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21 Cards in this Set
- Front
- Back
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How to determine if respiratory or metabolic alkalosis/acidosis? (4) |
Acidosis (pH under 7.35) a) respiratory if PCO2 is elevated b) metabolic if HCO3 is decreased
Alkalosis (pH over 7.45) a) respiratory if PCO2 is decreased b) metabolic if HCO3 is increased |
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Treatment of respiratory acidosis, respiratory alkalosis, metabolic acidosis?
Treatment of metabolic alkalosis? |
CORRECT THE CAUSE
correct cause BUT if urine Cl- is under 10 use NS first, acetazolamide if not responsive to that and HCl if pH over 7.55 |
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normal PCO2 level
Normal HCO3 level
Normal pH level |
a) 35-45
b) 22-26
c) 7.35 to 7.45 |
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Hypovolemic shock tx (3) |
a) crystalloids or colloids b) blood products if in hemorrhagic shock c) vasopressor if hypotensive and not reversable with fluids |
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Sepsis tx (5) |
a) NS or LR at 30mL/kg as long as you see hemodynamic improvement after each 1000mL bolus b) consider albumin when patients need significant crystalloids c) hetastarch NOT recommended (incr risk of kidney injury/death) d) vasopressors to keep MAP over 65; levophed is drug of choice e) start abx ASAP |
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Choice of vasopressor in shock after levophed (4) |
a) epinephrine can be added to or sub for NE if needed b) vasopressin can be added to NE if needed c) dopamine is an alternative to NE; but increased risk of arrhythmia d) phenylephrine is an alternative in pts with vasopressor induced tachyarrhymthia or persistent hypotension |
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When to empirically start antifungals in a septic patient? (5) |
a) abdominal surgery b) chronic parenteral nutrition c) indewelling CVC d) recent tx w/ broad spectrum abx e) immunocompromised |
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Bicarb use in sepsis? |
NO, never |
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Order of doing airway, breathing, chest compressions in CPR? |
CAB, reduces time to chest compression |
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Med admin during a code? (3) |
a) intraosseous is preferred over endotracheal if IV is not possible
b) NAVEL (naloxone, atropine, vasopressin, epinephrine, lidocaine) can be given by endotrachael
c) be sure and dilute meds in 20mL if given peripheral IV to facilitate drug flow |
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When to consider hypothermia after cardiac arrest? (3) |
a) for 12-24h beginning ASAP after cardiac arrest can improve neurologic recovery and mortality
b) do not give if its over 10h after cardiac arrest
c) consider in patients who have been resuscitated but remain comatose |
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2 sedatives to never bolus? |
a)propofol b) dexmedetomidine
causes hypotension and/or bradycardia |
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Use of a lot of lorazepam complication
How to tell it is/will happen (2) |
a) propylene glycol toxicity
b) osmolal gap over 10 indicates it b) total daily dose of 1mg/kg can cause it |
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Best IV benzo if hepatic or renal failure |
lorazepam (diazepam and midazolam will have prolonged effect both have active metabolites with lorazepam will not) |
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Propofol dosing
Dexmedetomidine dosing |
a) 5mcg/kg/min and titrate by 5mcg/kg/min every 5 minutes until goals achieved
b) 0.5mcg/kg/hr for a max of 24 hours |
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Delirium treatment (2) |
a)haloperidol 1-10mg (start with 1mg IV and double the dose very 20minutes)
b) atypicals are alternatives |
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Stress ulcer prophylaxis is recommended for what patients (with two or more of the following risk factors)-dont forget about plt under 50, INR over 1.5 on vent for 48+hrs (11) |
1) head or spinal cord injury 2) severe burn (more than 35% of BSA) 3) hypoperfusion 4) acute organ dysfunction 5) hx of GI bleed/ulcer w/in 1 year 6) high doses of steroids (steroid use alone is NOT a risk factor) 7)liver failure with coagulopathy 8) postoperative transplantation 9) acute kidney injury 10) major surgery 11) multiple trauma |
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Calculating MAP |
(2 X DIASTOLIC)+SYSTOLIC DIVIDED BY 3 |
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NE is better than dopamine b/c.... |
less tachyarrhythmias |
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Never use a paralytic on what type of patient... |
if the patient is NOT SEDATED |
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Drugs that potentiate a nerve block (5 among others) |
a)AGs b) corticosteroids c) furosemide d) cleocin e) tcn |
