Pocket Reference for ICU

7/27/2019 Pocket Reference for ICU

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-.)!/01&/&2&3456&65/3.7/1.-&IV Drip GuidelinesIV Push Medications

AcetazolamideActivated charcoalAdenosineAlbuterolAlteplaseAmiodaroneBretyliumBumetanideBuspironeCarvedilolCisatracuriumDantroleneDesmopressin

DigoxinDigibindDiltiazemDobutamineDopamine Infusion ChartDopamineEnalaprilatEpinephrineEsmololEsmolol Infusion ChartEpoprostenolEpoprostenol Dilution ChartEtomidateFentanylFlumazenilFurosemideGlucagonHaloperidolHydralazineInsulinIsoproterenolKetamineLabetalolLidocaineLorazepamMagnesiumMetoprolol

MidazolamMilrinone Infusion ChartMilrinoneNaloxoneNitroglycerin Infusion ChartNitroglycerinNitroprussideNitroprusside Infusion ChartNorepinephrine Infusion Chart

NorepinephrinePhenylephrinePropofol Infusion Chart

PropofolProcainamideSuccinylcholineThiopentalTromethamineVasopressinVecuronium Infusion ChartVecuroniumVerapamil

.7.)!4078!.&4.97:).;.1!&PotassiumMagnesium

PhosphateCalcium

Drug Compatibility Chart

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Predicting successful weaning from the ventilatorExtubation procedureFailure to wean mnemonicNon-invasive positive pressure ventilation (NIPPV)

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All of the following medications may be administered IVP by the RN to patients within the criticalcare section except for those that are annotated for a specific patient population.

Adenosine (Adenocard)

AlbuminAtivanAtropineBenadryl (Diphenhydramine)Bretylium (Bretylol)

Bumex (Bumetanide)Calcium ChlorideCalcium GluconateCardizem (Diltiazem)Compazine (Prochlorperazine)Q&DDAVP (Desmopressin Acetate)Decadron (Dexamethasone)Demerol (Meperidine)Dextrose 50%Diazoxide (Hyperstat)Digoxin (Lanoxin)Enalapril (Vasotec)EpinephrineEsmolol HCL (Brevibloc)Fentanyl (Sublimase)Haldol (Haloperidol)HeparinHydralazine (Apresoline)Inapsine (Droperidol)Inderal (Propanalol HCL)Insulin

Ketamine

Lasix (Furosemide)Lidocaine

Lopressor (Metoprolol Tartrate)

MannitolMorphine SulfateNarcan (Naloxone HCL)Neo-Synephrine (Phenylephrine HCL)Norcuron (Vecuronium)QQ&Ondansetron (Zofran)Pavulon (Pancuronium Bromide) QQ&Phenergan (Promethazine)PhosphenytoinQ&Procainamide (Pronestyl, Procan)Protamine SulfateRegitine (Phentolamine Mesylate)Reglan (Metoclopramine)Robinul (Glycopyrrolate)Romazicon (Fulmazenil)Sodium BicarbonateSolu-Cortef (Hydrocortisone)Solu-Medrol (Methylprednisone)Tensilon (Edrophonium Chloride)ThiamineThorazine (Chlorpromazine)Toradol (Ketoralac Tromethamine)Valium (Diazepam)

Verapamil (Calan)Versed (Midazolam HCL)Vitamin K (AquaMephytoin)

Vistaril (Hydroxyzine HCL)

Zemuron (Rocuronium Bromide) QQ&

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5,%U&Diuretic, urine alkalinization, lowers intraocular pressure, adjunct tx of refractory seizures, acute altitude sickness,and centrencephalic epilepsies.3',% : .A%@" : Oral, IV, IM: 250-375 mg or 5 mg/kg once daily:*+BC'*=>$,"*+ : 8-30 mg/kg/24 hrs in divided doses Q 6-12 hours5


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:@B'A" 3 week IV infusion administer 400 mg PO / day

R>@%+"*BA%&OR>@%NTP&

5,% : diuretic3',% : 0.5-1 mg/ dose IV push over 1-2 mins; maximum 10 mg/day)'*+B*>'>,&/D&B*(>,B'* : 0.9-1 mg/hour;BN: may be given undiluted;%CV"*B,@ : inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal renal tubule..$B@B*"+B'* : renal G"$(2$B(% : 1-1.5 hours:A=%


