Preventative Mesures In the ICU

Question 1

What are the 3 components of virchows triad?

Answer 1

1. Stasis
2. Vascular injury
3. Hypercoagulable states

Question 2

What are the major risk factors for VTE? 5

Answer 2

1. Cancer
2. Previous DVT
3. Obesity
4. Trauma
5. Surgery

Question 3

Without a contradiction, what should be started in all critical care patients as early as possible?

Answer 3

DVT prophylaxis

Question 4

What heparin dose should be given for VTE prophylaxis?

Answer 4

5000 units Q8H or Q12H

Question 5

If a patients CrCl is <30, what dose of enoxaparin should be given?

Answer 5

Enoxaparin 30 mg SubQ Q24H

Question 6

What is the dose of enoxaparin for the general medical ICU patient?

Answer 6

Enoxaparin 40 mg SQ Q24H

Question 7

What is the dose of enoxaparin for more surgical patients?

Answer 7

Enoxaparin 30 mg SQ Q12H

Question 8

What CrCl is fondaparinux contraindicated in?

Answer 8

<30

Question 9

What has no role in ICU patients for DVT prophylaxis?

Answer 9

DOACs

Question 10

What’s contraindicated if a patient has an active DVT?

Answer 10

Sequential compression devices/ SCDs

Question 11

When are mechanical methods used as mono therapy for patients with an increased bleeding risk?

Answer 11

Platelets <50,000

Question 12

How does heparin induced thrombocytopenia present?

Answer 12

Presents as low platelets in the presence of UFH or LMWH that leads to thrombosis

Question 13

How long should you hold thromboprophylaxis after a major surgery? Minor surgery?

Answer 13

Major: 48-72 hours
Minor: 24 hrs after minor surgery

Question 14

What BMI level would cause an increase in doses of pharmacologic prophylaxis?

Answer 14

BMI>40

Question 15

What are 2 major risk factors for stress ulcers?

Answer 15

1. Coagulopathy (platelets <50,000)
   AND/OR
2. Mechanical ventilation for > 48 hrs

Question 16

What 2 drugs are not typically given for stress ulcer prophylaxis due to their efficacy?

Answer 16

1. Antacids
2. Sucralfate

Question 17

What can occur overtime with the use of H2RAs?

Answer 17

Tachyphylaxis

Question 18

What dose of Famotidine can be given for stress ulcers?

Answer 18

20 mg IV or PO Q12H

Question 19

What dose of Famotidine should be used if a patients CrCl is <50?

Answer 19

20 mg IV or PO Q24H

Question 20

What 2 PPIs are available as IV?

Answer 20

1. Pantoprazole
2. Esomeprazole

Question 21

What medication class can cause hyperglycemia?

Answer 21

Steroids

Question 22

If the patient becomes hypoglycemic, what are 3 steps that are used to treat?

Answer 22

1. Stop insulin
2. Administer dextrose (25 g IV is most common)
3. Re-evaluate insulin/glucose control

Question 23

True or False: Oral antidiabetic medications are used routinely for glucose control

Answer 23

False

Question 24

What is the most common initial method of glucose control in the ICU?

Answer 24

Sliding/correctional scale

Question 25

What are two dosing options used when giving sliding scale insulin?

Answer 25

1. 0-6 Units SQ
2. 0-18 Units SQ

Question 26

True or False: Pre meal insulin or basal/bolus regimens are not routinely used for glucose control

Answer 26

True

Question 27

What method for glucose control has a higher incidence of hyperglycemia?

Answer 27

Infusion

Question 28

When can insulin infusions be used?

Answer 28

If the correctional scale failed