Q3 Shock/burns Flashcards
See cards 58-67 of pulm
What is the BEST indicator of hydration status?
UOP: 30-50ml/hr in adults, and 0.5ml/kg/hr in Peds.
What is a common method for maintenance IVF therapy?
For a 76kg patient?
100ml/kg for 1st 10kg, 50ml/kg for next 10-20kg + 20ml/kg for every kg greater than 20
1000+1000+920 = 2,920ml/day = 121ml/hr.
When should vasopressors NOT be used in hypovolemia?
When shock is 2* to or accompanied by cardiac failure.
For hemorrhagic shock, what is the SBP and MAP target?
Permissive hypotension
SBP<90mmHg
MAP <55
Since symptoms are vague, you might not catch hemorrhagic shock in these stages?
Stage I and II. Most trauma patients have a lot of adrenalin going on - they are naturally going to be anxious, antsy, tachypneic and tachycardia……. Or are they??
CaCl every _____ Units PRBC during MTP?
4 units to maintain Ca++>1.0
What should we administer to patients with severe bleed within 3 hours of their traumatic injury?
Anti-fibrinolytic therapy
If a patient with an unknown blood type gets a infusion of LTOWB, then what will their subsequent infusions be fore up to 1mo?
LTOWB or group O, because it is not possible to test their blood type after receiving LTOWB.
FWB can be stored for?
35days in CPDA-1
21 Days CPD
8hours at room temp.
Universal donor?
O neg.
What plasma is considered universal? However what if you don’t have it?
Type AB is considered Universal and can be given to anyone, however plasma type A has such low antiB antigens that it can be used instead in the absence of AB.
Is kcentra (4-factor ______ pcc) activated or unactivated?
3-factor Profiling/bebulin?
Febia?
kcentra = UNactivated
UN activated
ACTIVATED
Kcentra MOA.
SE?
4-factor unactivated pcc
Increased levels of vit K dependent coagulation factors (II, VII, IX and X and C + S)
SE: hypotension, tachycardia, a fib, Pulm Edema, HA, thrombosis, flushing, MI.
3-factor unactivated pcc (Profilnine/bebulin) MOA?
SE?
MOA: replace deficient clotting factor including factor, II, XI, X and some VI.
Control bleeding in those with little factor IX (hemophilia B or Christmas disease)
SE - similar to 4-factor
FEBIA MOA?
SEs?
MOA: factor VIII antibody inhibitor bypass to control bleeding by induction and facilitation of thrombin generation.
SE: CVA, PE, tachycardia, thromboembolism, malaise, abd distress, bronchospasm
TXA MOA
SEs?
TXA = forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis - blocks plasmin formation.
SE: abd px, HA, anemia, fatigue, muscle cramps, DVT, profound hypotension (if administered rapidly), sz, visual disturbances.
Vasopressin MOA
SEs
MOA: synthetic ADH = absorb more NA/fluid and vasoconstriction
SE: a fib, bradycardia, ischemic heart disease, hypoNa, low plt, hemorrhage, D renal insuff.
Octreotide MOA, SEs?
MOA: mimics somatostatin and reduces blood flow to the portal system
SEs: sinus Brady, HTN, fatigue, hyperglycemia, anemia, blurred vision, PE, prolonged QT.
What is a treatment for CHRONIC not ACUTE anemia?
Goal? Onset?
SEs?
Erythropoietin
Start if Hgb <10
2-4wk onset.
Goal Hgb = 11 in 2-4wks
SEs: HTN, HA, purities, N/v, fever, joint pain, thrombosis, CVA, erythema,
Sepsis criteria
Organ dysfunction (>=2qSOFA) + confirmed or suspected infx.
GCS < 15
RR > = 22
SBP <=100
Septic SHOCK criteria
Sepsis PLUS
Hypotension requiring vasopressors
Lactate >2 despite fluid resuscitation.
For septic shock, administer fluids at a rate of __________ to get a UOP of _______
30ml/kg/3hrs
0.5-1ml/kg/hr
QSOFA (quick sequential Organ Failure Assessment)
AMS: GCS <15
Tachypnea: RR> =22
Hypotension: SBP <=100
0 or 1 point = not high risk, continue to manage as appropriate
2-3points High risk of poor outcome, assess for evidence of organ dysfxn.
Your patient has GCS 15, RR 22 and SBP 107. What is their qSOFA score?
1 point (for RR >=22).
When is the qSOFA score performed?
24hrs after admission and every 48hrs.
What is to be completed within the 1st hour of suspected or dx sepsis?
Lactate, blood cultures, broad spec abx, fluid resuscitation
Goal of fluid resuscitation in sepsis?
To restore intravascular volume.
VAP Abx for gram+w/MRSA
Vanc/Linezolid
VAP abx for gram-
PCN, cephalosporins, carbapenim or Aztreonam.
Non-betalactam based agents
Cipro, levo, amikacivn, gent, Tobramycin, polymixin.
VAP abx for gram-
Flour
When should vasopressors be used?
AFTER restoration of intravascular volume - fill the tank before pressing the gas
What is the 1st line vasopressors?
Norepinephrine (levophed)
2nd and 3rd line vasopressors?
Vasopressin or epi
Dopamine
Phenyllephrine
Dobutamine/milrinone.
What is the 1st line vasopressors in anaphylactic shock?
Epinephrine.
What is the initial agent of choice in cardiogenic shock with low CO and maintained BP?
Dobutamine.
What does norepinephrine act on?
Alpha1 and some Beta1
What is Hct?
RBC vol/total blood vol.
When would you use Corticosteroids in sepsis?
Clinical considerations?
Refractory Hypotension despite adequate pressures.
Monitor glucose and Na levels. No evidence to prove improved clinical outcomes.
