ERCC Flashcards
(98 cards)
1
Q
At what level of fluid resuscitation does Abd ACS
become a concern?
A
>250ml/kg within 24hrs
2
Q
A bladder pressure >_____ should be monitored for possible ACS.
A
>12 mmHg
3
Q
Bladder pressure over _____ indicates active ACS.
A
>20mmHg
4
Q
A pt with low UOP, high PIPs and low BP
are most likely suffering from
A
Abdominal Compartment Syndrome (ACS)
5
Q
Initial priorities in treating ACS:
A
- 100% FiO2
- Sedation and paralysis
- Stomach/bladder decompression (NGT/OGT & Foley)
- Reverse Trendelenburg (in flt = not on backrest)
- Initiate Vasopressors for Hypotension
- Paracentesis if >20mmHg (g=<20)
6
Q
Adjunct used when mask ventilating a pt prior to intubation:
A
NPA or OPA
7
Q
Airway alternatives if provider is inexperienced with intubation:
A
LMA (I-Gel) or Cricothyocotomy
8
Q
Acronym for assessing high PIPS:
A
D: Displacement
O: Obstruction
P: Pneumothorax
E: Equipment
9
Q
Minimum ETT size for burns
A
ETT 8.0
10
Q
GCS criteria for intubation
A
GCS of 8 or lower
“GCS 8, intubate”
11
Q
TBSA >____% requires intubation
A
40%
12
Q
TBSA >_____% is criteria to begin fluid resuscitation.
A
20%
13
Q
UOP goal for burn pt’s.
A
30-50 ml
14
Q
MAP goal for burn pt’s with UOP >30cc/hr
A
MAP >55 mmHg
15
Q
CVP goal for burn pt’s.
A
CVP 6-8 mmHg
16
Q
Rule of 10’s:
A
10ml/%TBSA/hr + 100ml per 10kg over 80kg
17
Q
High limit for fluid resuscitation in burn pt.
A
> Over 1,500 ml or projected >250 ml/hr in 24 hrs
18
Q
When should you initiate 5% Albumin in a burn pt?
A
8-12 hrs post-injury
19
Q
How often are you required to monitor
bladder pressure when indicated?
A
Q 4 hrs
20
Q
Per the Burn CPG, UOP >50ml/hr and MAP >55mmHg indicates:
A
the need to reduce the IVF rate by 20-25%
21
Q
Per the Burn CPG, if CVP > 6-8mmHg, treat by
A
First-line: starting Vasopressin at 0.04 units/min
Second line: Norepinepherine 2-20 mcg/min
Third: Epinepherine 2-20 mcg/min
Fourth: Phenylepherine 50-200 mcg/min
22
Q
pH goal for a burn pt is:
A
pH > 7.2
23
Q
iCal goal for burn pt’s
A
iCal >1.2
24
Q
Preferred MIVF for burn pt’s:
A
LR
25
Systolic goal for Catastrophic Head TBI:
SBP \>100mmHg
26
MAP goal for Catastrophic TBI:
MAP \> 65 mmHg
27
CVP goal for Catastrophic TBI:
CVP \>7
28
Regarding Catastrophic TBI, initiate T4 protocol if total vasopressor dose \>\_\_\_\_\_\_.
