Surgical- ICU Flashcards
two major reasons for admittance to the ICU
- Organ failure affecting biologic homeostasis that cannot be appropriately managed on a regular floor
Ex: Respiratory distress - Concern for progressive worsening of conditions that could warrant the need for close and frequent monitoring
ex: Multiple rib fractures in a fragile patient
3 mortality risk scoring systems. why do these matter for the ICU?
APACHE (Acute Physiology and Chronic Health Evaluation)
SAPS (Simplified Acute Physiologic Score)
MPM (Mortality Probability Model)
* The key is to transfer patients out of ICU as fast as possible once they have stabilized.
central venous access is placed with the assistance of what?
visualization with US guidance
except sometimes not for subclavian placement- US on bone doesnt work
central venous line: types of access, what to know about each?
Femoral
Subclavian
IJ
PICC (periph. inserted central cath: like IV in the arm)
what are the risks for each type of central line access? femoral, subclavian, IJ
Femoral: “Dirty”: near the groin– should change to access site that is less likely to become infected ASAP
Subclavian – increased risk of Pneumothorax
IJ – close to carotid!! (don’t accidentally dilate this!)
what is the benefit of the PICC central line?
allows for prolonged access in patients required prolonged IV therapy. They can go home with this
types of lines
MML (multi-med line)
Vascath (larger for more viscous fluid)
what are 4 types of meds used for sedation in the ICU?
Benzos
Propofol (Diprivan)
Precedex (Dexmetomidine)
Haloperidol (Haldol)
benefit of using Benzos (ex/ versed, ativan) for sedation? Cons to using benzos?
sedation + amnesia
- amnesia can prevent the PTSD assoc. with ICU stay
Cons: overdose, withdrawal
what is the RASS score?
a scoring system used to measure the patient’s sedation. providers tell the nurse a score range in which they want their patient to be at. (+4 combative down to -5 unarousable sedation)
don’t provide sedation without _____
analgesia
4 drugs used for analgesia
IV morphine IV fentanyl epidural Toradol (NSAID) *PCA (patient- controlled-Analgesic)
IV morphine vs IV fentanyl
*both need titrated dosing
Morphine: active metabolites can accumulate in renal failure (dose reduction by 50%), increased incidence of vasodilation and hypotension due to stimulation of histamine release;
Fentanyl: faster acting than morphine, no active metabolites, less likely to decrease BP, absorbed readily into CNS so quicker onset of action and shorter acting;
SIRS criteria
At least 2 of the following Temperature >38C or <36 C Heart rate > 90 bpm RR > 20 bpm or pCO2 < 32 mmHg WBC >12,000 or < 4,000 Or >10% bands
what is SIRS?
Systemic Inflammatory Response Syndrome
what is sepsis?
SIRS due to infection
severe sepsis vs septic shock
Severe Sepsis: One or more vital organ dysfunction/failure
Septic Shock: Severe sepsis + hypotension refractory to volume resuscitation
shock that causes hypovolemia, what order of fluids are you giving the pt?
two liters of crystalloid- switch to a colloid: if blood counts are low - give blood, if blood counts are normal and they need volume- give albumin
MODS and MOF stand for what?
MODS (Multiorgan Dysfunction Syndrome) and MOF (Multiorgan Failure)
what 4 organs are frequently injured in SIRS and sepsis?
Lungs: ARDS (Acute Respiratory Distress Syndrome) – see in about 40% of severe sepsis cases
Kidneys
CV system
CNS (encephalopathy)
benefits of Propofol (Diprivan) for sedation?
maybe weeds
- rapid acting, short-term, amnesia
- head injury
- reduction in delerium tremens (alc withdrawal)
two things to consider when using propofol
maybe weeds
Dosage based on IBW (ideal body weight) and not actual body weight
Prepared in lipid emulsion: Check triglycerides and CK
two uses of precedex for sedation?
maybe weeds
- Sedation without respiratory depression (for pts who are not ventilated, for other meds you need a ventilator)
- used for weaning from sedation
ADRs for precedex (maybe weeds)
Hypotension and Bradycardia (may be severe)
