ACLS
What are the cornerstones of ACLS?
Excellent CPR and early defibrillation of treatable arrhythmias
Name at least two ICU admission criteria?
Unstable airway/respiratory failure, hypotension, life threatening cardiac arrhythmias, severe metabolic derangements, need for frequent measurement of vitals (< q 2 hrs)
Name types of shock?
Hypovolemic, cardiogenic, distributive (septic, neurogenic, anaphylactic), obstructive (tamponade, PE, pneumothorax).
What is vasopressor of choice in patient with anaphylaxic shock?
Epinephrine
Name 4 ventilator settings?
Rate, tidal volume, FiO2, PEEP
Treatment of choice for pulseless ventricular tachycardia and ventricular fibrillation?
Defibrillation
What is target MAP in patient with septic shock?
Target MAP > 65 mmHg
Define septic shock?
Sepsis-induced hypotension and perfusion abnormalities developed despite adequate fluid resuscitation.
What is vasopressor of choice in patient with septic shock?
Norepinephrine
Calculate tidal volume for male patient with Ideal Body Weight of 70 kg?
420 - 560 ml (6 -8 ml/kg)
Males: IBW = 50 kg + 2.3 kg x every inch over 5 ft
Females: IBW = 45.5 kg + 2.3 kg x every inch over 5 ft
What shall be the depth and rate of chest compressions?
Depth of compressions shall be 2 - 2.5 inches and rate of compressions shall be 100-120 of compressions per minute.
When is it appropriate to begin mobilizing ICU patient to prevent deconditioning?
In 48 hrs, even if still intubated or on vasopressors.
Early mobilization with progressive PT, along with management of pain/agitation/delirium, reduces hospital stay and improves survival.
Environmental factors contributing to ICU delirium (name at least two)?
Sleep deprivation, anxiety, sensory overload (i.e. noise), immobilization
How much IV fluids 70kg patient in septic shock shall receive in the first 6 hours?
30 mls/kg = 2.1 L of crystalloid solution
In what pulmonary conditions Noninvasive Positive-Pressure Ventilation may be used?
1. COPD exacerbation
2. Cardiogenic Pulmonary edema
3. Acute respiratory failure in immunosuppressed patients
4. Prevention of recurrent respiratory failure in recently extubated high-risk patients
Contraindicated: respiratory arrest, arterial pH < 7.10, medical instability, inability to protect airway and/or excessive secretions, uncooperative or agitated patient.
When patient is intubated during ACLS, how many breaths shall be delivered per minute?
ACLS guidelines recommend 10 breaths per minute
When would you initiate enteral nutrition in ICU patient?
In 24-48 hrs of admission, providing patient is hemodynamically stable. Advance to goal by 48-72 hrs.
Name ALL absolute indications for Renal Replacement Therapy?
Acidosis
Electrolyte derangements (i.e. hyperkalemia with ECG changes, hypercalcemia)
Uremia (AMS, pericarditis, intractable bleeding)
Volume overload
Ingested Toxins (lithium, ethylene glycol, salicylates
What is the antidote and its dose for treatment of opioid overdose?
Naloxone 0.4 mg SC/IV/IM q 2-3 min PRN
What is the appropriate ventilator tidal volume setting for ARDS patients?
Lung protective strategy - 6ml/kg of Ideal Body Weight
Name transient side effects of Adenosine?
Warn the patient about transient side effects of adenosine such as chest discomfort, dyspnea, and flushing. Reassure that these effects are very brief.
Perform continuous ECG, while giving adenosine.
What type of shock characterized with low cardiac output, elevated Pulmonary Capillary Wedge Pressure (PCWP), and high Systemic Vascular Resistance (SVR)?
Cardiogenic shock
Definition of Acute Respiratory Distress Syndrome (Berlin definition)?
1. Acute onset <1 week of respiratory sx/hypoxia
2. Bilateral lung opacities on CT not explained by other disease processes
3. No evidence of CHF/volume overload
4. Mod-severe impairment of oxygenation (PaO2/FiO2 <300), measured with PEEP >5 cm H2O
- mild 201-300/ -moderate 101-200/ - severe <100
What steroid medication and dose is recommended for septic shock that is NOT responsive to volume resuscitation and vasopressor therapy?
IV Hydrocortisone 200 mg/day via continuous infusion
What are the extubation criteria (name at least two)?
- Reason for intubation resolved
- Able to maintain adequate gas exchange without positive pressure ventilation (FiO2<50 %, PEEP < 8 cm H2O)
- Adequate cardiovascular reserve to tolerate unassisted breathing.
When these criteria are met, Spontaneous Breathing Trials (SBT) are performed and if tolerated, patient gets extubated.