Q3 Shock/burns Flashcards

1
Q

See cards 58-67 of pulm

A
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2
Q

What is the BEST indicator of hydration status?

A

UOP: 30-50ml/hr in adults, and 0.5ml/kg/hr in Peds.

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3
Q

What is a common method for maintenance IVF therapy?
For a 76kg patient?

A

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.

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4
Q

When should vasopressors NOT be used in hypovolemia?

A

When shock is 2* to or accompanied by cardiac failure.

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5
Q

For hemorrhagic shock, what is the SBP and MAP target?

A

Permissive hypotension
SBP<90mmHg
MAP <55

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6
Q

Since symptoms are vague, you might not catch hemorrhagic shock in these stages?

A

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??

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7
Q

CaCl every _____ Units PRBC during MTP?

A

4 units to maintain Ca++>1.0

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8
Q

What should we administer to patients with severe bleed within 3 hours of their traumatic injury?

A

Anti-fibrinolytic therapy

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9
Q

If a patient with an unknown blood type gets a infusion of LTOWB, then what will their subsequent infusions be fore up to 1mo?

A

LTOWB or group O, because it is not possible to test their blood type after receiving LTOWB.

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10
Q

FWB can be stored for?

A

35days in CPDA-1
21 Days CPD
8hours at room temp.

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11
Q

Universal donor?

A

O neg.

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12
Q

What plasma is considered universal? However what if you don’t have it?

A

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.

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13
Q

Is kcentra (4-factor ______ pcc) activated or unactivated?
3-factor Profiling/bebulin?
Febia?

A

kcentra = UNactivated
UN activated
ACTIVATED

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14
Q

Kcentra MOA.
SE?

A

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.

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15
Q

3-factor unactivated pcc (Profilnine/bebulin) MOA?
SE?

A

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

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16
Q

FEBIA MOA?
SEs?

A

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

17
Q

TXA MOA
SEs?

A

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.

18
Q

Vasopressin MOA
SEs

A

MOA: synthetic ADH = absorb more NA/fluid and vasoconstriction
SE: a fib, bradycardia, ischemic heart disease, hypoNa, low plt, hemorrhage, D renal insuff.

19
Q

Octreotide MOA, SEs?

A

MOA: mimics somatostatin and reduces blood flow to the portal system
SEs: sinus Brady, HTN, fatigue, hyperglycemia, anemia, blurred vision, PE, prolonged QT.

20
Q

What is a treatment for CHRONIC not ACUTE anemia?
Goal? Onset?
SEs?

A

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,

21
Q

Sepsis criteria

A

Organ dysfunction (>=2qSOFA) + confirmed or suspected infx.
GCS < 15
RR > = 22
SBP <=100

22
Q

Septic SHOCK criteria

A

Sepsis PLUS
Hypotension requiring vasopressors
Lactate >2 despite fluid resuscitation.

23
Q

For septic shock, administer fluids at a rate of __________ to get a UOP of _______

A

30ml/kg/3hrs
0.5-1ml/kg/hr

24
Q

QSOFA (quick sequential Organ Failure Assessment)

A

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.

25
Q

Your patient has GCS 15, RR 22 and SBP 107. What is their qSOFA score?

A

1 point (for RR >=22).

26
Q

When is the qSOFA score performed?

A

24hrs after admission and every 48hrs.

27
Q

What is to be completed within the 1st hour of suspected or dx sepsis?

A

Lactate, blood cultures, broad spec abx, fluid resuscitation

28
Q

Goal of fluid resuscitation in sepsis?

A

To restore intravascular volume.

29
Q

VAP Abx for gram+w/MRSA

A

Vanc/Linezolid

30
Q

VAP abx for gram-

A

PCN, cephalosporins, carbapenim or Aztreonam.
Non-betalactam based agents
Cipro, levo, amikacivn, gent, Tobramycin, polymixin.

31
Q

VAP abx for gram-

A

Flour

32
Q

When should vasopressors be used?

A

AFTER restoration of intravascular volume - fill the tank before pressing the gas

33
Q

What is the 1st line vasopressors?

A

Norepinephrine (levophed)

34
Q

2nd and 3rd line vasopressors?

A

Vasopressin or epi
Dopamine
Phenyllephrine
Dobutamine/milrinone.

35
Q

What is the 1st line vasopressors in anaphylactic shock?

A

Epinephrine.

36
Q

What is the initial agent of choice in cardiogenic shock with low CO and maintained BP?

A

Dobutamine.

37
Q

What does norepinephrine act on?

A

Alpha1 and some Beta1

38
Q

What is Hct?

A

RBC vol/total blood vol.

39
Q

When would you use Corticosteroids in sepsis?
Clinical considerations?

A

Refractory Hypotension despite adequate pressures.

Monitor glucose and Na levels. No evidence to prove improved clinical outcomes.