Kudigo Edited.doc

Indications for weaning 1. Stable oxygenation (PaO2/FiO2 >200); (PEEP ≤5cm H20) 2. Intact cough and airway reflexes 3. No vasopressor agents being administered FAILURE: 1. RR ≥35 BPM for 5 minutes 2. O2 sat 140 BPM; 20% increase/decrease from baseline 4. Systolic BP 180 mm Hg 5. Increase anxiety diaphoresis SUCCESSFUL 1. Breathing ratio of RR to TV in L 28 BPM 2. BP 0.6 >200 IU 500 u/mL >50% PMS

AORTIC ANEURYMS De Bakey Type 1 Ascending Aorta and beyond Type 2 Ascending Aorta only Type 3 Aorta distal to the subclavian A.

Type A Type B

I II III IV V VI

Stanford Ascending Descending

MURMUR GRADING So faint Quiet but can be heard by stethoscope Loud Moderately loud with thrill Very loud, audible with stet partly off the chest Very loud, audible with stet removed from the chest

DIAZ STROKE SCALE Character Grade Vomiting 4 Level of consciousness 4 Unarousable 2 Drowsy 0 Awake Fever 3 Respiratory pattern Ataxic/apneustic 3 Hyperventilation 2 Cheynes-strokes 1 Regular/Normal 0 Upper GI bleed 3 Neuro deficit (max at 2 onset) Headache 2 Nuchal rigidity 2 DBP 100 2 SBP

0.6 3. Pleural LDH >2/3 upper limit

Motor Neuron Lesions Character UMN LMN Tone Hypertonic Hypotoni clonus c Fasciculati Neg Pos ons Wasting Neg Pos Reflexes Exagerated Neg

Sta ge I

II III

Hepatic encephalopathy Mental Status Asterix ia Euphoria or depression, Either mild confusion, blurred speech, disorientation, asleep Lethargy, moderate Pos confusion Marked confusion, Pos incoherent speech, sleeping, arousable

EEG N

AbN AbN

IV

Coma, initially responsive to noxious stimuli; later unresponsive

Neg

Indications for Thrombolytic Therapy 1. Chest pain consistent with AMI 2. ECG changes a. ST segment elevation >/= 1 mm in atleast 2 contiguous leads b. ST segment elevation >/= 2mm in atleast 2 contiguous chest leads or c. New LBBB 3. Time from chest pain to thrombolytic treatment a. 200/120 Relative contraindication for thrombolysis 1. Known bleeding diathesis 2. Prev streptokinase treatment for the past 6-9 months 3. BP >/=180/100 on at least 2 readings 4. Active PUD 5. Hx of thrombotic CVA 6. Prolonged CPR >/= 10m or traumatic CPR 7. Diabetic hemorrhagic retinopathy or other hemorrhagic ophthalmic conditions 8. Pregnancy 5 Dressler’s Sign of Post-MI Pericarditis 1. Pericarditis 2. Pneumonitis 3. Pleuritis 4. Pyrexia 5. Pain SEPSIS (>2 or more) Fever >38 or 24/min 3. Tachycardia >90/min 1.

AbN

4. 5. 6.

Inc WBC >12, 000 Dec WBC 10% Bands

Urine Osmolality Spc Gravity U/P creatinine ratio Urine Na BUN/ Creatinine FE Na (%) Renal failure index Sediment

Causes

Prerena l >500

Renal

>1.018

40

40 40 >15

1

>4

Acellular, transpar ent hyaline cast Hypovole mia; dec CO, inc resistanc e

Muddy brown granular cast

Hyaline casts

GN vasculat is, ATN, nephriti s

Calculi, CA, fibrosis

9 0

Action

I (asym p)

Injury not acute with preserved GFR

II (asym p) III

Mild kidney disease

6089

Moderate

3059

IV (symp ) V (symp )

Severe

1529

Treat complications; ESRD, education Prepare for ESRD treatment

Kidney failure

15 Vasoconstrictive agent µg/kg/min

Color CHON Pressu re Glucos e Cells

Normal Colorles s 1545mg/dl 30180mm H20 4570mg/d L 55 yo  Leukocytosis >16,000 per cubic millimeter  Hyperglycemia >11mmol/L (>200 mg/dL)  Serum LDH >400 IU/L  Serum AST >250 IU/L During initial 48 hours  Fall in hematocrit by >10%  Fluid deficit >4000mL  Hypocalemia