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critical care > week 1 ICU, SHOCK, DKA/HHS > Flashcards

week 1 ICU, SHOCK, DKA/HHS Flashcards

1
Q

Fast hugs bid

A

Feeds
- enteral> parenteral
- parenteral ae: thrombosis, fungal inf

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2
Q

(6) Consequences of malnutrition

A
  • dec immune function
  • inc susceptibility to inf
  • impaired wound healing
  • bacterial overgrowth
  • ulcers
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3
Q

fAst hugs bid

A

Analgesia
- nociceptive: Tylenol, opioids (Fentanyl, hydromorphone, morphine, oxy)
- neuropathy: gaba
- do not underdose compared to at home dose
- scales: CPOT, BPS

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4
Q

faSt hugs bid

A

Sedation
- propofol + presadex > benzos
- benzos cause delirium and cog impairment
- RASS light sedation -2
- optimize control and minimize acute stress response

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5
Q

fasT hugs bid

A

thrombolytic prophylaxis
- EVERYONE in ICU gets it unless high risk bleed
- LMWH 40 mg SQ QD or 30 BID
- renal impairment use Heparin 5000 units SQ Q8H
- high risk bleed pts use mechanical (non pharm treatment): graded compression stocks or other device

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6
Q

fast Hugs bid

A

head of the bed
- elevate bed to 30-45 deg in pts with tube
-chlorhexidine .12% mouth rinse TID to prevent bacteria/inf

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7
Q

fast hUgs bid

A

ulcer prophylaxis
- PPIs or H2RA (famotidine)
- high risk (1 or more): mech vent >48hrs, coagulopathy
- minor risk (2 or more) meds, shock/sepsis/hypotension, hepatic or renal failure, multiple trauma, burns, organ transplant

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8
Q

fast huGs bid

A

glycemic control
- monitor often; goal 140-180

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9
Q

fast hugS bid

A

spontaneous breathing trial
- test daily, d/c mech vent at earliest opportune time

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10
Q

fast hugs Bid

A

bowel regimen
- if pt on opioids add on regimen
- docustae, sennosides, peg
- for emergency release: bisacodyl, enemas, mag citrate

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11
Q

fast hugs bId

A

indwelling catheters
- peripheral/ venous- iv meds
- central venous- into superior vena cava, long term
- arterial- continous bp, sampling
- foley- urine
** assess need for lines daily and assess site for infection

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12
Q

fast hugs biD

A

De-escalation of abx
- source control, narrow spectrum when species identified
- dose adj for pk changes

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13
Q

Shock Goals (vitals/labs)

A
  • MAP>65, HR<100
  • Hgb 7-9, o2 sat 88-92, svo2>65
  • lactate <2
  • urine output >.5 ml/kg/hr
  • mental status
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14
Q

preload

A

left ventricle volume
- give too much fluids too fast can cause overload
- pcwr

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15
Q

invasive monitoring options
1. central venous

A

measures scvo2s from blood pH
- tells how well heart is contracting
- admin flusids, vasopressors, antimicrobals, parenteral nutrition, sample

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16
Q

invasive monitoring options
2. Pulmonary artery catheter

A

measures svo2 and svr (venous resistance) as well as preload, cardiac outpt
- ae: rupture, inf

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17
Q

invasive monitoring options
3. Arterial line

A

meausres BP, MAP, Arterial blood gas (pH) **continuously

18
Q

what is the calc for MAP

A

1/3 sbp + 2/3 dbp

19
Q

what is hypovolemic shock, causes, vitals, treatment options

A

low and sudden loss of intravascular volume
- caused by: hemorrhage, GI losses, severe dehydration, third spacing, burns
- dec PCWP, dec pump function, inc svr, dec svo2
- packed RBCs for hemorrhage, crystalloid fluids

20
Q

what is cardiogenic shock, causes, vitals, treatment options

A

failure of left ventricle to deliver blood due to impaired SV or HR
- causes: acute MI, arrhythmias, end stage HF, valve disease
- inc PCWP, dec pump function, inc svr, dec svo2
- revascularization, LV assist devices

