02 ICU
Misc
Admission Criteria
Q1 monitoring
Bipap
Drips: cardine
Intubation
Presentation
Patient
fever
pain
any problems
Medications
Pressors and how much
VS
I/O: even or negatives are better
Other VS
PE
Labs
ABG, vent settings, interpretation
Chest Xray
Others
Assessment/Plan
Chest Xray
Airway
Carina, distance ET tube from carina in cm (2-3 cm normal)
Any lines
Bones
C: everything else
Cardiac shadow
Lung parenchyma
Costophrenic angles
Ventilation
Extubation
FiO2 < 0.4
PO2 > 60
P/F ratio > 100
Off sedation
Spontaneous breathing
ABG good
Neuro status good
Rapid shallow breathing index: fraction of respiratory rate to tidal volume.
<65 is good for extubating
less than 105: 85% chance of extubating
more than 105: can't wean
Ventilation modes
Bipap: help with hypercapnia
CPAP: help with O2
Tidal Volume
ARDS: 4-6 mm/kg ideal body weight
Others: 6-8 mm/kg ideal body weight
Septic Shock
Sepsis: 2 or more:
Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
Heart rate of more than 90 beats per minute
Respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO2) of less than 32 mm Hg
Abnormal white blood cell count (>12,000/µL or <4,000/µL or >10% immature [band] forms)
Severe sepsis: with acute organ damage
septic shock: sepsis refractory to fluid or high lactic acid
EGDT
EGDT protocols:
1: early sepsis detection, culture, abx
2: risk stratification via lactate levels and fluid response
3: protocol
The protocol was as follows. A 500-ml bolus of crystalloid was given every 30 minutes to achieve a central venous pressure of 8 to 12 mm Hg. If the mean arterial pressure was less than 65 mm Hg, vasopressors were given to maintain a mean arterial pressure of at least 65 mm Hg. If the mean arterial pressure was greater than 90 mm Hg, vasodilators were given until it was 90 mm Hg or below. If the central venous oxygen saturation was less than 70 percent, red cells were transfused to achieve a hematocrit of at least 30 percent. After the central venous pressure, mean arterial pressure, and hematocrit were thus optimized, if the central venous oxygen saturation was less than 70 percent, dobutamine administration was started at a dose of 2.5 μg per kilogram of body weight per minute, a dose that was increased by 2.5 μg per kilogram per minute every 30 minutes until the central venous oxygen saturation was 70 percent or higher or until a maximal dose of 20 μg per kilogram per minute was given. Dobutamine was decreased in dose or discontinued if the mean arterial pressure was less than 65 mm Hg or if the heart rate was above 120 beats per minute. To decrease oxygen consumption, patients in whom hemodynamic optimization could not be achieved received mechanical ventilation and sedatives.
ARDS
Vent
TV:
Fluid Management
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