Critical Care Course

bicarb is ________.

BASIC

what assessment is essential when your patient has an arterial line or recently removed line?

peripheral vascular checks

The ________ system gets up-regulated in HF.

RAAS

Which medications down-regulate the RAAS system in HF? What will this help with?

ACEs and ARBs, decrease afterload

What do beta blockers help with in HF?

lowering afterload

ACE inhibitor examples (3)

lisinopril, captopril, enalapril

ARB examples (3)

valsartan, losartan, telmisartan

Angiotensin Receptor-Neprilysin inhibitor (ARNi) is a combination of ________ and __________.

sacubatril, valsartan

SGLT2 inhibitors examples (2)

Farxiga, Jardiance

Milrinone improves ________ and reduces ________ through _____________.

contractility, afterload, vasodilation

SGLT2 inhibitors improve HF because they promote ______ __________ and promote _____________, which ends up reducing _______________.

osmotic diuresis, vasodilation, afterload

one concern with milrinone is that you could end up with a ____________ patient.

hypotensive

In addition to reducing afterload, SGLT2 inihibitors also improve ____________ _____________, improving cardiac efficiency. They also reduce ________ _____________.

myocardial metabolism, myocardial fibrosis.

“advanced therapies” MEANS

LVAD, RVAD, heart transplant

biggest LVAD considerations

must have an antiplatelet on board, have to have good enough RV SV, need to have power all the time, can only shower, never bathe

Patients with pulmonary HTN have reduced production of _________________/_______________, which means that our drug therapies focus on providing _____________.

prostacyclines, vasodilators, prostacyclines

What are some serious side effects of PHTN meds? (2)

spider vein rashes and bleeding

What’s the worst way to fix hypotension in R sided HF? (Unless they have a swan and their numbers are really dry) Alterative, use: _____________.

fluids, pressors

What two things tank fragile oxygenation status the fastest?

fever, seizures, shivering, pain

SVO2 is dependent on O2 __________ and O2 ____________.

delivery, extraction

which system compensates for increased CO2/acidity in the blood in patients with COPD?

kidneys

Too much O2 in patients with ________ can cause more mismatch in perfusion of alveoli that are not being ventilated, leading to increased dead space in the lungs —> poor ventilation perfusion match.

COPD

Patients with ________, __________, and __________ _____________ will all end up being diagnosed with COPD.

emphysema, asthma, chronic bronchitis

Most of the time, COPD patients will have an SpO2 goal of _____-______.

88, 92

NEVER restrain a patient who is on _________ or __________, it is against policy, because it is an __________ risk (if they puke and they can’t pull it off).

CPAP, BiPAP, aspiration

What is the ideal number of oscillations for the flush test on a swan?

1.5-2

Normal CO is ___-___L/min

4, 8

CVP is a measure of ___________ for the _____ side of the heart.

Preload, R

Wedge is a measure of __________ for the _____ side of the heart.

Preload, L

A normal wedge is _____-______mmHg

6, 12

A normal CVP is between _____-______mmHg.

2, 6

Symptoms of PE (7)

anxiety, SOB, CP, syncope, tachy, tachypnea, cough

An SvO2 below ______% indicates lactic acidosis.

50

kidneys influence acid-base balance mainly by retaining or getting rid of ________, which is a ___________.

HCO3, base

Normal PAP: ____-_____/____-____ mmHg

15, 25, 8, 15

Normal CI is…

>2

Normal SvO2 =____-_____%

60, 80

What swan number will be most obviously elevated in R sided HF?

CVP

Which swan number will be most elevated with L sided HF?

PAWP

what kind of pain will patients describe with dissecting aortic aneurysm?

tearing/stabbing, or sharp back/chest/abd pain

what is the most dangerous complication of aortic abdominal aneurysm repair and thoraco-abdominal aneurysm (TAA) (open or closed)?

spinal cord ischemia

what are the most important ways to prevent post-op spinal cord ischemia with aneurysm repair patients?

TIGHT BP control, early detection of neuro changes

what medication is given to patients showing signs of post-op spinal cord ischemia? What does it do?

Levophed/norepinephrine, raise BP via vasoconstriction

normal SVR

800-1200

the first signs of shock are (4)

tachycardia, cool/clammy skin, no bowel sounds, drop in urine output

Assessment for compensatory stage of shock

skin cool/clammy, AMS, pulse, urine output

normal lactic acid level is technically <_____, but really, it’s usually _______.

