sumnerl's version from 2015-05-01 14:24

Section 1

Question Answer
Goal CPOT score< 3
Hydromorphone drip rateCIVI 0.25-2 mg/hr
Fentanyl Drip RateCIVI 25-200 mcg/hr
Morphine drip rateCIVI 2.5-30 mg/hr
When starting analgesics do you need bowel regimen?YES
What CPOT is considered severe pain3 or greater
Can Fentanyl be IV push for chronic pain controlno, bc too short duration of action, so easy to titrate

Section 2

Question Answer
Goal Sedation level0 (alert and calm) -1 (drowsy) -2 (more sedated but better in chronically ill)
Monitor for ____ during sedationhypotension and bradycardia
Dexmedetomidine drip rateCIVI 0.4-1.5 mcg/kg/hr
Can dexmed have loading doses?NO, bc dose dependent hypotension that is profound enough to need increase in pressors
Likelihood of dexmed to cause delirium?less likely than other agents
Can you be extubated while on dexmed?yes
Monitor for ___ with dexmedbradycardia
Propofol drip rateCIVI 5-80 mcg/kg/min
Propofol risk of deliruim?low risk
Monitoring for propofol?triglycerides after 4-5 days of infusion, if > 500 dc propofol
Why does propofol increase trigs?in a lipid emulsion
Propofol infusion syndrome when?> 80 mcg/kg/min
Medazolam drip rateCIVI 0.5-2 mg/hr
can accumulation occur with medazolam and lorazepam?yes because lipophilic and causes prolonged awakening
Lorazepam drip rateCIVI 0.5-4 mg/hr
Lorazepam can cause what toxicity?propylene glycol
BZD have ____ delirium riskincreased
Only time to use BZD for sedation?alcohol wd, seizures, non-tolerance to other sedatives
When NOT to use BZD for sedation?head trauma, depresses CNS too much to do assessments

Section 3

Question Answer
Non pharm prevention of deliriumearly mobilization, improve sleep hygiene, minimize noise disturbances, give them glasses or hearing aids if normally wear them, spontaneous awakening trials
Pharm options for deliriumhaloperidol, quetiapine, olanzapine
Haloperidol should not be used when qtc?~500
Quetiapine has a lot of ___ as side effect sedation
Haloperidol dosage forms?PO and IV but never CIVI bc qtc prolongation
Quetiapine dosage forms?PO
Quetiapine may be best for?decreasing duration of delirium
Olanzapine dosage forms?PO and IV
Side effects of olanzapine?metabolic (gluc, trig, chol)
Olanzapine is on what list?beers bc anticholinergic
2 styles of deliriumhypo (calm) and hyper (pulling at tubes, combative)
What drug best for hyper deliriumHaloperidol, IV push and within min calm down
CAM ICU assessment is either?positive (have delirium) or negative (not delirious)
Does Quetiapine have QTC prolongation?Yes can increase QTC too

Section 4

Question Answer
Heparin dosage5000 u q12 hr
Enoxaparin dosage40 u sq qd
monitor for ___ on enoxaparinSCr
Monitor for ___ when on dvt prophHITT (watch platelets), bleeding
if have HITT what are other drug optionsarixtra, rivaroxaban

Section 5

Question Answer
Risk factors that need SUPmechanical vent (> 48 hrs), platelets < 50,000
Even if take endotracheal tube out but still vented do they need SUP?YES
Pantoprazole dosing40 mg QD IV (also available PO)
other option for SUPFamotidine PO or IV
PPI has increased risk of?C. Diff and Pneumonia
Keep head of bed at? to reduce risk of pneumonia elevated 30*

Section 6

Question Answer
if gluc > ? initiate insulin drip?180
IV Insulin drip rate?1-2 units/hr
Goal gluc range?140-180

Section 7

Question Answer
what needs to be elevated to have SIRS?Temp (> 38.5C or < 36C), HR > 90, RR> 20 or pCO2<32, WBC >12000 or <4000 or >10% bands
Sepsis is?SIRS positive plus source of infection
septic shock?sepsis induced hypotension persisting despite adequate fluid resucitation
What are preferred fluids for shock?Crysalloids Lactated ringers or NS
Central venous pressue goal?8-12 mmhg
Mean arterial pressure goal> 65 mmhg
MAP=[(1XSBP) + (2XDBP)]/3

Section 8

Question Answer
NE drip rate0.5-20 mcg/min
start NE at? and titrate up every ?5 mcg/min, 3-5 min
NE stimulates?alpha and beta
What constricts vessels to help with pressure?alpha 1
EPI drip rate1-10 mcg/min
epi hits?alpha and beta
Vasopressin drip rate0.03 units/min
max vasopressin0.04 units/min
do you titrate vasopressin?NO!!
vasopressin hits/V1 and V2
Dopamine 2-5 mcg/kg/minDA
Dopamine 5-10 mcg/kg/minBeta, DA
Dopamine 10-20 mcg/kg/minalpha, B1, small B2
is dopamine used much anymore? why?no, bc tachyarrhythmias, get more beta than alpha stimulation
phenylephrine drip rate10-220 mcg/min
phenylephrine hitsalpha only
when is phenylephrine used?as second add on instead of EPI in pts with high hr
side effect of pressors?hypoperfusion leading to tissue necrosis, decreased GI and AKI
extraversionleaks out of line and gets into tissue around the line, extreme vasoconstriction occurs

Section 9

Question Answer
use steroids only if?pressors ineffective (MAP not above 65)
Hydrocortisone dose50 mg IV q6
stop pressors=stop steroids

Section 10

Question Answer
MDR risk factorsabx within past 90 days, 5 days or more in hospital, resistance in local area, immunosuppressive therapy or disease
Pseudo tx duration14 days
NOT pseudo tx duration 7 days
HCAP risk factorshospitalization for 2d or more in preceding 90 d, residence in nursing home or extended care facility, home infusion tx (including abx), chronic dialysis within 30 d, home wound care, family member with MDR pathogen
considered HAP?in hospital for more than 2 days
DAY 3 and 4=?NMDR

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