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Flashcards in Crashing Patients Deck (24)
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1
Q

what’s a good needle size for IV access, esp for an actively bleeding patient?

A

18 gauge (green)

2
Q

definition of sepsis

A

infection + (Greater than 2 SOFA)

sepsis related organn failure: hypotension, low Pao2 fio2)

3
Q

goal MAP

A

above 65 for most normal adults

4
Q

how much fulids to give for resuscitaiton from sepsis induced hypoperfusion?

A

30 ml/kg (roughly 2 L within first 3 hours)

5
Q

good way to measure perfusion in sepsis/infection

A

UOP!

6
Q

nml lactate

A

<2

7
Q

good pressor to use on the floor when things are getting bad?

A

DOPAMINE (good since it can be given via peripheral line until patient can be transferred to ICU)

norepi can also be given through central line

8
Q

FLUIDS ARE THE KEY TO ALL TYPES OF SHOCK except….

A

cardiovascular shock due to LV pump failure

9
Q

Additional special ICU things to present for patients

A
highlights of last 24 hours
Is and Os
ventilator settings
neuro exam usually harder to do(level of sedation, pupils, gag, motor function)
drain output, types of lines

systems based A/P

10
Q

Most important labs for ICU patient

A

CBC
chem
ABG with lactate

11
Q

Goals of mechanical ventilation (5)

A
maintain airway
oxygenation
ventilation
acid base (high CO2/renal failure, may need to blow off as an example)
decrease energy consumption
12
Q

What does positive pressure ventilation help with?

A

adding POSITIVE PRESSURE via endotracheal tube at the lips to create a POSITIVE PRESSURE so air flows from lip/endotracheal tube into lungs

air flows from POSITIVE -> NEGATIVE pressure

13
Q

How is PPV different from NIPPV aka bipap

A

NIPPV doesn’t require an endotracheal tube

used when there is no absolute cardiac/respiratory shock as an alternative to intubation

14
Q

Main utility for CPAP

A

provides PEEP (increases positive pressure) to allow cycles of inspiration and expiration to continue while IMPROVING HYPOXIA

expiratory and inspiratory remain the same

15
Q

CPAP vs BIPAP

A

CPAP - expiratory and inspiratory have less of a difference; good for HYPOXIC FAILURE
BIPAP - huge difference between inspiration (IPAP) and expiration pressure (EPAP); therefore this increases TIDAL VOLUME; big tidal volumes are good for blowing off CO2; good for HYPERCAPNIC FAILURE

16
Q

What is PEEP?

A

think balloon (need lots of air to blow up balloon before there is air in it)…think of collapsed balloon as alveoli after expiration

if we put air in balloon/aka alveoli initially (via PEEP), it is easier to fill the alveolis up!…HELPS WITH OXYGENAITON

17
Q

What to know to help anesthesiologists before they intubate your patient

A

most recent K/ renal function
cardiac fxn
allergies

18
Q

When setting up ventilator settings…which mode to use when in doubt?

A

Assist control: all breaths are mandatory, can be volume/pressure controlled, triggered by patient

19
Q

How to set up tidal volume

A

8cc/kg based on ideal body weight

20
Q

What is physiologic PEEP?

A

at least 5

almost everyone should get PEEP!

21
Q

How to set FIo2

A

@ 100% then decrease as soon as ABG performed (20 min after intubation)

22
Q

how to tailor ventilator setting to improve oxygenation

A

increase FI02

or increase PEEP

23
Q

how to tweak ventilator to improve ventilation

A

increase RR

increase TV

24
Q

what to order as soon as patient is done intubating

A

chest xray

ABG