 30
Cerebral perfusion pressure goal 60
myoglobinuria
Positive on dipstick
Microscopic evaluation shows absence of RBCs
Best way to protect kidneys from contrast
Start fluids 12 hours before in continue 12 hours after
Better than Mucomyst
If you have to take a number to start transfusing by hematocrit what would you choose
24 percent if asymptomatic
30% of cardiac
Spontaneous breathing trial
This is the best for weaning
Turn off sedation
FiO2 40%
PEEP5
What is the rapid shallow breathing index
Respiratory rate / title vol in Liters
Measurement is done with a handheld spirometer attached to the endotracheal tube while a patient breathes room air for one minute without any ventilator assistance.
As an example, a patient who has a respiratory rate of 25 breaths/min and a tidal volume of 250 mL/breath has an RSBI of (25 breaths/min)/(0.25 L) = 100 breaths/min/L
Goal is less than 105 “Tobin”
What isn’t important burn lab to get when patient comes in after a house fire
carboxyhemoglobin level
The potential for carbon monoxide poisoning mandates that a carboxyhemoglobin level be obtained in all patients with moderate or severe burns.
A standard arterial blood gas reports the concentration of oxygen dissolved in blood and cannot be used
A serum lactate measurement and end-tidal CO2 (EtCO2) monitoring may provide useful information when determining management of these patients and should be performed if cyanide poisoning is a possibility. Cyanide toxicity poisons mitochondria forcing cells to use anaerobic metabolism. This results in a lactic acidosis and a compensatory drop in EtCO2.
We suggest treatment for cyanide toxicity to be initiated in severe burn victims with an unexplained lactic acidosis or a low or declining EtCO2 level. If these measurements are unavailable, we suggest treatment be initiated in any patient demonstrating a depressed level of consciousness, cardiac arrest, or cardiac decompensation. Particularly with severe burn victims, we strongly prefer hydroxocobalamin to alternative cyanide antidotes.
Hydroxocobalamin (vitamin B12a supplement and cyanide antidote):
Initial: 5 g as single infusion;
What does FAST stand for
Focused assessment with sonography for trauma
What do “comet tails mean on FAST”
this is NORMAL
streaks from the plural surfaces siding past each other.
What is the normal split thickness skin graft pickiness
10 one thousandth of an inch
brain death criteria
Warm
Off sedatives barbiturates benzo’s
Electrolytes corrected
Dolls eyes Cold caloric Pupillary reflex Corneal reflex Gag reflex
Apnea test
Apnea test
Standard procedure — The apnea test is performed after all other criteria for brain death have been met. Core temperature ≥36ºC or 97ºF, systolic blood pressure ≥100 mmHg, eucapnia (PaCO2 35 to 45 mmHg), absence of hypoxia, and euvolemic status are prerequisites [5,6].
The test is not valid in patients who chronically have high PaCO2 values (CO2 retainers or high cervical spinal cord lesions.
In a positive apnea test there is no respiratory response to a PaCO2 >60 mmHg or 20 mmHg greater than baseline values and final arterial pH of
best medicaiton of for afib if low pressure
Amioderone
yes, same med used for code
Patient with stroke loses their peg tube what is the management
Number one peg tube study
(CT scan would be okay)
If contrast week must go to operating room washout
Resect old peg tube site with primary nastiness is
Place gastrostomy tube in new sites.
Basic Swan set up
Trendelenburg
Flush Swan
Check balloon
Leave the transducer on
Prep Right IJ
What tells you that you are in the pulmonary artery on the waveform
Dicrotic notch
