NUMBER GAME

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Author:
thesaint81
ID:
178340
Filename:
NUMBER GAME
Updated:
2012-10-26 21:12:19
Tags:
critical care
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Description:
ABSITE NUMBER GAME
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  1. CO
    4-8 L /min
  2. CI (Cardiac Index)
    2.5-4.0 L/min/m2
  3. SV
    60-100 ml/beat
  4. SVI (Stroke Volume Index)
    33-47 mL/beat/m2
  5. SVR (Systemic Vascular Resistance)
    800-1200 dynes-sec/cm-5
  6. SVV (Stroke Volume Variation)
    • <15%
    • Reverse of CVP
  7. ScvO2
    >70%
  8. FloTrac Alogrithim
    1) SVI Normal (40-50)
    2) SVI Low (<40)
    3) SVI High (>50)
    • 1) SVI Normal (40-50) - Pressor
    • 2) SVI Low (<40) - Inotrope
    • 3) SVI High (>50) - Diuretic
  9. Propofol Dose
    5-50 mcg/kg/min titrate to effect
  10. Verapamil Dose for AFIB
    5-10 mg IV push over 2 min/ Max 20
  11. Norepinephrine (Levophed)
    0.01-5 microgram/kg/min
  12. Octreotide
    25-50 mcg/hr
  13. Vasopressin (ADH Analog)
    • 0.04 unit/min (septic shock)
    • 0.2-0.4 (variceal bleed)
  14. Fentanyl dose
    • 1-3 mcg/kg (loading dose)
    • 0.7-5 mcg/kg/hr (maintainance)
  15. Lasix Drip
    • 40 mg over 1-2 min (loading)
    • 10-40 mg/hr titrate to effect (max 160 mg/hr)
  16. Insulin drip
    • 0.1 units/kg (loading dose)
    • 0.5-20 units/ hr (weight based, usually 0.1 units/kg/hr and titrate to effect)
  17. Lorazepam (Ativan drip)
    • 1-6 (loading dose)
    • 0.5-15 mg/ hr (usual dose, high dose associated with metabolic acidosis)
  18. Narcan (Naloxone) usual dose
    • 0.4-2 mg IV q2-3min PRN
    • Look for pulmonary edema
  19. Amiodrone drip
    • 150mg in 100ml D5W over 10 min (loading)
    • 1mg/min for 6hours, then 0.5/min for 18 hours
    • Then change to PO
  20. Precedex
    • 1mcg/kg over 10 min (loading dose)
    • 0.2-1.5 mcg/hr (usual dose)
  21. Dobutamine
    • 2.5-20 Mcg/kg/min (usual dose)
    • ------------------
    • 5-15 beta 1 (contractility)
    • >15 (vasodilation, Inc HR)
  22. Dopamine (renal, cardiac, pressor doses)
    • Renal 1-3 mcgm/kg/min
    • Cardiac 3-10 mcgm/kg/min
    • Pressor 10-30 mcgm/kg/min
  23. Diltiazem drip
    • 0.25 mg/kg over 2 min then 0.35 mg/kg over 2 min (load)
    • 5-10 mg/hr (usual)
  24. Vancomycin drug level
    • Peak 20-40, Trough 5-10
    • If peak too high > Decrease amount of each dose
    • Trough too high> Decrease frequency of doses
  25. Gentamicin
    • Peak 6-10 mcg/ml; trough < 1 mcg/ml
    • If peak too high > Decrease amount of each dose
    • Trough too high> Decrease frequency of doses
  26. Cortisol level
    • 3-20 High in AM Low in PM
    • High in stress states 20-40
    • Stim Test: 0.25 ACTH IM, peak cortisol response, 30 to 60 minutes later, should exceed 18 to 20 g/dL (> 497-552 nmol/L).
