Critical Care

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antruong
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304294
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Critical Care
Updated:
2015-06-21 19:44:22
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Critical Care
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  1. AAA (Abdominal Aortic Aneurysm)
    Requiring emergency surgery OR patient is admitted *AAA is the reason for admission
  2. Acidosis *Any Age
    PH < 7.25 (ABG or Venous)
  3. Airway Compromise
    • • Epiglottis
    • • Angioedema
    • • Croup Adult
    • • Ludwig’s angina
    • • Retropharyngeal
    • abscess
    • • Airway edema (radiation or abscess)
    • • Smoke inhalation- Intubation or ICU admission/transfer
  4. Anaphylactic Shock (Allergic Reaction)
    Hypotensive requiring fluid boluses OR IM/IV/ Epinephrine (not subQ)
  5. Anemia (adult) *Hgb<8
    • ONE or more of the following:
    • • Abnormal Vitals: Heart rate >120, top BP <80
    • • Syncope
    • • Chest pain
    • • Packed RBC or Platelet transfusion
  6. Angina (Unstable)
    IV Nitro Drip/ IV Dopamine/ OR other continuous IV medication infusion being adjusted.
  7. Angioedema of airway
    • Airway swelling aggressive treatment (IM/IV/racemic epinephrine)
    • Admission
  8. Aortic Dissection
    Requiring immediate surgery, transfer or IV BP meds to control BP.
  9. Appendicitis
    Patient is septic (see sepsis)
  10. Arterial Occlusion
    Requiring immediate surgery, transfer or infusion of blood thinners.
  11. Atrial Fibrillation with tachycardia lasting more than 60 minutes OR A Fib, new onset, Vent rate >150
    • ONE or more of the following:
    • • Continuous IV medications
    • • Ventricular rate >150 with treatment
    • • Chest pain, Dyspnea or Lightheadedness
  12. Asthma (Status Asthmaticus)
    • ONE or more of the following:
    • • Bi Pap
    • • >3 respiratory treatments (i.e. DuoNeb, Albuterol, Ventalin, Proventil) and still in distress.
  13. *Bradycardia (symptomatic)
    • ONE or more of the following:
    • • Pulse < 40 or Pacer or Atropine;
    • • Consult w/ cardiology for transvenous pacer
  14. Cardiac Arrest
    CPR/ multiple meds *(Need 30 minutes of CC not counting the CPR procedure)
  15. Cardiac Tamponade
    Hypotension OR IV fluid bolus OR Pericardiocentesis
  16. Cervical Spine Fracture
    Requiring Admission, Transfer or has a Neurologic deficit (i.e. weakness, parathesia)
  17. Comatose/Unconscious or Acute *Except for Hypoglycemia
    Always Critical Care
  18. Chest Pain (Unstable Angina or Acute Coronary Syndrome)
    • TWO or more of the following:
    • • Nitro drip, (being adjusted)
    • • Transfer to cardiac center
    • • TPA or Integrilin administered
    • • New changes on EKG (i.e. ischemia, injury)(ST segment depression or elevation)
    • • CT scan (look for other causes of pain)
    • • Cath lab
    • • Pulmonary edema
    • • Positive Troponin (Elevated)
    • • Heparin or Lovenox
  19. CHF severe
    BiPAP (elevated pCo2 > than 60) (Respiratory Acidosis) OR one of the following: IV Nitroprusside, nitro, Doputamine, or Dopamine
  20. Compartment Syndrome
    Sent to the OR or fasciotomy in the ED or transfer for such.
  21. COPD – severe exacerbation
    • ONE or more of the following:
    • • Continuous nebulizers and still in distress
    • • Bi Pap
    • • O2 sats <80%, on usual 02
    • • Respirations >32
    • • pH 7.25 or lower (CO2 retention)
  22. *Croup (Adult or Pediatric)
    Multiple Racemic Epinephrine nebs with documentation of airway distress after the 1st nebulizer treatment.
