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CLABSI
CLABSI
- related: ICU
- tags: #icu
- Look at time to positivity: for central line infection, culture becomes positive 2 hours from central line blood compared to peripheral blood
Cause
- cause:
- central line, HD catheters
- bacteria:
- coag neg staph
- staph aureus
- GNR
Empiric treatment
- management:
- 2 sets of blood cultures, ideally one from a peripheral site and one from the central catheter
- Empiric antibiotic therapy should then be initi
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Medicine
Medicine
Todos
- tolearn
- MKSAP todos
- heart murmurs
Organ Systems
- Allergy and Immunology
- Rheumatology
- Cardiology
- Dermatology
- Endocrine
- ENT
- GI
- Hemeonc
- ID
- MSK
- Nephrology
- Urology
- Neurology
- Pulmonology
- Podiatry
Subject Areas
- General
- Biostats
- Psychiatry
- [[Geriatric
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Sedation and Analgesics
04 Sedation
- related: ICU
- tags: #icu
- analgesics (pain) vs anxiolytics (sedation)
- IV push vs drip
- RASS goal? Stay in 0, -1, -2
Anxiolytics
| | Push | Drip | Dosing | Indication | Caution | | ---------------------------- | ---- |
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Airway Management
airway management
- related: emergency medicine, ICU, Pulmonology
FiO2 and liters
- Each liter is 4% increase
- Just remember 6L = 44%, 10L = 60%
Escalation of Oxygen Delivery
- Simple nasal cannula: up to 6L
- High flow nasal cannula: up to 15L
- Face mask: up to 15L. Use this if has nasal obstruction
- Face tent: up to 15L. Use this if claustrophobic or trauma and can't use
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Cardiology with Critical Care
cardiology with critical care
- related: Cardiology, ICU
mechanical ventilation
- Increasing oxygenation
- increase FiO2
- Increase PEEP, I:E ratio (increase alveolar recruitment)
- Decrease O2 consumption (increase sedation, analgesia, paralysis, synchrony)
- Minute Ventilation = RR X tidal volume
modes of ventilation
- AC: assist control. Specified volume or pressure for all breaths regardless whether patient or machine initiates breath
- default
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Enteral Feeding
enteral feeding
- related: Medicine, ICU
- tags: #note
- source: https://www.uptodate.com/contents/enteral-feeding-gastric-versus-post-pyloric
Types
- nasogastric: most preferred
- nasoduodenal
- nasojejunal
- PEG: percutaneous endoscopic gastrostomy. Consider if needed more than 4-5 weeks
- PEJ: jejunostomy
Types of feeding
- Bolus: patient in stable condition
- Continuous: less stable patient
Timing
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Lactic Acidosis
lactic acidosis
- related: anion gap metabolic acidosis, ICU
- tags: #nephrology
Type B
D-Lactic acidosis presents with an increased anion gap metabolic acidosis and characteristic neurologic findings of intermittent confusion, slurred speech, and ataxia in patients with short-bowel syndrome. Accumulation of the D-isomer of lactate can occur in patients with short-bowel syndrome follow
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Capnography
capnography
- related: ICU
Capnography is the measurement of the partial pressure of CO2 in the exhaled breath over time. The maximum CO2 concentration at the end of each tidal breath (end-tidal, ET CO2) can provide information about ventilation and perfusion in patients in cardiac arrest undergoing cardiopulmonary resuscitation (CPR).
