Most common type of delirium in the ICU
Mixed delirium
Receptors involve in Dyspnea sensation (3)
Chemoreceptors peripheral (carotid bodies and aortic arch) and central (located in the medulla) PH / CO2
Upper airway receptors: Innervated by the trigeminal nerve (Fan)
Chest wall Mechanoreceptors
Pulmonary receptors: via the vagus nerve:
●Pulmonary stretch receptors, activated by increase in tension in the walls of airways,(hyperinflation). Slowly adapting receptors
●Irritant receptors: Stimulated by mechanical stimuli, or inhalation of irritants. Rapidly adapting
● Juxta pulmonary capillary receptors (c fibers) stimulated by mechanical and chemical factors.
Survival after withdrawal of dialysis (ambulatory)
7 to 10 days
Opioid receptors in the respiratory system
mu-opioid receptors
Six steps of the SPIKES model of communication
Setting
Perception
Invitation
Knowledge
Emotion/empathy
Strategy/summary
Percentage of VC at which PEG should be place in ALS patients
PEG should be placed when vital capacity (VC) falls to 50 percent of predicted. There is increased morbidity of the procedure as respiratory function declines.
Average 5 year survival in dialysis patients
50%
Life expectancy 25% of non renal pts
25% Die after decision to D/C dialysis
Opioid for ICU patients with renal failure
Fentanyl
Medications that need to be stopped in a patient with hypercalcemia (3)
Thiazide, Digoxin, Lithium Ca supplements theophylline, tamoxifen, Vitamin A and D
Mechanisms by which supplemental oxygen may reduce dyspnea (3)
Reversal of hypoxemia
Reduced PA pressure, dynamic hyperinflation and ventilatory muscle fatigue
Stimulation of facial, nasal, or pharyngeal receptors
Increased capacity for exercise training
Placebo effect
90 day mortality rate for cancer related hypercalcemia
75%
Opioid that is least associated with respiratory depression
Buprenorphine
Partial mu agonist: It has a ceiling effect on respiratory depression
Management bowel obstruction when surgery is not an option (3)
Analgesics, Octreotide, anticholinergics, GI decompression, glucocorticoids, antiemetics (haldol)
Mechanisms by which opioids may reduce dyspnea (3)
Analgesia - reduce pain-induced respiratory drive
Anxiolytic effects
Vasodilation (improved cardiac function, decreasing preload)
Decreased metabolic and ventilatory requirements
Reduced medullary sensitivity and response to hypercarbia or hypoxia
Blunted afferent transmission from pulmonary mechanoreceptor to the CNS
Alteration of neurotransmission within medullary respiratory center
Cortical sedation (suppression of respiratory awareness)
Minimal performing status to tolerate chemotherapy
ECOG PS 2
0: Fully active. 1: Ambulatory light work. 2: Self-care, Up >50% of waking hrs 3: Bed or chair>50% of waking hrs 4: Completely disabled; confined to bed or chair.
AB initially discovered as psychotropic with antidepressant effects.
Linezolid
Variables of Provent score (Prognosis of prolonged MV)
-Age >50
-Hemodialysis
-Thrombocytopenia
-Vasopressors
Validated at day 14 and 21 of MV.
0--> 15 %mortality, 3 --> 97% mortality
Elements of DECAF score (COPD in hospital mortality)
Dyspnea,
Eosinopenia,
Consolidation,
Acidemia
Fibrillation (atrial)
Minimal life expectancy needed to recommend Surgery for spinal cord compression due to metastatic cancer
Greater than 3 months.
First test needed when admitting patient with methadone use
ECG
Associated with prolonged QT and torsade. QT >500 msec in up to 10% of pts.