Q3 Shock/burns

Question 1

See cards 58-67 of pulm

Question 2

What is the BEST indicator of hydration status?

Answer 2

UOP: 30-50ml/hr in adults, and 0.5ml/kg/hr in Peds.

Question 3

What is a common method for maintenance IVF therapy?
For a 76kg patient?

Answer 3

100ml/kg for 1st 10kg, 50ml/kg for next 10-20kg + 20ml/kg for every kg greater than 20
1000+1000+920 = 2,920ml/day = 121ml/hr.

Question 4

When should vasopressors NOT be used in hypovolemia?

Answer 4

When shock is 2* to or accompanied by cardiac failure.

Question 5

For hemorrhagic shock, what is the SBP and MAP target?

Answer 5

Permissive hypotension
SBP<90mmHg
MAP <55

Question 6

Since symptoms are vague, you might not catch hemorrhagic shock in these stages?

Answer 6

Stage I and II. Most trauma patients have a lot of adrenalin going on - they are naturally going to be anxious, antsy, tachypneic and tachycardia……. Or are they??

Question 7

CaCl every _____ Units PRBC during MTP?

Answer 7

4 units to maintain Ca++>1.0

Question 8

What should we administer to patients with severe bleed within 3 hours of their traumatic injury?

Answer 8

Anti-fibrinolytic therapy

Question 9

If a patient with an unknown blood type gets a infusion of LTOWB, then what will their subsequent infusions be fore up to 1mo?

Answer 9

LTOWB or group O, because it is not possible to test their blood type after receiving LTOWB.

Question 10

FWB can be stored for?

Answer 10

35days in CPDA-1
21 Days CPD
8hours at room temp.

Question 11

Universal donor?

Answer 11

O neg.

Question 12

What plasma is considered universal? However what if you don’t have it?

Answer 12

Type AB is considered Universal and can be given to anyone, however plasma type A has such low antiB antigens that it can be used instead in the absence of AB.

Question 13

Is kcentra (4-factor ______ pcc) activated or unactivated?
3-factor Profiling/bebulin?
Febia?

Answer 13

kcentra = UNactivated
UN activated
ACTIVATED

Question 14

Kcentra MOA.
SE?

Answer 14

4-factor unactivated pcc
Increased levels of vit K dependent coagulation factors (II, VII, IX and X and C + S)
SE: hypotension, tachycardia, a fib, Pulm Edema, HA, thrombosis, flushing, MI.

Question 15

3-factor unactivated pcc (Profilnine/bebulin) MOA?
SE?

Answer 15

MOA: replace deficient clotting factor including factor, II, XI, X and some VI.
Control bleeding in those with little factor IX (hemophilia B or Christmas disease)
SE - similar to 4-factor

Question 16

FEBIA MOA?
SEs?

Answer 16

MOA: factor VIII antibody inhibitor bypass to control bleeding by induction and facilitation of thrombin generation.
SE: CVA, PE, tachycardia, thromboembolism, malaise, abd distress, bronchospasm

Question 17

TXA MOA
SEs?

Answer 17

TXA = forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis - blocks plasmin formation.
SE: abd px, HA, anemia, fatigue, muscle cramps, DVT, profound hypotension (if administered rapidly), sz, visual disturbances.

Question 18

Vasopressin MOA
SEs

Answer 18

MOA: synthetic ADH = absorb more NA/fluid and vasoconstriction
SE: a fib, bradycardia, ischemic heart disease, hypoNa, low plt, hemorrhage, D renal insuff.

Question 19

Octreotide MOA, SEs?

Answer 19

MOA: mimics somatostatin and reduces blood flow to the portal system
SEs: sinus Brady, HTN, fatigue, hyperglycemia, anemia, blurred vision, PE, prolonged QT.

Question 20

What is a treatment for CHRONIC not ACUTE anemia?
Goal? Onset?
SEs?

Answer 20

Erythropoietin
Start if Hgb <10
2-4wk onset.
Goal Hgb = 11 in 2-4wks
SEs: HTN, HA, purities, N/v, fever, joint pain, thrombosis, CVA, erythema,

Question 21

Sepsis criteria

Answer 21

Organ dysfunction (>=2qSOFA) + confirmed or suspected infx.
GCS < 15
RR > = 22
SBP <=100

Question 22

Septic SHOCK criteria

Answer 22

Sepsis PLUS
Hypotension requiring vasopressors
Lactate >2 despite fluid resuscitation.

Question 23

For septic shock, administer fluids at a rate of __________ to get a UOP of _______

Answer 23

30ml/kg/3hrs
0.5-1ml/kg/hr

Question 24

QSOFA (quick sequential Organ Failure Assessment)

Answer 24

AMS: GCS <15
Tachypnea: RR> =22
Hypotension: SBP <=100

0 or 1 point = not high risk, continue to manage as appropriate

2-3points High risk of poor outcome, assess for evidence of organ dysfxn.

Question 25

Your patient has GCS 15, RR 22 and SBP 107. What is their qSOFA score?

Answer 25

1 point (for RR >=22).

Question 26

When is the qSOFA score performed?

Answer 26

24hrs after admission and every 48hrs.

Question 27

What is to be completed within the 1st hour of suspected or dx sepsis?

Answer 27

Lactate, blood cultures, broad spec abx, fluid resuscitation

Question 28

Goal of fluid resuscitation in sepsis?

Answer 28

To restore intravascular volume.

Question 29

VAP Abx for gram+w/MRSA

Answer 29

Vanc/Linezolid

Question 30

VAP abx for gram-

Answer 30

PCN, cephalosporins, carbapenim or Aztreonam.
Non-betalactam based agents
Cipro, levo, amikacivn, gent, Tobramycin, polymixin.

Question 31

VAP abx for gram-

Answer 31

Flour

Question 32

When should vasopressors be used?

Answer 32

AFTER restoration of intravascular volume - fill the tank before pressing the gas

Question 33

What is the 1st line vasopressors?

Answer 33

Norepinephrine (levophed)

Question 34

2nd and 3rd line vasopressors?

Answer 34

Vasopressin or epi
Dopamine
Phenyllephrine
Dobutamine/milrinone.

Question 35

What is the 1st line vasopressors in anaphylactic shock?

Answer 35

Epinephrine.

Question 36

What is the initial agent of choice in cardiogenic shock with low CO and maintained BP?

Answer 36

Dobutamine.

Question 37

What does norepinephrine act on?

Answer 37

Alpha1 and some Beta1

Question 38

What is Hct?

Answer 38

RBC vol/total blood vol.

Question 39

When would you use Corticosteroids in sepsis?
Clinical considerations?

Answer 39

Refractory Hypotension despite adequate pressures.

Monitor glucose and Na levels. No evidence to prove improved clinical outcomes.