15 mcg
29
INR goal for Catastrophic TBI:
INR \<1.5
30
Plt goal for Catastrophic TBI:
Platelets \>50K
31
ICP goal for Catastrophic TBI:
ICP \< 22 mmHg
32
SBP goal for unmonitored Catastrophic TBI:
SBP \>110 mmHg
33
CPP goal for Head Injury:
\>60
34
PaCO2 goal for Head Injury:
35-40 torr
35
SpO2 goal for Head Injury:
SpO2 \>93%
36
PaO2 goal for Head Injury:
PaO2 \>80 torr
37
First-line diuretic for Head Injury:
3% (Hypertonic) Saline
bolus 250 ml + 50 ml/hr
check Na q4 hrs with goal of \_\_\_\_\_\_
38
First-line pressor for Head Injury:
Vasopressin
Then → Phenylepherine or Norepinepherine
39
First-line paralytic for Head Injury:
Vecuronium
0.1 mg/kg or 10 mg IVP
40
Treat temp for Head Injury _if_ :
99.0 deg F
(mechanical and pharmacological)
– watch out for seizures above this
41
Hgb and Hct goal for Catastrophic TBI:
10/30
42
Volume status goal for Head Injury:
Euvolemia
43
Head position goal for Head Injury:
– Elevated 30 deg
– Head Midline
– Non-constricting C-collar & tube securing devices
44
Seizure prophylaxis for Catastrophic TBI:
Phosphenytoin
Fosphenytoin
Keppra
45
Prepare for effects of Catastrophic TBI:
Increased ICP
Vasospasms
waxing/waning mental status
seizures
46
Catastrophic TBI - T4 protocol meds:
1 amp D50
Solumedrol 2g
Regular Insulin 20 units (via IV or SQ)
Thyroid Hormone (t4) 20 mcg + 10mcg/hr
47
Catastrophic TBI Diabetes Insipidus (DI) Tx:
DI = DDAVP 2-4 mcg q 2-4 hrs IVP (4mcg/ml)
location: fridge bag
48
If give T4 protocol to a Catastrophic TBI,
monitor and treat for:
Decreased potassium
| (T4 induces dec K)
49
Preferred sedation and pain control in Catastrophic TBI:
Propofol and Fent
50
Positioning preference with Abd ACS
Reverse Trendelenburg
51
Vasopressor MAP goal in Abd ACS
\>60 mmHg
52
Prior to pressor administration in an Abd ACS, ensure:
NO active bleeding
| (pressors don't fill the tank)
53
Immediate treatment for pulmonary embolism:
100% FiO2
54
PaO2 less than _____ indicates hypoxemia in a normal pt per CPG
\<60mmHg
55
PaO2 goal for burn pt's:
PaO2 \>70 torr
56
SpO2 goal for burn pt's:
SpO2 \>92%
57
P/F ratio under _____ indicates some degree of ARDS
\<300
58
Goal PIP for intubated pt:
30-35 cm H2O
59
PBW equation for males:
50 + (2.3\* (Ht-60))
60
PBW for females:
45.5 + (2.3\* (Ht - 60))
61
Vt (tidal volume) range for ARDSnet protocol:
4-6 ml/kg
– Can start at 8ml but must titrate w/in 2 hours
62
SpO2 goal for pt's in respiratory failure:
88-95%
63
pH goal for pt without lung pathology:
pH \>7.3
64
Normal range for RR (Resp Rate):
6-35
65
I-time should be approx _____ for each pt:
1.0 (give or take)
66
A pt with an FiO2 of _____ and a PEEP of \_\_\_\_\_
should be reconsidered for transport.
FiO2 70% and PEEP 14cm H20
67
Consider proning a pt if P/F ratio is less than:
P/F ratio of 150
68
Indications for ECMO
| (Top 3)
P/F ratio \<100 (severe)
FiO2 \>70%
PEEP \>15
69
VSB is only indicated for spine injuries
occurring in the _____ and ______ vertebrae.
Thoracic and Lumbar
70
SpO2 goal for spinal cord injuries pt's:
\>93%
71
MAP goal for spinal cord injuries:
MAP \>85-90 mmHg
72
Spine injury pt's should be log rolled every _____ hrs.
