All About the Labs
What labs would you check for your patient in stable VT?
Interpret the following ABG:
pH 7.55/ CO2 22/ PaO2 83/ HCO3 24
Uncompensated respiratory alkalosis
A 58 yo is admitted with septic shock. The shock is resolved and off pressors. He becomes confused and tries to get OOB. What type of screening should you assess?
Name a medication commonly given in the ICU for delirium that can cause a prolonged QT interval.
Antiemetics- Zofran, reglan
Which of the following complications should be aggressively treated to prevent worsening of cerebral edema and infarct expansion after an acute ischemic stroke?
A. Hypernatremia
B. Fever
C. Hypokalemia
D. Hypoglycemia
B. Fever
Fever, hyponatremia, and hyperglycemia have all been associated with worsening infarcts and neurological outcomes
A pt was transfused 4 units of PRBC. What electrolyte do you anticipate replacing?
Calcium
A pt admitted with pulmonary contusions and ARDS is on the vent and the settings are APVCMV - Rate 12/Vt 350/PEEP 10/FiO2 60%.
ABG is pH 7.20/ CO2 65/ PaO2 80/ HCO3 22.
What vent changes would you anticipate?
Increase respiratory rate
What physical assessment findings would be expected in the setting of thrombocytopenia?
Petechiae
How many joules do you use for synchronized cardioversion?
200
What medication and dose is given for a prolonged seizure under ESO protocol?
Ativan 2mg IVP, repeat x1 in 3-5min
What two labs/ specimens would you draw to assess patient detorioration?
ABG and lactic acid
68 yo male with COPD has SOB, interpret his ABG results:
pH 7.22/ PaCO2 74/ PaO2 103/ HCO3 30
Partially compensated respiratory acidosis
A pt is suspected of having a R-sided tension pneumothorax. What are 2 assessment findings you would expect?
Tracheal deviation to the left and absent breath sounds over the pneumothorax
What medications do we give for symptomatic bradycardia?
Atropine 1mg q3-5min for max of 3mg
Dopamine gtt 400mg/ 250ml at 5mcg/kg/minute to max of 20
Epinephrine gtt 2mg/ 250ml at 2mcg/ minute to max of 10
Which finding distinguishes neurogenic shock from other forms of distributive shock?
A. BP 80/45 (MAP 57)
B. HR 45
C. SVR 1400
D. CO 3 L/min
B. HR 45
Name 3 contraindications to using a BiPAP.
Respiratory Arrest
Inability to maintain a patent airway or clear secretions
Risk for aspiration of gastric contents (nausea, vomiting, or bowel obstruction)
Pre-existing pneumothorax without chest tube or pneumomediastinum
Epistaxis
Recent facial, oral or skull surgery or trauma
Encephalopathy/altered mental status
Hypotension due to suspected intravascular volume depletion
Unable to tolerate NIV (BiPap)
Name the 3 categories of the Glasgow Coma Scale.
Motor response, verbal response, eye opening
Pt's invasive hemodynamics are: CVP 6, PAD 10, CO 5, CI 2.7, SVR 1700. What medication would bring down the abnormal value into the desired range?
A. Lasix
B. Dobutamine
C. Lidocaine
D. Nicardipine
D. Nicardipine
What is the NICOM used for?
Assessing fluid responsiveness
iCal <1.1
A patient with PNA has been sustaining a respiratory rate of 25-30 per min and SpO2 96% on BIPAP. The nurse should notify the provider for probable intubation when which of the following is observed?
A. Nasal flaring
B. RR 20 with shallow breathing and decreased LOC
C. Increased accessory muscle use
D. SaO2 91%
B. RR 20 with shallow breathing and decreased LOC
In a patient with respiratory distress, a sudden decrease in RR indicates exhaustion
What trends in vital signs would be expected in a patient experiencing herniation and Cushing's triad?
Wide pulse pressure, bradycardia, increased systolic pressure
A pt with severe mitral insufficiency is prone to which dysrhythmias?
Atrial fibrillation
Name 4 SIRS criteria.
1. SBP < 90, MAP < 65, or SBP drop > 40
2. Lactate > 2
3. Creatinine > 2.0 or urinary output (UOP) < 0.5 mL/kg/hr
4. T. Bili > 2
5. Platelet < 100,000
6. INR > 1.5, aPTT > 60 sec
7. New onset respiratory failure requiring BIPAP or intubation
8. New mental status changes