Onc Emergencies
Febrile neutropenia is defined as a single oral or axillary temperature greater than 101 degrees F in a patient with an ANC less than what value?
<500
This is the first line vasopressor agent recommended by the 2016 Surviving Sepsis Campaign Guidelines
Norepinephrine
The initial target RASS goal in a mechanically ventilated ICU patient is:
0 to -1
The 2016 Surviving Sepsis Campaign Guidelines recommend this type of fluid for volume resuscitation for patients with sepsis and septic shock
Crystalloids
This study showed a benefit of Angiotensin II in increasing blood pressure in patients with vasodilatory shock that did not respond to high doses of conventual vasopressors
ATHOS-3 Trial
This drug functions to break down uric acid and is used in the treatment of TLS
Rasburicase
The SOAP II study showed significantly more CV adverse events with the use of this agent in septic shock
Dopamine
Name 3 interventions to reduce pain in the ICU
A code blue is called to labor and delivery and upon arrival you notice a bag of magnesium sulfate infusing. What should be given in the setting of hypermagnesemia?
Calcium
This trial showed a higher number of ventilator free days and lower mortality in patients with NON covid ARDS treated with dexamethasone 20mg IV x 5 days followed by 10mg IV x 5 days
DEXA ARDS
This potential complication of TLS is the cornerstone in regards to treatment/prevention and is a major predictor of mortality
AKI
These receptors are located in the CNS and GI tract and cause decreased sympathetic tone with activated
alpha-2
Cisatracurium is metabolized via this mechanism
Hoffman Elimination
What is the formula to calculate free water deficit?
TBW x ((Serum Na/140)-1)
This trial which was modeled after the DEXA ARDS trial showed benefit for the treatment of moderate to severe COVID-19 ARDS
CoDex Trial
If no source is identified in a NF patient, antibiotics should be discontinued after afebrile for how long?
48 hours
Name the four main shock states
Hypovolemic, cardiogenic, obstructive, distributive
Bradycardia, metabolic acidosis, and an elevated creatine kinase can all be signs of what adverse reaction to a common ICU sedative?
PRIS
Pt RJ is admitted with 2 week history of diarrhea and poor oral intake. She is started on D5W1/2NS at 125/hr. Next morning labs Na 141 mEq/L, K 2.9 mEq/L , SCr 0.5 mg/dL, Phos 1.4 mg/dL. What is likely cause of hypophosphatemia?
Glucose admin/refeeding syndrome
This trial showed no difference in composite of thrombosis or mortality comparing standard vs intermediate dose VTE PPX in covid patients.
INSPIRATION
What are four factors that would prompt the addition of vancomycin in a NF patient?
hypotensive, skin and soft tissue source, currently taking a FQ or Bactrim, have an indwelling catheter
Name the SLHS Giapreza restricted use criteria (5 items)
1. Restricted to Critical Care attending physician for patients with septic shock who meet the following use criteria:
2. Pharmacological VTE Prophylaxis present, AND
3. Adequate fluid resuscitation delivered, AND
4. MAP ≤ 65 mmHg AND
5.Receiving the following combination of medication therapy for at least 6 hours:
Norepinephrine 0.5 mcg/kg/min and increasing
Vasopressin 0.04 units/min
Hydrocortisone 50 mg every 6 hours
Name all four components of the Berlin Criteria
Timing -w/in 7 days symptom onset
Chest radiography -bilateral infiltrates
Oxygenation - P/F less than 300
Edema -not caused by HF
Patient TB presents with complaints of N/V and headache over last several weeks. Initial labs significant for Na of 116 and serum Osm of 265. Appears euvolemic on exam and was recently started on carbamazepine. What is likely cause of hyponatremia?
SIADH
This study compared regional citrate with systemic heparin use in critically ill patients with AKI on CRRT and showed regional citrate extended filter life compared with systemic heparin
The RICH trial