q2 hrs
73
Goal Abdominal Perfusion Pressure:
\>60 mmHg
74
Concentration for Propofol:
10mg/ml
75
Concentration for Etomidate:
2mg/ml
76
Concentration for Ketamine:
1mg/1ml
77
Dose for Succinylcholine:
1-1.5mg/kg
78
Concentration for Fentanyl:
50mcg/ml
79
Dose for Vasopressin:
2.4 Unit/hr = (0.04U/min)
80
Risk factors associated with Abd ACS:
Trauma
Burns
Internal Bleeding
Massive Transfusion
Massive Fluid replacement (\>250ml/kg in 24 hrs)
Bladder pressure \>12mmHg
Post-op TAC's (temp abd closure's)
81
Differential for profound hypotension not responsive
to fluids and/or vasopressors:
Abdominal Compartment Syndrome (ACS)
82
Burn hourly fluid titration:
Increase/Decrease IVF by 20-25% q hour
f/UOP goal of 30-50ml/hr
83
Circumferential burns treatment:
Escharotomies
84
Burn pt with a Head injury – specific considerations:
Use Normal Saline (instead of LR)
and
FFP (instead of Albumin)
85
In burn care treatment – If UOP \<30 but MAP and CVP at goal:
Accept renal insult and STOP increasing IVF
86
Initiate Difficult Resus Guidelines for Burn Care if:
At 8-12 hr post-burn, the fluid rate is \>1,500 ml/hour
OR
projected 24 hour total for fluids is \>250 ml/kg
87
Per CPG, monitor for abdominal/extremity compartment syndrome
q\_\_\_\_hrs.
q4hrs
88
IF bladder pressure:
\>12 mmHg consider \_\_\_\_\_\_
\>20 mmHg consider \_\_\_\_\_\_
\>12 mmHg consider _colloids_ (albumin, dextran)
\>20 mmHg consider _paralytics_
89
5% Albumin in Burn Resus guidelines:
_IF_ over the 1500ml or 250ml/kg in 24 hrs
– Initiate at 8-12 post-burn injury
AND
– Continue Albumin until 48 hr mark
with attempt to wean IVF at same time
90
Goal MAP for burn pt's UOP \<30cc/hr:
MAP \<55mmHg
and utilize Hypotensive Guidelines
91
Burn Hypotensive Guidelines for
UOP \<30 ml/hr or MAP \<55 mmHg
first step:
_Assess for missed injuries_
– Bleeding?
– Renal Insult? (d/t Rhabdo)
– Adrenal? iCal?
– CVP/volume?
92
Burn Hypotensive Guidelines for
UOP \<30 ml/hr or MAP \<55 mmHg
second step:
Assess CVP
Goal = 6-8 mmHg
93
Burn Hypotensive Guidelines for
UOP \<30 ml/hr or MAP \<55 mmHg
_IF_ CVP \<6:
Increase fluid rate by 20-25%
and
resume hourly goal assessments
94
Burn Hypotensive Guidelines for
UOP \<30 ml/hr or
MAP \<55 mmHg & CVP \>6-8:
Start Vaso 0.04 u/min
If MAP remains \<55, add Norepi 2-20mcg/min
If still \<55 add Epinepherine and/or Phenyleprine
Consider: Dobutamine 5mcg/kg/min ( if **suCO2** \<60)
95
Burn Hypotensive Guidelines for
UOP \<30 ml/hr or MAP \<55 mmHg
– reevaluate for Refractory Hypotension if not at any pressor goal:
\*\* Missed injury/bleeding
– Acidemia - pH\<7.2
Hypocalcemia - iCal \<1.2
Adrenal Insufficiency - Hydrocortisone 100mg q8 hr
96
Hypoxemia Mgmt -- High PIP's differentals:
– Pt agitation/dyssynchrony - sedation, pain, not tol vent settings, paralyze)
– Obstruction - kinked, bronchospasm, PE, atelectasis
– External compression - chest eschar, Abd ACS
– Decreased lung compliance - ARDS
97
Common causes of ARDS:
Direct vs Indirect Lung injury--
Direct: PNA, aspiration (gastric), combat--pulm contusion, inhalational, fat emboli
Indirect: polytrauma, req mass transfusion, septic shock, severe/acute pancreatitis
98
Avoid ________ for spinal cord injuries sustained in theater.
Avoid STEROIDS
