Surgical critical care Review Flashcards
What is the paralytic agent of choice in the ICU
- cisatracurium
How is cisatracurium metabolized by the body?
- hoffman metabolism
- ester hydrolysis
- i.e. does not need renal or liver function
indications for stress ulcer prophylaxis in ICU patients
- mechanical ventilation greater than 48 hours and no tube feeds
- INR > 1.5
- platelets < 50
- TBI
- Spinal cord injury
What should you be careful with when using vasopressin as a second line agent?
- can cause hypotension secondary to decreased cardiac output, as a result of decreased stroke volume
- can precipitate ischemia in coronary artery disease (be careful with older patients)
Main effect of epinephrine use?
increases heart rate
side effects of epinephrine use in SICU
- can lead to tachyarrhythmias
- can lead to ischemia (increased cardiac demand)
main effect of dobutamine
increases heart rate and myocardial contractility
Target receptors for Norepinephrine
alpha 1 > beta 1
target receptors of vasopressin
V1a
target receptors of epinephrine
alpha 1, beta 1, beta 2
beta > alpha
target receptors of dobutamine
beta 1, beta 2
when do hepatic glycogen stores run out
within 24 hours of being made NPO
primary precursor of hepatic gluconeogensis
Alanine
which narcotic do you use in patient’s with renal insufficiency?
Hydromorphone (Dilaudid)
what the main physiological issue in ARDS?
- protein rich fluid saturates the alveoli causing poor oxygenation
first line pressor for cardio-genic shock?
dobutamine
drugs that can cause cyanide toxicity?
- Nitroprusside
- thicyanate
antidote for cyanide toxicity
- amyl nitrite
- sodium nitrite
- hydroxocobalamin
respiratory quotient of <0.7
patient is starving (underfed)
respiratory quotient of 0.7
pure fat utilization
respiratory quotient of 0.8
pure protein utilization
respiratory quotient between 0.8-0.9
mixed substrate utilization (desired)
respiratory quotient of 1.0
pure carbohydrate utilization
respiratory quotient > 1.0
overfeeding