  23. Dehydration
    With BP < than 80 systolic (treated with more than 1 liter of NS)
  24. DKA (Diabetic Ketoacidosis)
    *all ages (pH < than 7.25) (Respirations >see Vital signs)
  25. Tylenol (Acetaminophen) Overdose
    Use of IV/PO Mucomyst (NAC)
  26. Digoxin overdose
    Use of IV Digibind
  27. Ethylene Glycol (Anti-Freeze) poisoning
    Use of Formeprizole (Antizol)
  28. Salicylate
    Treated with Emergent Dialysis
  29. Snake Bite
    Use of IV Crofab
  30. Dysrhythmia
    • ONE or more of the following:
    • • Ventricular Tachycardia
    • • Ventricular fibrillation
    • • 3rd Degree Heart Block
    • • Pacemaker (inserted in ED or External pacer used in ED)
    • • Use of Atropine/Lidocaine/Amiodarone IV, Procainamide IV
    • • Synchronized cardioversion
  31. Ectopic pregnancy (Rupture)
    Requiring Admission OR Transfer OR Blood transfusion in ED
  32. Epiglottitis
    Always Critical Care
  33. Esophageal perforation
    Always Critical Care
  34. FB Airway Obstruction
    Partial or Complete
  35. Fractures (OPEN) due to trauma
    Femur, tibia, pelvis or humerus
  36. GI Bleed (acute)
    • ONE or more of the following:
    • • Patient is hypotensive (systolic BP <80)
    • • GI consult for scope in ED or ICU that day
    • • Blood transfusion, plasma or platelet transfusion &Fluid bolus
    • • Emergency surgery scheduled w/in next 12 hrs or EGD or colonoscopy
    • • Pressors
    • • Dobutamine
    • • Hemoglobin [HGB] < than 7
    • • Abnormal vital signs (pulse > 120)
    • • Mental status change
  37. Glasgow Coma Scale 12 or below
    Always Critical Care (except Hypoglycemia)
  38. Head Injury
    Glasgow Coma Scale 12 or below
  39. Hemorrhage intercerebral, subdural, subarachnoid, epidural/subdural
    Always Critical Care (not chronic subdural)
  40. Hemothorax
    Chest tube placement
  41. Hypercalcemia
    Requiring Admission
  42. Hypertensive Emergency
    • Systolic (top) blood pressure >230 OR Diastolic (bottom) blood pressure >130 With one of the following:
    • • Signs or symptoms of end organ involvement (CVA, acute renal failure, non-STEMI)
    • • Attempted control w IVP Meds
    • • Nitro, Nipride, Cardene Drip
    • • Mental Status change
    • • CHF
    • • Chest pain
    • • Pulmonary Edema
    • • Pre-eclampsia
  43. Hypokalemia
    Potassium <2 WITH IV potassium ordered in ED
  44. Hypoglycemia
    • ONE or more of the following:
    • • Frequent finger sticks (3 or more) and intervention
    • • D50: 3 or more doses
  45. Hypothermia
    Temperature < than 91.4 F or 33 C
  46. Hypotension (adult only)
    • ONE or more of the following:• Blood pressure < than 80
    • • Multiple Fluid bolus 3L or greater
    • • Dopamine or other pressors
    • • Central line
    • • Respiration > than 32
  47. Hypoxia/Hypoxemia
    02 SAT < 80% on usual 02
  48. Hyperkalemia
    Key indicators are treated with (calcium, bicarb and/or insulin and D50W)
  49. Hyponatremia
    Requiring admission or transfer or seizure
  50. Meningitis (Bacterial)
    Always Critical Care
  51. Meningitis (Viral)
    With Encephalopathy
  52. Mesenteric Ischemia
    Always Critical Care
  53. MI (Myocardial Infarction)
    • ONE of the following:
    • • (STEMI) ST segment elevation
    • • NSTEMI (non ST segment elevation)
    • • Elevated Troponin (not chronic)
    • • Emergent to cath lab/TPA
  54. MVA
    • ONE or more of the following:
    • Altered mental status (Glasgow Coma Scale <12)
    • Abnormal vital signs: (O2 <85, HR >120, systolic BP <80) AND any one of the following:
    • • Transfer to trauma center
    • • Multiple fluid bolus
    • • Blood transfusion
    • • Platelet transfusion
    • • Central line
    • • Immediately to OR
    • • Spine, pelvis, or femur fracture
    • • Flail chest
    • • Pneumothorax chest tube
    • • Intracranial bleed
    • • Intubation
    • • Solid organ injury
