Lecture 8: ICU cases

Question 1

What are the 5 causes of post-op fever based on timeframe?

Answer 1

“1, 3, 5, 7”

1. Wind (atelectasis) - Day 1
2. Water (UTI) - Day 3
3. Wound (SSI) - Day 5
4. Walking (DVT/PE) - Day 7
5. Wonder Drugs - anytime

Question 2

Which type of non-invasive oxygen delivery device can deliver the highest concentration of oxygen?

Answer 2

Non-rebreather mask

10-15 L/min

Question 3

What are the 4 measures used to assess effectiveness of NIV?

Answer 3

1. Dyspnea improves
2. Decreased PaCO2
3. Increased pH
4. Respiratory acidosis is corrected

Question 4

When should you intubate a patient?

Answer 4

1. Respiratory arrest
2. Decr LOC
3. Dyspnea/WOB worsens
4. Increasing agitation
5. Symptomatic dysrhythmias
6. Hemodynamically unstable
7. Increased ICP

Question 5

What is the progression of SIRS criteria?

Answer 5

SIRS –> Sepsis –> Severe Sepsis –> Septic Shock

Question 6

What does the SIRS criteria include?

Answer 6

1. Temp > 100.4 or < 95.0
2. RR > 20
3. HR > 90
4. WBC > 12K or < 4K

Need 2+ to be positive for SIRS

Question 7

Definition of Sepsis

Answer 7

SIRS + infection (positive culture)

Question 8

Definition of Severe Sepsis

Answer 8

SIRS + infection + end organ damage
(Sepsis + end organ damage)

• includes: AMS, ARDS, acidosis, Oliguria, Lactate > 2

Question 9

Definition of Septic Shock

Answer 9

SIRS + infection + end organ damage + HoTN

Severe Sepsis + HoTN

Question 10

What is the late response in shock?

Answer 10

HYPOinflammatory –> organs starting to fail/die

Question 11

What is the general approach to sepsis management?

Answer 11

1. Start broad spectrum ABX
2. Give fluids (preload)
3. Give pressors (afterload)

Question 12

If you are are suspecting a pt is in shock, therefore give them fluids and pressors but no improvement occurs, what should you give next?

Answer 12

Steroids –> if give steroids and see improvement –> adrenal crisis