A one day ‘basics’ of intensive care course A Practical Introduction to Intensiv

A one day ‘basics’ of intensive care course A Practical Introduction to Intensiv www.phwiki.com

A one day ‘basics’ of intensive care course A Practical Introduction to Intensiv

Metcalf, Randy, General Assignment Reporter has reference to this Academic Journal, PHwiki organized this Journal A one day ‘basics’ of intensive care course A Practical Introduction to Intensive Care ICU Housekeeping How did your 1st day on the ICU go

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A Practical Solution the H in addition to over Sheet

Problem Lists: A Solution Airway Breathing (Ventilatory Mode) PaO2:FiO2 Ratio Positive End Expiratory Pressure RR:TV Ratio Peak Airway Pressure Secretions Chest X-Ray Respiratory & Ventilation P1: VAP A1: Start Ceftazidime P:F Ratios PaO2 10 on 21% PaO2 10 on FiO2 100% P:F = PaO2 / FiO2

Everything’s fine, doc Pressure Sup port Ventilation RR/TV Weaning Cardiovascular Rate in addition to Rhythm MAP Inotrope / Vasopressor No. 1 Inotrope / Vasopressor No. 2 Steroids Hb Markers of Perfusion Clinical – Warm Well Perfused Central Venous Oxygen Saturation Lactate Base Deficit

Cardiovascular Numbers MAP 65 mmHg is OK 0.5 mcg/kg/min (Adr / NAd) is A LOT ScvO2 <70% is TOO LOW Lactate >2 mmol/l is TOO HIGH Base deficit < -2 is TOO MUCH Steroids in Sepsis Controversial Previously shown to reduce mortality amongst those unable to mount a steroid stress response (Synacthen) CORTICUS study (2008): No effect on mortality but faster time to resolution of shock (i.e. reduced inotrope/vasopressor duration). Same as long as responders in addition to non-responders thus synacthen test no longer indicated Renal Target Fluid Balance Achieved Fluid Balance Urine Output in 24hrs (= hourly urine output) Oedema Biochemistry Na K Urea Creatinine Magnesium Phosphate Fluid Balance Controversial Crispy or Bloated Colloids as long as Filling Crystalloids as long as Maintenance +500ml / day is normal Add if febrile / diarrhoea Subtract if oedema / bad lungs Renal Numbers Normal Mg2+ >0.8 Give 10mmol over 1 hour Normal PO43- > 0.8 <0.5 mmol / kg over 6 hours Target Nutrition In Achieved Nutrition In Nutrition Out Ulcer prophylaxis BM - Glycaemia Bilirubin GI / Liver Nutrition Controversial Starvation is bad (eventually) 30ml/kg/day TNIN ANIN Metoclopramide Gastric Protection Controversial Ranitidine / Sucralfate Ventilator Associated Pneumonia Glycaemic Control NICE-SUGAR (2009) Tight (4.5-6 mmol/L) vs conventional (4.5-10mmol/L) glycaemic control --------Increased mortality in addition to hypoglycaemic episodes as long as tight control. Conventional range recommended Metcalf, Randy Explorer Newspaper General Assignment Reporter www.phwiki.com

Bilirubin Haemoglobin Platelets Clotting DVT Prophylaxis Haematology Blood in Critical Care Controversial TRICC Exceptions

DVT Prophylaxis Don’t as long as get Sedation Scores Hypnotic Dose Opiate Dose Sedation Holidays CNS Intact PNS Intact Neuro & Sedation Temperature White Cell Count C-Reactive Protein Organism Site of infection Antibiotic 1 Day Antibiotic 2 Day (Lines ) Central Arterial Vascath Micro & Sepsis

Metcalf, Randy General Assignment Reporter

Metcalf, Randy is from United States and they belong to Explorer Newspaper and they are from  Tucson, United States got related to this Particular Journal. and Metcalf, Randy deal with the subjects like City/Metropolitan News; Local News; Regional News

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