ICU Lecture

Question 1

ABCDEFGHI

Answer 1

Airway 
Breathing
Circulation
Disability 
Exposure/environment/examination
Finger in every orifice 
Glucose, NG tube
Hang fluids (fluids/abx)
Inject (tetanus, pain meds)

Question 2

3Cs for managing a crashing pt

Answer 2

Control the room
Communicate
Continue with confidence

Question 3

What labs do we check every time an ICU pt is having trouble breathing?

Answer 3

ABG pH/pCO2/pO2/HCO3-

troponin
BNP

Question 4

What do you do if you suspect an ICU pt has PNA?

Answer 4

ask them if they have hospitalized within the last 90 days

get 2 blood cultures from 2 different areas

Question 5

How do you treat CAP vs HCAP?

Answer 5

community acquired PNA vs hospital acquired PNA

community - macrolide (azithromycin) or cephtriaxone
(levofloxacin if PCN allergy)

hospital - pip/tazo + vanco (meropenem + vanco if allergic to PCN)

Question 6

5 Ws for courses of post-op fever

Answer 6

Wind (1d) - atelectasis 
Water (3d) - UTI (pts on narcotics don't void often and are at an increase risk of UTI) 
Wound (5d) - SSI
Walking (7d) - DVT
Wonder (9d) - drugs

Question 7

Rank the methods of oxygen delivery from least oxygen % to most

Answer 7

NC = Venti mast < simple face mask < NRB

Question 8

CPAP vs BiPAP

Answer 8

CPAP

• constant pressure
• no ventilatory support
• OSA, pulm edema

BiPAP

• additional pressure during inhalation
• assists ventilatory muscles
• COPD, ALS, muscle dystrophy

Question 9

How can you tell if your NIV is effective?

Answer 9

NIV - no invasive ventilation (BiPAP)

if the acidosis is correcting
increase in pH and a decrease in pCO2

Question 10

When is BiPAP NOT recommended?

Answer 10

cardiac arrest 
ARDS
end stage pulmonary fibrosis 
unstable shock 
upper airway surgery

Question 11

When to intubate?

Answer 11

respiratory arrest 
GCS < 8 
hemodynamic instability 
suspected increase ICP 
symptomatic dysrhythmia