  27. Risk of HIV and HepB after transfusion
    • HIV 1 in 1-2 million
    • Hep B/C 1 in quater to half million
  28. Estimation of maintainance fluid / hr by weight
    • 4/2/1
    • 4ml for first 10 kg
    • 2 for second 10kg
    • 1ml /kg thereafter
  29. Normal protein/Albumin value
    • protein 6-8.5
    • Albumin 3.5-5.5
  30. Half life
    Albumin
    Transferrin
    Prealbumin
    • Albumin- 20
    • Transferrin- 10 (normal 200–400 mg/dL)
    • Prealbumin- 2 (normal 20-40) <5 severe, 5-10moderate, 10-15 mild depletion
  31. RQ
    • 1- carbohydrate
    • 0.8 protein
    • 0.7 fat
  32. CEA (Carcinoembryonic antigen)
    • 0–2.5 ng/mL
    • Increased in: Colon cancer (72%), lung cancer (76%), pancreatic cancer (91%), stomach cancer (61%), cigarette smokers, benign liver disease (acute 50% and chronic 90%), benign GI disease (peptic ulcer, pancreatitis, colitis). Elevations >20 ng/mL are generally associated with
    • malignancy. For breast cancer recurrence (using 5 ng/mL cutoff), sensitivity 44.4% and specificity 95.5%.
    • Monitoring after surgery: Test is used to follow progression of colon cancer after surgery (elevated CEA levels suggest recurrence 3–6 months before other clinical indicators), although such monitoring
  33. Weaning parameter
  34. Short Gut syndrome
    In adults, 480cm normal small bowel length, <180 increase risk of SGS and <60cm (with colon) are unlikely to achieve independence from parenteral nutrition.
  35. Surgical site Infection:
    Clean
    Clean contaminated
    Contaminated
    Gross Contaminated
    • Clean- 2%
    • Clean contaminated- 3-5%
    • Contaminated 5-10%
    • Gross Contaminated 30%
  36. Central line infection: how many CFU?
    >15 colony forming uits = line infection
  37. SIRS
    • Temp <36C (<96.8F)
    •            >38.3C (100.4F)
    • RR      >20 or PaCO2 <32
    • HR      >90
    • WBC >12k or <4k or >10% band
  38. SEPSIS
    SIRS + long with either a culture-proven or visually identified infection
  39. SEVER SEPSIS
    • Severe sepsis refers to sepsis plus at least one of the following signs of hypoperfusion or organ dysfunction:
    • Areas of mottled skin
    • Capillary refilling requires three seconds or longer
    • Urine output <0.5 mL/kg for at least one hour, or renal replacement therapy
    • Lactate >2 mmol/L
    • Abrupt change in mental status
    • Abnormal electroencephalographic (EEG) findings
    • Platelet count <100,000 platelets/mL
    • Disseminated intravascular coagulation
    • Acute lung injury or acute respiratory distress syndrome (ARDS)
    • Cardiac dysfunction (ie, left ventricular systolic dysfunction), as defined by echocardiography or direct measurement of the cardiac index
  40. Septic shock
    • Septic shock exists if there is severe sepsis plus one or both of the following despite adequate resucitation:
    • MAP  <60 mmHg (or <80 mmHg if the patient has baseline hypertension
    • MAP >60 mmHg requires dopamine >5 mcg/kg per min, norepinephrine <0.25 mcg/kg per min, or epinephrine <0.25 mcg/kg per min .
  41. Adequate fluid resuscitation:
    • 20 to 30 mL/kg of starch, 
    • infusion of 40 to 60 mL/kg of saline solution
    • PCWP 12 to 20 mmHg.
    •  (CVP) of 8 to 12 mmHg
  42. Refractory Septic Shock
    >60 mmHg (or >80 mmHg if the patient has baseline hypertension) requires dopamine >15 mcg/kg per min, norepinephrine >0.25 mcg/kg per min, or epinephrine >0.25 mcg/kg per min despite adequate fluid resuscitation
  43. Epinephrine
    0.1-1 mcg/kg/min (max 5)
  44. Mortality rate of SIRS, sepsis, severe sepsis, and septic shock
    7, 16, 20, and 46 percent, respectively
  45. Indication of thoracotomy based on CTube outpu
    • >1500 after initial insertion
    • >250cc/hr for 3 hours
    • 2500 cc/24hour
    • or bleeding with instablity

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