Critical Care Bcps - Last 10 Pages Of Cc

Front 1

What are the 2012 SSC (surviving sepsis campaign) blood glucose goals for pts in the ICU?

Back 1

-initiating insulin when two consecutive blood glucose readings are greater than 180 mg/dL.

-titrate insulin therapy to be kept less than or equal to 180 mg/dL

Front 2

What are the 2012 Society of Critical Care Medicine recommend for BG goals in ICU pts?

Back 2

-if BG is 150 mg/dL or higher then insulin management should be initiated.

-titrate insulin to keep BG less than or equal to 150 mg/dL

Front 3

What is considered a hypoglycemic BG?

Back 3

70 mg/dL or less

Front 4

What pts are is continuous insulin infusion preferred in?

Back 4

type 1 diabetics

pts w/ hyperglycemia who are hemodynamically unstable

for those whom long acting basal insulin should not be used in because of changing clinical status

Front 5

What pts should SubQ insulin be avoid in?

Back 5

pts on vasopressors

pts w/ significant peripheral edema

pts requiring rapid correction of blood glucose

Front 6

How often should BG be checked in pts on a continuous insulin infusion?

Back 6

1-2 hrs

arterial or venous whole blood sampling is recommended over point of care testing

Front 7

What are S/S of stress ulcers?

Back 7

hematemesis, gross blood in gastric tube aspirates, coffee ground emesis or aspiration from gastric tube, and melena.

Front 8

What pts are stress ulcer prophylaxis recommended?

Back 8

1. Initiate if either of these major risk factors present

a. respiratory failure necessitating mechanical ventilation

b. coagulopathy defined as plts < 50,000, INR > 1.5, or activated partial thromboplastin time more than 2x control

2. initiate prophylaxis or continue home acid suppressive therapy for any pt w a hx of Gi ulceration or bleeding w/in 1 yr of ICU

3. Phrophylactic meds recommended if 2 or more of the following present

a. head or spinal cord injury

b. severe burn (>35% of body)

c. hypoperfusion

d. acute organ dysfunction

e. high doses of corticosteroids (>250mg/d)

f. liver failure associated w/ coagulopathy

g. postop transplant

h. acute kidney injury

i. major surgery

j. multiple trauma

Front 9

What are some adverse effects of H2-receptor blockers?

Back 9

mental status changes

thrombocytopenia (cimetidine)

Front 10

What are some adverse reactions and risks associated with PPIs?

Back 10

headache, diarrhea, constipation, abdominal pain, nausea

Risk of ventilator-associated pneumonia increased

Risk of C.Diff infection

Risk of pneumonia in general (HCAP or CAP)

Front 11

What meds are not recommended for stress ulcer prophylaxis?

Back 11

antacids

avoid sulcralfate: found to be inferior to h2blockers

Front 12

What are risk factors for VTE?

Back 12

surgery, major trauma, lower extremity injury, immobility, malignancy, sepsis, heart failure, respiratory failure, venous compression, previous VTE, age, pregnancy, obesity, central venous cath, myeolid growth factor hx

Front 13

What is some nonpharmacologic prevention of VTE?

Back 13

1. early mobility is the best

2. mechanical prophylaxis w/ intermittent pneumatic compression or graduated compression stockings are recommended if medical proph contraindicated

-can use mechanical in addition to medical

Front 14

What are teh SSC and ACCP recommendations for VTE prophylaxis?

Back 14

a. LMWH lor low-dose unfractionated heparin

b. if bleeding; use mechanical

Front 15

When compared with enoxaparin, how did rivaroxaban fair as a VTE prophylaxis agent?

Back 15

it was as efficacious as enoxaparin at day 10, however, there was an excess risk of bleeding in the rivaroxaban group.

Same with apixaban

Front 16

what factor Xa is contraindicated in pts w/ CrCl < 30?

Back 16

fondaparinux

Front 17

For pts with regional anesthesia (lumbar puncture, epidurals, lumbar drains) what are the guidelines are pts receiving antithrombotic therapy?

***American Society of Regional Anesthesia and Pain Medicine

Back 17

a. no contraindication to low-dose UFH at doses less than 10000mg/day.

b. for LMWH, needle placement should occure 10-12 hrs after the last LMWH dose.

c. indwelling catheters should be removed before initiating BID LMWH postoperatively, however, a daily regimen is OK

i. first dose of LMWH should be atleast 2 hours after catheter removal

ii. catheter removal should be at least 10-12 hours after the last LMWH dose

d. AVOID FONDUPARINUX

Front 18

What is recommended to help prevent complications from ventilator-associated pneumonia according to the ventilator bundle?

Back 18

1. head of beat elevated

2. daily sedation interruptions and assessment of readiness to extubate

3. stress ulcer prophylaxis

4. VTE prophylaxis

5. daily oral care w/ clorhexidine (0.12%)

Front 19

What are some proven ways to reduce infection in pts w/ VAP but aren't widely used?

Back 19

1. Selective decontamination of the digestive tract (SDD)

i. SDD is a short course of antimicrobial therapy aimed at eradicating potential pathogens to minimize ICU-aquired infections

ii. despite decades of research, not routinely performed

2. endotrachial tubes coated in silver

Front 20

How long to American and Canadian guidelines allow a critically ill pts to be hypocaloric before TPN is started?

Back 20

for a previously well nourished pt 7 days of hypocoloric feeding is OK wait to see if oral intake an increase. If not, consider TPN

Front 21

What is indirect calorimetry?

What is normal?

What level should make you question test validity?

Back 21

Indirect calorimetry measures the metabolic rate, but requires special equipment and trained staff. Indirect calorimetry is measured as respiratory quotient (RQ).

Normal RQ is 0.82 to 0.85

RQ less than 0.67 or greater than 1.3; outside range, question test validity

Front 22

What does the SSC (surviving sepsis campaign) recommend when it comes to hypocaloric feeding?

What about obese pts?

Back 22

avoid full caloric feeding in the first week, rather initiate low dose feeding (up to 500 kcal/day), advance as tolerated.

One study showed that intentional underfeeding (60-70%) but still providing 90-100% of protein showed a significant reduction in mortality.

For obese pts (BMI > 30) give 60-70% of target or 11-14 kcal/kg of actual body weight per day. Protein of 2-2.5 g/kg IBW

Front 23

What are the protein needs of critical pts?

Back 23

protein of 1.2-2 g/kg of actual body weight

i. CRRT may require 2.5 g/kg/d

ii. AKI may need as little as 0.6-0.8 g/kg/d

iii. pts w/ extensive burns may require up to 3 g/kg/d

Front 24

What area of the GI tract should EN be administered if possible?

Why?

Back 24

administer directly to the small bowel

reduces risk of pneumonia