Critical care (Part 9)
Fluid bolus is almost always the correct initial therapy.
b1 myocardium- contractility
b2 arterioles- vasodilation
b1 SA node- chronotropy
b2 lungs- bronchodila
Critical care (Part 8)
Persistent neuromuscular blockade
Drug accumulation in critically ill patients
Renal failure and >48 hr infusions raise risk
In patients given neuromuscular blockers for >24 hours, there is a 5-10% incidence of
prolonged muscle we
Critical care (Part 7)
Paralyze skeletal muscle at the neuromuscular junction.
They do not provide any analgesia or sedation.
Prevent examination of the CNS
Increase risks of DVT, pressure ulcers, nerve compression syndromes.
Use of Paralytics
Critical care (Part 6)
Metabolized by the liver, excreted in the urine.
Morphine- Potential for histamine release and hypotension.
Fentanyl- Lipid soluble, 100X potency of MSO4, more rapid onset, no histamine
Demerol- Not a good ana
Critical care (Part 5)
Pain leads to a stress response which causes:
Pain in the ICU
What causes pain in the ICU?
Critical care (Part 4)
Propofol vs. midazolam
Similar times to sedation, faster wake-up time with propofol AJRCCM, 15:1012,
Nursing implemented sedation protocol
duration of mech vent, ICU stay, trach rate Crit Care Med 27:2609, 1
Critical care (Part 3)
Sedative, anesthetic, amnestic, anticonvulsant
Respiratory and CV depression
Highly lipid soluble
Rapid onset, short duration
Onset <1 min, peak 2 min, duration 4-8 min
Clearance not changed in liver or kidney disease.
Critical care (Part 10)
Renal dose dopamine probably only transiently increases u/o without changing
There are better b and a agents.
Adverse effects- tachyarrhythmias .
Primarily b1, mild b2.
Dose dependent incre