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5,%U& beta-adrenergic antagonist overdose3',%U&Load 5-10mg IVP

Maint 1-5mg/hr;BNU& 10mg in 100ml D5W/NS;%CV"*B,@U& adrenal release of catecholamines and enhanced calcium-dependent cAMP

synthesis.$B@B*"+B'*U& hepatic G"$(2$B(%U& 3-10 minutes:A=%C"H'*&/*(>,B'*&)V"$B*&4%H>$"@"*F&/*+


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5,%U& skeletal muscle relaxation during surgery and intubation3',%U&Load 0.5 - 1.5 mg/kg IV with usual induction dose of 1.0 mg/kg. IM dose: 2-5 mg/kg.;BNU& administer undiluted as intravenous push or IM injection;%CV"*B,@U& depolarizing steroidal neuromuscular blocker; competitive antagonism of

acetylcholine.$B@B*"+B'*U& hydrolyzed by plasma pseudocholinesterases G"$(2$B(%U& seconds

0*,%+U& 30-60 seconds 3>


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.$%C+@&)V$'25ml/hr and Creatinine < )K+>4.3 mEq/L, give 0 KClK+ 4.2-4.3 mEq/L, give 10 mEq KCL IV over 1 hr.K+ 3.8-4.1 mEq/L, give 20 mEq KCL IV over 1 hr.K+ 3.4-3.7 mEq/L, give 40 mEq KCL IV over 2 hr.K+ 2.8-3.3 mEq/L, give 60 mEq KCL IV over 3 hr.K+ 5.0 mEq/L

4%*"$&E"B$>_4.0 mEq/L , give 0 KCLK+ 3.8-3.9 mEq/L, give 10 mEq KCL IV over 1hr.K+ 3.4-3.7 mEq/L, give 20 mEq KCL IV over 1hr.K+ 2.8-3.3 mEq/L, give 30 mEq KCL IV over 1.5hr.K+ _4.0 mEq/L


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Standard MgSO4 Scale 9 2.0 mEq/L, give 0 MgSO 4Mg

2+

1.8-2.0 mEq/L give 2 gms. MgSO4 IV over 1hr.

Mg

2+

1.5-1.7 mEq/L give 4 gms. MgSO4 IV over 2hr.Mg

2+


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Establish the diagnosis by observing one additional seizure in a patient who has seized or by observinga continuous seizure for more than 10 minutes.

ABCs and establish intravenous access with normal saline, dextrose is incompatible with phenytoin.

Send a CBC, P1, and any anti-epileptic drug levels, if indicated.

Administer thiamine 100mg IM (if there is any suspicion of alcohol abuse) followed by dextrose 50%50mL.

Administer lorazepam 0.1 mg/kg IV.

If seizure persists, administer phenytoin 20mg/kg IVPB at a rate of 50mg/min. Monitor EKG and BP.If seizure persists, administer phenytoin 5mg/kg.

If seizure persists, intubate (if not already accomplished) and administer phenobarbital 20mg/kg at a

rate of100mg/min.

If seizure persists, initiate a barbiturate coma. Patient will require intubation. Administer pentobarbital5mg/kg IV loading dose followed by a continuous infusion of 0.5 - 2mg/kg with the goal of achieving anEEG demonstrating a burst suppression pattern. Achieving this EEG pattern is more important thanspecific blood levels.

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Calculated ParameterE'$"&

Mean Arterial Pressure (MAP) MAP = 1/3 (SBP-DBP) + DBPMAP = CI SVRI

1'%&

5-95 mm Hg

Cardiac Output (CO) CO = HR SV 4 - 6 L/min

Cardiac Index (CI) CI = CO / BSA 2.5 - 4 L/min/m

2

Stroke Volume Index (SVI) SVI = CI/HR 1000 36 - 48 mL/b/m2

Left Ventricular Stroke Work LVSWI = (MAP - PCWP) SVI 0.0136 44 - 56 gm m/m2

Index (LVSWI)