  55. Myxedema Coma
    Treated with IV Thyroxine (Levothyroxine)
  56. Neonatal Fever
    30 days or younger w/ Fever >100 & Full Septic Workup including (LP)
  57. Ovarian/ Testicular Torsion
    Always Critical Care
  58. Perforated Viscus
    Always Critical Care
  59. Pneumonia (Adult)
    • ONE or more of the following:
    • • O2 sats < than 80% on usual 02
    • • Pulse > than 120 (in adult)
    • • BP (top) <80
    • • Respiration > than 32 (adult)
  60. Pneumonia (Pediatrics)
    • ONE or more of the following:
    • • O2 sats < than 80% on usual 02
    • • Pulse > than 150
    • • BP (top) <60
    • • Respiration > than 40
  61. Pneumothorax
    Requiring urgent chest tube inserted by ED physician
  62. Pre-eclampsia/eclampsia
    Patient Admitted
  63. Pulmonary Edema
    When treated with IV NTG , BIPAP or Intubation*Always Critical Care
  64. Pulmonary Emboli
    Treated with Heparin or Lovenox
  65. RPA (Retropharyngeal abscess)
    Always Critical Care
  66. Rapid heart Rate (Vent rate > 150)
    IV fluids/ Adenosine/ continuous meds
  67. Renal Failure (Renal Insufficiency)
    • ONE or more of the following:
    • • Immediate dialysis needed today
    • • Abnormal vital signs: HR >120, BP <80
    • • Bicarb, Calcium or IV Insulin/D50W
    • • Pulmonary Edema
    • • EKG changes [Peaked T Waves or widened QRS]
  68. Respiratory Distress/Failure/Arrest
    BiPAP, CPAP or Intubation
  69. Status Epilepticus
    Continuous seizure or repeated seizures without returning to an alert baseline of over 20 minutes. *Always Critical Care
  70. Sepsis (septic shock)
    • BP < than 80 *Always Critical Care Or need at least TWO of the following:
    • • Multiple fluid bolus
    • • 2 or more IV antibiotics
    • • Altered mental status (i.e. confused)
    • • Top BP <80
    • • HR > than 120
    • • Temp > than 104 or < than 91.4
    • • Elevate Lactate
  71. Shock
    BP < than 80 *Always Critical Care
  72. Stroke, Hemorrhagic, Sub arachnoid hemorrhage, New Intra-cranial mass
    Always Critical Care
  73. Stroke, Thrombotic/Embolic
    TPA considered or given/ Transfer/ Intubation
  74. Suicide attempt Drug/Alcohol overdose
    • ONE of more of the following:
    • • Abnormal VS (medically ill)
    • • Serious attempt to harm (near hanging, neck wounds, gsw etc.)
  75. *Thyrotoxicosis/Thyroid Storm
    Treated with IV B-blockers (Propranolol)
  76. Trauma
    Altered consciousness, life or limb, threatened or transfer
  77. Ventricular Fibrillation
    Always Critical Care
  78. Ventricular Tachycardia
    Requiring IV meds, Cardioversion
  79. 3Rd Degree Heart Block
    Always Critical Care
  80. What eye conditions suggest critical care?
    • Acute Glaucoma
    • Retinal Artery Occlusion
    • Central Vein Occlusion
  81. Signs of aggressive management
    • • IV anti-arrhythmics: Adenosine, Atropine, Cardizem (Diltiazem), Inderal, lidocaine, Magnesium, and Sulphate
    • • Pressors: Dopamine, Epinephrine, and Dobutamine
    • • Vasodilators: Nitro Drip, Nipride, and Cardene
    • • Others: Aminophyline, Glucagon, Sodium Bicarb, Dobutamine, Propofol, and Diprivan
    • • Anti-Coagulants: Heparin, Lovenox, Integrilin, and Fragmin
    • • Platelet Transfusion
    • • Fresh Frozen Plasma
    • • Prothrombin Complex Concentrate (PCC)
  82. Procedures that suggest critical care
    • • Tube Thoracostomy
    • • Transfer out via helicopter
    • • Defibrillation
    • • Cardioversion
    • • Intubation /CPR
    • • Open Cardiac Massage
    • • BiPAP Ventilation
    • • Surgical Airway
    • • TNK, TPA, or Streptokinase Infusion
    • • Lumbar puncture(i.e. Meningitis, Encephalitis)
    • • Transfer to a higher level of care
    • • Central line or I.O. (Excludes routine transfers to Pediatrics, OBS or Psychiatric)
    • • Ewald or Gastric Lavage

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