ICU Cheat Sheets

Guideline · Apr 2020 · 1 min read

In brief

Quick-reference clinical guides for intensive care unit management, likely covering common protocols, drug dosing, ventilator settings, and critical care algorithms for bedside use.

Written by the GCMD Library team from the guideline.

Troubleshooting Basics of Mechanical Ventilation

Foundational principles for identifying and resolving common mechanical ventilation problems. Covers systematic approaches to ventilator alarms, patient-ventilator dyssynchrony, and equipment malfunction.

Positive End Expiratory Pressure (PEEP)

Clinical application of PEEP in mechanically ventilated patients. Discusses optimal PEEP titration strategies, effects on oxygenation and hemodynamics, and considerations in ARDS management.

ARDS Overview and Ventilator Settings

Acute Respiratory Distress Syndrome pathophysiology and evidence-based ventilator management. Includes lung-protective ventilation strategies, PEEP/FiO2 tables, and rescue therapies for refractory hypoxemia.

Shock Syndromes and Hypotension Management

Classification of shock states including septic and cardiogenic shock with mechanisms of impaired oxygen delivery. Covers systematic examination approach and initial management strategies for hypotension in critically ill patients.

COVID-19 Clinical Management Guidelines

Comprehensive overview of SARS-CoV-2 infection including transmission, clinical course, and risk stratification. Details diagnostic workup with emphasis on lymphopenia, inflammatory markers (ferritin, CRP, D-dimer), and supportive care strategies including investigational therapies.

Arterial Blood Gas Interpretation

Critical threshold values on arterial blood gas analysis requiring clinical intervention. Provides reference ranges for pH, PaCO2, PaO2, and bicarbonate with concerning levels that indicate respiratory or metabolic derangements.

Statements in this guideline

Shock is a syndrome of impaired oxygen delivery to tissues.
EstablishedShock
Mechanisms of shock include absolute or relative decrease in oxygen delivery, ineffective tissue perfusion, and ineffective utilization of delivered oxygen.
EstablishedShock
COVID-19 spreads by droplet and survives 2-3 hours on most surfaces and 2 days on smooth metal or plastic.
EstablishedGeneral facts
The incubation period for COVID-19 is 2-14 days.
EstablishedGeneral facts
In the first week of COVID-19, patients present with fever, cough, headache, fatigue, myalgias, and pharyngitis.
EstablishedGeneral facts
In the second week of COVID-19, 80% of patients resolve and 20% develop viral pneumonia.
EstablishedGeneral facts
Risk of severe COVID-19 is increased in patients with heart or lung disease, immunosuppression, or poorly controlled diabetes mellitus.
EstablishedGeneral facts
COVID-19 labs typically show lymphopenia with normal WBC count or relative leukopenia.
EstablishedLabs
Elevated ferritin, CRP, and D-dimer are negative prognostic indicators in COVID-19.
EstablishedLabs
Mortality in COVID-19 is due to oxygenation failure or septic shock with multiorgan failure.
EstablishedMortality
Testing for COVID-19 should include CBC, CMP, ABG, troponin, G6PD, rapid flu testing, bacterial sputum and blood cultures, coronavirus PCR, CRP, ferritin, and D-dimer.
RecommendationTesting
Coinfection with bacterial respiratory pathogens is unlikely in COVID-19.
EstablishedTesting
Treatment for stable COVID-19 patients is symptomatic support; unstable patients should be managed per critical care guidelines.
RecommendationTreatment

Full text

Troubleshooting Basics of Mechanical Ventilation Positive End Expiratory Pressure M. DaniyalHashmi, MD

ARDS -overview Ventilator settings M. DaniyalHashmi, MD

Shock• Syndrome of impaired oxygen delivery to tissues • Mechanisms -Absolute/relative decrease in oxygen delivery -Ineffective tissue perfusion -Ineffective utilization of delivered oxygen Septic shock Cardiogenic shock Examination Management of Hypotension M. DaniyalHashmi, MD

General factsSpread: Droplet spread, survives 2-3 hours on most surfaces, 2 days on smooth metal/plastic Incubation: 2-14 days 1stweek: Fever, cough, headache, fatigue, myalgias, pharyngitis 2ndweek: Resolves in 80%, Viral pneumonia 20% Risk increased: Heart/lung disease, immunosuppression, poorly controlled DM Exam: Non specific Labs:Lymphopenia with normal WBC count or relative leukopenia, Elevated Ferritin/CRP/D-Dimer is negative prognostic indicator Mortality: Due to oxygenation failure or septic shock/multiorgan failure Imaging: Testing: CBC, CMP, ABG, Troponin, G6PD, Rapid flu testing and bacterial sputum and blood cultures (coinfection with BACTERIAL respiratory pathogens unlikely), Coronavirus PCR testing, CRP, Ferritin, D- Dimer Treatment: Symptomatic support for stable patients otherwise refer to guidelines for critical care support -Currently under investigation (Plaquenil, Azithromycin and Remdesivir) M. DaniyalHashmi, MD Per présentation by Dr. Leon Liang-Yu Lai, MD

Concerning levels on ABG M. DaniyalHashmi, MD

Open in a new tab ↗