2, 0

someone on a beta blocker can be ________ at 80, that’s why we hand down HR and BP in report.

tachy

if someone seems like they’re going into shock, your first orders of business are (

find and correct the cause of fluid loss, check labs, get at least 2 IVs (a bigger one if possible), provide O2 or non-rebreather

vasopressors (4)

levo, epi, neosynephrine, vasopressin

minimum of gauge of IV for resuscitation

20

before giving vasopressors, you need to give the patient _________.

fluids

when resuscitating with fluid and blood, make sure everything is _________.

warm

triangle of death: __________, __________, ___________

acidosis, coagulopathy, hypothermia

patients on GDMT may not be able to get ______ even if they’re entering sepsis!

tachy

normal bicarb level

22-26

In septic shock, ________ utilization is low, driving your _______ up.

O2, SvO2

volume resuscitation with blood can cause _____________.

hypocalcemia

even though perfusion is inadequate in shock, the arteries ______, driving ______ up.

constrict, SVR

sepsis definition

systemic inflammatory response leading to dysfunction of one or more organs

septic shock definition

sepsis with need for vasopressors despite IVF resuscitation

Anything above _________ is when we start giving Tylenol and getting cultures.

100.3

creatinine elevated _______ above baseline is concerning for AKI or sepsis.

0.5

normal creatinine levels, ______-______

0.7, 1.3

normal INR levels: ____-____

0.8, 1.1

therapeutic PTT for heparin is _____-______ sec

60, 85

Therapeutic INR for warfarin: _____-_____

2.5, 3.5

what does CALF stand for? What would you personally add to the list?

cultures, antibiotics, lactate levels, fluids, large bore IVs

gram negative or gram positive antibiotics first?

gram negative

which antibiotics are gram negative? (want to give first)

Cefepime, Levofloxacin, Piperacillin-Tazobactam, Gentamycin

What should you be trending in sepsis?

lactate

which fluid do you use in sepsis resuscitation?

LR

what does LR have in addition to sodium and chloride?

potassium, calcium, lactate buffer

which crystalloid more closely mimics blood plasma?

LR

what is the gold standard pressor for sepsis?

norepi

S/sx hypokalemia (5)

numbness & tingling, heart palpitations, muscle weakness, twitching

normal WBC level

4.5-11

S/sx of hyperkalemia (5)

n/v, abd pain, diarrhea, palpitations

CRRT

continuous renal replacement therapy

S/sx of hypomagnesemia (5)

fatigue, muscle weakness, nausea, loss of appetite,

S/sx of hypermagnesemia (5)

dizziness, nausea, confusion, weakness, difficulty breathing

when you’re educating about reducing stroke risk, know your population. If someone is afraid to exercise outside, tell them to _________ their plan to work for them. Tell them to get exercise inside their house.

modify

S/sx of stroke (6)

facial drooping, slurred speech, unilateral weakness, sudden onset bad headache, numbness, CMS, gait dysfunction

TIA = transient ischemic attack

transient episode of neurological dysfunction

way to educate about strokes: ______ strokes versus _____ strokes. Pipes burst versus pipe blocked.

wet, dry

treatment for hemorrhagic stroke: ______ _____ _________.

get BP down

if someone have a stroke, prior to CT, you can’t give any type of _____________, ________, OR _____ ________ unless MAP is OVER 140mmHg.

anticoagulation, aspirin, BP meds

If a CT was negative, can you say that a person did not have a stroke? Why or why not? ______ is standard of care.

NO! CT negative strokes exist, MRI

The 5 Fs of stroke care + one other thing

Flat, fluids, frequent checks, finger stick, fever control, oxygen

before giving a thrombolytic, you need:

BP (<185/110), BG, CT results

why do you check blood sugar if your patient has stroke symptoms?

hypoglycemia can look like stroke and vice versa

BP = _____ x _____

CO, SVR

Norepinephrine stimulates ______ and _______ receptors.

alpha, beta

Monroe-Kellie hypothesis refers to the balance of _____, ________, and _______ in the skull.

brain, blood, CSF

to find ICD settings, look in the “_________” tab of the chart, and open the document regarding their ICD placement.

medview