The increase in cardiac output with the return of spontaneous circulation (ROSC) causes rapid transport of CO2 accumula
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Vibrio Vulnificus Can Be Fatal in Liver Disease Patients
vibrio vulnificus can be fatal in liver disease patients
This patient’s presentation is consistent with Vibrio vulnificus infection, a gram-negative bacterium that causes serious wound infections and sepsis. The organism is most virulent in patients with cirrhosis, hemochromatosis, and chronic diseases (e.g., diabetes mellitus, chronic kidney disease, hepatitis). Vibrio vulnificus is associated with undercooked or raw shel
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Brain Death Exams
brain death exams
- related: ICU
- tags: #icu
Brain Death
When clinical criteria suggest brain death, the best next step is apnea testing. Patients must be hemodynamically stable with a body temperature > 36 C (97 F), normal pH,
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ARDS
ARDS
- related: ICU
- tags: #icu
- diagnosing ARDS
- ventilation strategies for ARDS includes low tidal volume, high peep, target plateau pressure of 30
Treatment
Fluid Balance
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Sedation
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Diagnosing ARDS
diagnosing ARDS
Diagnosis and definition for ARDS
- ARDS is diagnosed as acute onset (less than a week) of bilateral noncardiogenic pulmonary edema in setting of PEEP.
- Mild, moderate, severe ARDS are defined by PaO2 to FiO2 ratio
- P/F 200<300 is mild
- P/F 100<200 is moderate and sometimes called moderately severe
- P/F <100 is severe
- You can have ARDS without apparent hypoxemia (high SpO2 and high FiO2). For example
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Icu Intro Lecture Hypoxia
icu intro lecture hypoxia
- related: ICU
- tags: #icu
causes of hypoxemia
- Low FiO2 or PiO2
- Hypoventilation
- apneic patient
- Diffusion gradient
- pulmonary edema, ARDS, fibrosis
- Dead space: ventilated but not perfused. V/Q = infinity
- Shunt: perfused but not ventilated. V/Q = 0
Shunt
- causes of shunt: anything that causes collapsed alveoli
- atelectasis
- ARDS
- surfacta
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Icu Lecture Procedural Sedation
icu lecture procedural sedation
- related: ICU
- tags: #icu
Level of sedation
- Avoid general anesthesia in ICU for procedures
NPO
Evaluation and preparation
- Ample
- allergies, medications, PMHx, last eaten, events leading up to this
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Icu Lecture Resuscitation Fluid
icu lecture resuscitation fluid
- related: ICU
- tags: #icu
- NS high Na and Cl and very acidic
NS
- 1L: 275 cc to plasma and 825 to interstitium
- suppresses RAAS and leads to sodium retention. Decrease renal perfusion with chloride mediated vasoconstriction
LR
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Ventilation Strategies for ARDS Includes Low Tidal Volume, High Peep, Target Plateau Pressure of 30
ventilation strategies for ARDS includes low tidal volume, high peep, target plateau pressure of 30
Notes
Ventilation strategies for ARDS includes PEEP, tidal volume, and plateau pressure.
- Use low tidal volume, use 4 to 8 cc/kg ideal body weight. Target 6 cc/kg
- make sure to measure patients as females under report their height and males overreport
- Target plateau pressure < 30 cm H2O
- Use PEEP table
Us
- Use low tidal volume, use 4 to 8 cc/kg ideal body weight. Target 6 cc/kg
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Ventilation Stratigies for ARDS Includes Low Tidal Volume, High Peep, Target Plateau Pressure of 30
ventilation stratigies for ARDS includes low tidal volume, high peep, target plateau pressure of 30
Notes
Ventilation strategies for ARDS includes PEEP, tidal volume, and plateau pressure.
- Use low tidal volume, use 4 to 8 cc/kg ideal body weight. Target 6 cc/kg
- make sure to measure patients as females under report their height and males overreport
- Target plateau pressure < 30 cm H2O
- Use PEEP table
Using high
- Use low tidal volume, use 4 to 8 cc/kg ideal body weight. Target 6 cc/kg
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Icu Lecture Coagulopathy and Bleeding
icu lecture coagulopathy and bleeding
- related: ICU, massive transfusion protocol
- tags: #icu
Definition
- Coagulation: bleeding when you should; clotting when you should; no more and no less
- Coagulopathy: bleeding when you should not; clotting when you should not; more than less
Intrinsic and extrinsic pathway do not exist in real life. Real life is more complex
