critical care final

ABG - respiratory acidosis

r/t COPD, Trauma, CNS depression

Tx. Narcan, HOB raise, ABCs, mechanical vent. support breathing.

metabolic alkalosis

loss of CO2 ^ bicarb. vagal maneuvers, pain meds. decrease fTot, vT.

alarm high pressure r/t

obstruction = PIP. bitting, secretions, low lung compliance.

Tx. drain, check tubing. suction w/ hyperoxygenation first.

a flutter

CCB, BBs.

amiodarone 150mg @ 1mg/min > 48hr

anticoag q3wks if > 48 hrs

a fib

CCB, BBs, anticoagulation therapy Q3wk if. cardiovert if unstable

palliative care

for all patients serious, life-limiting illnesses, focusing on providing relief from symptoms and stress to improve quality of life.

propofol, fentanyl, precedex

goal. lightest sedation possible. reorient pt.

propofol - lipid. change tubing Q12h.

frequent v/s because RR depressant.

SVT

Adenosine is ONLY for SVTs.

UNSTABLE 90/60, aLOC, SOB> cardiovert

Stable> vagal! adenosine 6mg } 12mg } 12mg } cardiovert

v tach

HR 100 < “tombs”

check pulse. stable> amiodarone 150 mg } 300 mg } cardiovert

unstable > lidocaine 1-1.5 mg } max 3mg } cardiovert

pulseless v tach & torsades.

v tach = shock (defib). compressions > epi 1mg q3min no max. + amiodarone 300 mg > 150 mg > intubate

torsades > add magnesium 1-2 g IV.

v fib

v tach = shock (defib). compressions > epi 1mg q3min no max. + amiodarone 300 mg > 150 mg > intubate

torsades > add magnesium 1-2 g IV.

PEA & asystole

NEVER CARDIOVERT/DEFIB.

Dx cause > hypovolemic most common. CPR and epi1 mg q3min no max. Consider advanced airway management.

CVP

SVR

CO

PAP

PAOP

✅ CVP (Central Venous Pressure) volume: 2–6 mmHg

CHF > diuretics and vasodilators
✅ PAP (Pulmonary Artery Pressure):

• Systolic 15–25 mmHg

• Diastolic 8–15 mmHg
  ✅ PAOP (Pulmonary Artery Occlusion Pressure, aka wedge pressure): 6–12 mmHg
  ✅ SVR (Systemic Vascular Resistance): 770–1500 dyn·s/cm⁵
  ✅ CO (Cardiac Output): 4–8 L/min

Pulmonary artery catheter

measures CVP, CO, PAP, PAWP.

CVP 2-6, PAP 15-25/8-15

PAOP 8-12

VAP “POTHEADS”

P - PUD prophylaxis, PPIs

O - oral care w/ CHG

T - transmission control, hand washing

HOB 30 <

Enjoy sedation vacation

Aspiration precautions - suction at bedside

DVT prophylaxis. SCDs, heparin

S - subglottic suction PRN

anaphylactic - remove irritan. epinephrine, antihist.

septic - lactic lvls, ABX, levophed.

neurogenic - atropine, D5W/glucagon, dopamine.

obstructive. tension pneumo = needle decompress, chest tube. cardiac tamponade = pericardiocentesis

cardioenic - nitro, lasix, dixoxin/dobutamine

post renal

obstruction of flow. stones, tumors, BPH. foley, stent, cont. bladder irrigation. L1-L2 fracture

admin blood products

only w/ NS 18-20 gauge

Q15M. D/C if reactions. NS bolus, keep bag for identification/send pharmacy.

DIC -

Plt decrs

PTT ^ prolonged

D – dimer ^

Fibrinogen decrs

Antithrombin decrs

 

Fix clotting issue w/ Plasma & cryo contain clotting factors. Then treat H&H. correct acidosis.

MONA for ACS, MI

Morphine - 2-4mg IV

O2 4-6L and rest

Nitro - vasodilation, h/a is s/e. SL route @ 3 doses max q5mins

aspirin 325mg max

tidaling & bubbling

Cont bubbling is normal only in suction control OK. Not OK in the water seal chamber.

Tidaling in water seal chamber with each breath = proper function. Continuous bubbling suggests a leak or problem in the system.

failure to sense

spike but no wave d/t insufficient charge. increase milliamps, roll patient to left side

IABP

assess UOP, monitor H/D, provide cardiac support through counterpulsation (during diastole).

IABP – supports the heart

            Inflates on diastole. Deflates during systole.

            Interventions. Flat 10> log roll, leg immobile. Prevent bleeding out

            Loss pulse on left radial !! s/s complication > freq neurovasc. leg circumference

IABP interventions.

stable BP, atropine at bedside. hold manual pressure 30 mins. bed rest w/ reverse trend. log rol, leg immobilization.

acute pancreatitis.

s/s LUQ epigastric pain, radiation to back. positive turner’s (bruised flank), Cullen’s, ^ amylase/lipase/glucose/bili and hypocalcemia

tx manage RR dysfuction r/t hypocalcemia. sz precaution. NPO or NG, F/E replace

GI bleed

s/s of hypovolemic shock. 2 large bore IVs

• Tachycardia

• Hypotension

• Cool, clammy skin

• Decreased urine output

• Mental status changes

EN vs PN

EN > directly into GI tract. preferred over PN. done when functional GI but impaired swallow. OG for ETT pt. NGT for concious pt.

PN > IV Central line. TPN given through central line. contains complete nutrition. use dedicated port to avoid contamination. Q24h tubing change or Q12h for lipids.

cardiac contusion s/s and tx

bruising r/t blunt trauma to heart.

s/s dysrhythmias, PVCs, afib, ST changes, MI. ^CK, CKMB, troponin.

tx. digoxin, dopamine/dobutamine, EKG changes monitor freq. angina, tachy, low BP.

flail chest

s/s paradoxical chest mvt. tachypnea, dyspnea, hypoxemia.

tx intubation, ventilation

open pneumothorax

s/s sucking sound, hypoxemia

tx. 3 sided dressing, chest tube insert

burn injury ABCs

IV pain meds.

Airway, early oxygenation to recover lungs

Breathing - escharotomies to allow fluid release

Circulatory - 4mL x KG x TBSA % = fluid resuscitation 0.5/kg/hr = ideal UOP

ICP pt

keppra, cerebrex for sz

3 NS for fluids w/ strict I/O

mannitol for volume control

glucocorticoids for cerebral edema

^ RR and decrease PEEP on ventilation. hyperventilation (↑ RR) → reduces CO₂ → vasoconstricts cerebral vessels → lowers ICP (used short-term)

craniectomy.

NO NG tubes if TBI suspect. CPP = MAP - ICP. 60 = 100 is goal.

seizure pt

turn on side to keep patent airway. lorazepam IVP.

safety - padding rails, low position.