Systemic Vascular Resistance SVR = [(MAP - CVP) 79.9]/ CO 770-1500 dynesec/cm5

(SVR)

Systemic Vascular Resistance SVRI = [(MAP - CVP) 79.9]/CI 1200 - 2500 dynesec/cm5

m2

Index (SVRI)

Pulmonary Vascular PVRI = [(MPAP - PCWP) 79.9]/CI 80 - 240 dynesec/cm5

m2

Resistance Index (PVRI)

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NamEq/L

KmEq/L

CImEq/L

CamEq/L

Glucgm/L

LacmEq/L

mOsm/L

Albumin 5%

Albumin 25%

Plasma Protein Fraction 5%

(pp)*

130-160

130-160

130-160 < 2

130-160

130-160

130-160 167

308

1500

290

Dextran 40"n" (154) (154) (250) 278

Hetastarch 6% (Hespan) 154 154 310

D5W 250 278

NS 154 154 308

NaCI 3% 513 513 1025

Ringer's lactate 130 4 110 3 27 275

*- contains Albumin 44gm/L and globulin 6gm/L

" - available combined with either sodium chloride OR dextrose

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Saliva 30 20 35 15 1 - 1.5

Gastric, pH4 100 10 100 2

Bile 145 5 110 40 1.5

Duodenum 140 5 80 50

Pancreas 140 5 75 90 0.7 - 1

Ileum 130 10 110 30 3.5

Cecum 80 20 50 20

Colon 60 30 40 20

New ileostomy 130 20 113 30 0.5 - 2

Adapted ileostomy 50 5 30 25 0.4

Colostomy 50 10 40 20 0.3


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1>++ 50 mL/minTotal gms of nitrogen in (N IN) = Total gm of protein in / conversion factor

use a factor of 6.25 for food and enteral nutritionuse a factor of 6.06 for parenteral nutrition

Total gms of nitrogen out (N OUT ) = 24 hour UUN in gm + 4 gm insensible lossesNitrogen balance = NIN - NOUTGoal is nitrogen balance = 0 to 3+


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!'+"$&OC%*+$"+B'*&U&Lean Body Weight (LBW)=IBW + 0.4 (Actual body weight - IBW)Ideal Body Weight (IBW)=for males 50kg + (2.3kg for each in over 60')

=for females 45kg + (2.3kg for each in over 60')

Use a lean body weight if patient is significantly edematous and/or obese

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General

Blood Bank phone: 433-6042. Blood Bank physician is on call 24 hours a day 7 days a week Informed consent must be obtained once during each hospital stay using forms present in

patients chart Blood must be infused within 4hrs. It can be split into smaller aliquots. A unit of blood that has been issued and allowed to warm to 10 C but not used can not be

reissued. Blood must not be stored in unmonitored refrigerators

Standard blood filters have a pore size of 170 microns. Proper patient identification is essential, mislabeled specimens will not be accepted

Tests related to blood transfusions

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Consider if:1. Hospitalized >72 hours2. Hospitalized within past 3 mo.3. Significant prior antibiotic use

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)VB$Al,&"H%& ;B$K&"*A&-'$BA,& )$%"BA,&

< 6 months 4 hours 2 hours

6 mo to 3 years 6 hours 3 hours> 3 years 8 hours 3 hours

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G%@'A?*"@BC&.N"@&"*A&;'*B+'+X>+U&can be assessed by HR and capillary refill time, mentation, and UOP, (fallingBP is a late ominous sign)9


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Dead Space = 1 - (EtCO2/PaCO2 )Static Comp. = VT/ (P plat - PEEP)

A-a gradient =(P b-P H2O ) x FIO2 - (PCO2/.8) - PaO 2

G?X'N%@B"m&- T PEEP to T FRC, to allow FIO2 wean to < 50%.$%="+%A&X%"K&X5ml/kg)0&xygenation FiO 2 48 or aftermultiple airway instrumentations?9&ressures - PP #"+B'*&

ib\o& GBHV&4B,K&'(&4%B*+>#"+B'*&

ja`o&

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Oral Airway (mm)

40 40-50 50-60 60-70 70-80

7"

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Pocket Reference for ICU