Data

Meds ↑↓↔

Plan

Neuro

Propofol titrate to Ramsey II-III

Versed gtt 2-4mg/H

Morphine gtt 2-4mg/H

Fentanyl gtt 100-200mcg/H

MSContin 15-30 mg PO q12H

Oxycodone 5-10mg PO q6H

Diazepam 5-10mg PO q6H

Naloxone (Narcan) 0.4 – 2mg IV/IM; repeat q2-3min PRN

CV

MAP (>65); (normal range 80-100)

CVP (8-12); normal 2-6

Hct > 30

PAP (25/10);

PCWP (8-12,

ICU 15-18);

CI (2.8-3.6);

SVRI (1300-2100),

SVO2 (60-80%)

Nor Ep - Levophed

Neosynephrine - phenylephrine

Shock

Name/Primary/Secondary Site/ HD response

β1-inotrope, β2-chronotrope, vasodilator, α-vasoconstriction

Dobutamine -  β1; ↑CO, ↓TPR, ↑BP; 2.5-15mcg/kg/min; Dopamine -  β1; ↓CO, ↑↓TPR, ↑BP; 2.5-10; 20-50 mcg/kg/min; Epinephrine -  β1, α; ↑CO, ↓TPR, ↑↓BP; 0.01-0.05 for inotropy, >0.05 for vasoconstriction in mcg/kg/min; Norepinephrine - α, β1; ↓CO, ↑TPR, ↑BP; 0.02-3 mcg/kg/min; Phenylephrine - α, ↓CO, ↑TPR, ↑BP; 0.5-9mcg/kg/min

Anti-HTN

Beta Blocker: Metoprolol 25-50 mg PO BID; Metoprolol 5-10mg IV q6H (faster than labetalol)

Alpha Beta Blocker: Labetalol: 5, 10, 20, 40 mg IV

Afterload reducing: Hydralazine 20-40 mg IV, MR PRN

Nitroprusside gtt

Nitroglycerine gtt

Esmolol gtt

Labetalol gtt 10mg/H

ACLS

AFib:  Diltiazem Load 0.25 mg/kg IV over 2 min, then 0.35 mg/kg over 2 min in 15 min. gtt 5-15 mg/H

SVT: Adenosine 6, 12, 12 mg c NS flush

Brady: Atropine 0.5 - 3 mg

Shock:Epinephrine 1mg

Shock: Vasopressin 40U

V-Fib/Pulseless VTach: Shock then Amiodarone 300mg IV Push, Repeat 150mg PRN x 1; gtt 1mg/min when stable for next 6 hours;  or Lidocaine 1 – 1.5 mg/kg IV bolus; repeat 0.5-0.75 PRN; Max 3 mg; maintenance gtt 1-4 mg/min

HyperK: CaCl 1amp, Glc 50cc D50 then Insulin 5U IVPush; Kayexalate

Torsade: Magnesium sulfate 2-5gIV; antidote Calcium

FIRST LINE VASOPRESSOR: Nor Ep

FIRST LINE INOTROPE: Dobutamine

Electrical Therapy (Unstable Patient)

PSVT,

Atrial flutter c RVR: 

     sync 50, 100, 200, 300, 360

     or biphasic equivalent

AFib c RVR,

VT with pulse

     Sync 100, 200, 300, 360

     Or biphasic equivalent

Sustained Polymorphic VT – treat as VF

Pulseless VT/VFib:

     Biphasic: 120, 200

     If device range unknown, start with 200J

     Monophasic: 360J for all shocks

Causes of Cardiac Arrest:

PATCH 4 MD

PE, acidosis, Tension PTX, Cardiac tamponade, Hypovolemia, Hypoxia, Heat/Cold, Hypo/Hyperkalemia, Myocardial infarct, drugs/accidents

LV Heart Failure

SBP > 100, PAOP > 15, CI <2.5; use a vasodilator: IV Nitroglycerine 25mic/min or Nitroprusside at 0.3-1mic/kg/min; titrate to effect (make sure it’s not RV failure)

SBP < 90, PAOP > 15, CI <2.5 have cardiogenic shock: IABC, intraaortic balloon counterpulsation

Severe hypotension: NorEp; once BP is stabilized, dobutamine may be added and NorEP decreased

RV HF (elev RVEDP > 10, distended IJV; inferior MI, STE in V1 or V4R)

TX: Volume expansion until BP improved. Avoid vasodilators such as NTG, nitroprusside.

Pulm

 r/o PE

SVN

Mucomyst

GI

H2 Blockers: Pepcid 20mg IV/PO BID;

PPI: Prevacid 30mg PO QD; gtt 60mg bolus then 6mg/H

EES 250mg PO/PR Q6H; Dulcolax 10mg suppository x 1-2/qD; Colace 100-200mg PO BID; Senna 1 tab qD; MOM 30cc q6H

Kayexalate: 30cc q4-6H x 2-3 for Hyperkalemia

Renal

Cockcroft-Gault Equation: (140-age)*wt/(Cr*72)(x0.8 for female)

UO < 30

Diamox (Acetazolamide) 500 mg IV/PO QD-q6H, Epogen 40,000 weekly IV/SC

FEN

Perative, Jevity, Pivot, TPN

Ca-gluconate: 1-2 amps IV slowly

Mg: 1, 2, 4 mg IV

K: 20-40mEq IV in 100NS over 1 hour

NaPhos: 15-30mmol over 6H

K Phos: 15-30mmol over 6H

Heme

ASA 81mg PO QD, Plavix 75mg PO QD, Lovenox 40mg SC QD; Heparin variable, Coumadin, Epogen, Ferrous Sulfate 325 mg PO TID, Vit K 10mg IM/PO/IV QD

ID

PCN: Amp/Sulbactam (Unasyn) 1.5-3g IV q6h; Pip/Tazo (Zosyn) 3.375 g q4-6h for PNA 4.5g IV q6H

Carbapenems: Imipenem 1g IV q8H

Fluoroquinolones: Ciprofloxacin 400mg IV q12H, Levofloxacin 500mg IV/PO q24H, Gatifloxacin 400mg IV q24H

Macrolides: Azithromycin 500mg IV QDx2d, Erythromycin 250mg q6H

Vancomycin: 1g (15mg/kg) IV q12H

Linezolid: 600 mg IV/PO q12H

Aminoglycosides: Gentamycin 3mg/kg/day IV q8H, Tobramycin 3 mg/kg/day IV q12H, Amikacin 15 mg/kg/day IV q8H

Metronidazole: 500 mg IV q6-8H

Antifungal: Fluconazole 6-12 mg/kg/day; Voriconazole 6mg/kg q12 x 2doses, then 4mg/kg q12

Endo

Cosyntropin Stim Test:

Baseline, 0.1mg Cosyntropin, measure 15, 30min

TK: Hydrocortisone 100mg q8 then taper

PJO: Hydrocortisone 50mg q6hr x 7d

PT/OT