21
Q

what is distributive shock, causes, vitals, treatment options

A

pronounced vasodilation, intravascular volume dep
- septic shock #1 cause
- dec PCWP, variable pump function, dec svr, variable svo2

22
Q

what is obstructive shock, causes, vitals, treatment options

A

critical dec in LV stroke volume or inc LV outflow obstruction
- causes: PE, severe pulmonary hypertension, tension pneumpthorax, pericardial tamponade
-inc PCWP, dec pump function, inc svr, dec svo2
- thrombolytics, needle decompression, needle drain

23
Q

fluid management in shock

A

crystalloids 30ml/kg over 15-30, then followed by 10ml/kg boluses
- specifically cardiogenic shock 100-200 ml boluses
central line for fastest delivery

24
Q

when, how to give vasopressors in shock. different receptors

A
  • start when MAP <65 despite fluids
  • arterial lines
  • beta1 inc CO
  • alpha1 inc CO, contractility, inotropy
25
Q

vasopressor options

A

NE (1st line) a1
dobutamine b1
epi - anaphylactic shock, inc lactate
dopamine - hypotensive pts w/ dec cardiac function. AE- tachycardia, arrhythmogensis

26
Q

angiotensin II role in shock

A
  • used in septic and distributive shock
  • ae: risk of thromboembolism
27
Q

precipitating factors for DKA & HHS

A
  • infection
  • initial pres of Diabetes
  • insufficient insulin therapy
  • pancreatitis
  • acute CV events
  • meds: glucose, atypicals pyschs, BB, thiazides, stimulants
27
Q

clinical pres dka vs hhs

A

DKA: kussmaul breathing, acetone breathe, hours to days
HHS: days to weeks

27
Q

1 cause of DKA and HHS

A

insulin deficiency

28
Q

labs DKA vs HHS

A

DKA: bg>250, ph<7.3, urine ketones, anion gap 12 and up, +/- AMS
HHS: bg>600, osm>320, AMS

29
Q

How to cal anion gap

A

na - (cl + hco3)

30
Q

how to calc sodium correction

A

add 1.6 meq for every 100 mg over 100mg/dl to measured serum na

31
Q

how to calc serum osm

A

2(na) + (glu/18) + (bun/2.5)

32
Q

goals of treatment for DKA and HHS

A
  • hydrate
  • correct hyperglycemia + ketosis
  • correct electrolyte imbalance
33
Q

hydration in DKA and HHS

A
  • iv fluids 500-1000ml/hr of norm saline or lactated ringers
  • potassium
  • bicarb 100 meq in 400ml of sterile water w/ 20meq KCl @200 ml/hr over several hrs (risk of hypokalemia + cerebral edema)
34
Q

when to give or hold potassium

A

Goal K 4-5 meq
- if K<3.3 hold insulin, give 10-20 meq until K>3.3
- if K 3.3-5.2 give 20-30 meq in each liter of fluid
- if K>5.2 do not give K
Check q2hrs

35
Q

how to transition to subq insulin

A
  • new regimen : 0.4-0.5 units/kg/day. 40-50% of TDD as basal, the rest prandial
  • continue IV in sulin for 2 hrs after basal insulin is admin
  • assume home regimen when appropriate, avoid hyperglycemia
36
Q

euglycemic DKA risk factors

A
  • risk: fasting, surgery, pregnancy and SGLT2i (ozempic)
37
Q

euglycemic DKA labs

A

norm BG (<250), acidosis (ph<7.3) dec serum bicarb (<18), ketons

38
Q

euglycemic DKA treatements

A
  • insulin to correct acidosis + anion gap
  • dextrose
  • fluids
39
Q

end points of DKA

A

BG< 200 with 1 of the following
- serum bicard >=15
- ph >7.3
- anion gap <= 12

40
Q

end points of HHS

A

osm <320
recovery to mental alterness

critical care (2 decks)

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