Shock Flashcards

1
Q

Target Central Venous Pressure

A

8-12 mmHg, 12-15 mmHg intubated patients

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2
Q

Fluid Resuscitation

A

Initial: crystalloid (NS or LR); challenge min of 30 mg/kg w/in first 3 h; albumin add’n

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3
Q

Albumin in Resuscitation

A

Pt requires substantial amount of crystalloid, pt develops incr abdominal pressure or pulmonary edema

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4
Q

Hydroxyethyl Starches

A

Avoid in fluid resuscitation

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5
Q

Target of Resuscitation

A

MAP of at least 65 mmHg, UO of at least 0.5 L/kg/h, normal lactate

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6
Q

Vasopressors

A

Central line preferred, Norepinephrine (1st choice), epinephrine (add’n to or sub for norEpi), vasopressin (add to norEpi before Epi), Dopamine (highly select pts), Phenylephrine (not rec)

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7
Q

Norepinephrine

A

Initial 0.05 mcg/kg/min or 4 mcg/min; Max approx: 3 mcg/kg/min or 125 mcg/min

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8
Q

Epinephrine

A

Initial: 0.05 mcg/kg/min; Range: 2-10 mcg/min

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9
Q

Vasopressin

A

Indication: refractory septic shock, 1st line: malignant tachy or active coronary ischemia, dose: 0.01-0.04 units/min

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10
Q

Dopamine

A

Indication: pt w/ low risk of tachy; dose: 2.5-20 mcg/kg/min

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11
Q

Phenylephrine

A

Indication: NorEpi-assoc arrhythmias, high CO states, salvage tx; Dose: 100 mcg bolus or 50 mcg/min, Max: 400 mcg/min

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12
Q

Inotropes

A

Potentially useful in resuscitated pt w/ persistent evidence of systemic or organ hypoperfusion; Dobutamine and Milrinone

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13
Q

Dobutamine

A

Dose: 2.5-10 mcg/kg/min up to 20 mcg/kg/min; may cause hypotension and tachy

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14
Q

Milrinone

A

Dose: 0.2-0.75 mcg/kg/min (lower in renal pts), LD: 50 mcg/kg over 10 min may be used; monotx or combo with dobutamine

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15
Q

Corticosteroid Stress Dose

A

After fluids and vasopressors, hydrocortisone 50 mg iv q6h or 100 mg VI q8h for 7d

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16
Q

Glycemic Control

A

Maintain BG 110-150 mg/dL