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Cheatography

ICU Cheat Sheet (DRAFT) by

Cheat sheet for ICU physiotherapy

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Normal Values

Hb (g/L)
Normal: 70-100
Males: 135-180
Females: 115-160
Platelets (x10^9/L)
Normal: 140-400
Avoid P+V: <30
?NP suction: <50-60
Weight lifting: >100
INR
Normal: 1
Heart Valves: 2.5-3.5
DVT/PE/AF: 2-3
INR
Normal: 1
Heart Valves: 2.5-3.5
DVT/PE/AF: 2-3
BP
MABP
CVP
90/60 - 140/90
70-105
5-15
SIRS Criteria
WCC: <4 or >12
Temp: <36 or >38
HR: >90
RR: >20 or PaCO2 <32
SIRS: 2+/4 above
Sepsis: SIRS+s­ource infection
Sepsis+: Sepsis­+Org. Fail

Neurol­ogical Values

ICP (mmHg)
0-15
TBI target <22
CPP
>60
CPP = MABP - ICP
Upper Motor Neuron Lesions
Weakne­ss/­Spa­sti­cit­y/H­ype­ref­lex­ia/­Pri­mitive Reflexes
Babinski sign
Lower Motor Neuron Lesions
Weakne­ss/­Hyp­oto­nia­/Hy­por­efl­exi­a/A­trophy
Fasicu­lations

Sedatives

Midazolam
Short acting, avoid due to delirium
Morphine / Fentanyl (Opiod)
Also analgesic
Propofol
Short acting, rapid onset of action, short term sedation
Dexmed­eto­midine
Used for pt who are difficult to wake due to agitation

Inotro­pes­/Va­sop­ressor

Noradr­enaline (mcg/k­g/min)
Vasopr­essor
(>0.1)
Adrenaline (mcg/k­g/min)
Vasopr­essor + Isotrope
(>0.1)
Dobutamine (mcg/k­g/min)
Inotrope
(5-10, >10 risk of arrhyt­hmias)
Vasopr­essin (units)
Increases BP by increasing renal fluid resorption + peripheral vasoco­nst­riction
(0.01-­0.04)
 

MHI precau­tions

PEEP >10 +/- (FiO2>0.4)
Airborne or contact precau­tions
FiO2 >0.7
Pulmonary compliance is low (compl­iance <40­mL/­cmH2O)
Pulmonary bull or lung abscess -> CXR

MHI Contra­ind­ica­tions

Highly infectious respir­atory conditions
High frequency oscill­ating ventil­ation (HFOV)
Severe bronch­ospasm or gas trapping
Pneumo­thorax is present and is untreated (insertion of ICC)
Frank hemoptysis is present

MHI - Resp Consid­era­tions

Patients WOB
Accessory muscle use
Parado­xical breathing patterns
CVL insertion
Withhold MHI until CXR -> ptx
ICCs
Review swinging, bubbling and drainage prior/­after rx
Bronch­o-p­leural fistula
D/w ICU consultant

MHI - Haemod­ynamics Consid­era­tions

Acute PE is present
BP is low (MABP<60) especially 1) labile BP 2) High vasopr­ess­or/­ino­tropic) 3) acute resusc­itation phases of septic shock or hypova­lemic states
New arrhythmia (ok if present + contro­lled)

MHI - Neurol­ogical Consid­era­tions

ICP
Is it being monitored, caution when CPP/ICP is labile
Cerebral hemody­namics
Hypocapnia > vasoco­nst­riction > dec. ICP
Hyperc­apnia > vasodi­lation > inc. ICP
EVD
Should be clamped prior to MHI
Increase in ICP during MHI
Hyperv­ent­ilate > hypocapnia > vasoco­nst­riction > dec ICP
 

Subjective Ax

Heart and lungs: PMHx
Post Op: nausea, vomiting, light-­hea­ded­ness, pain
Resp: cough, sputum, wheeze, SOB, smk hx
PLOF: aids, ex-tol­era­nce­/li­mit­ation, indoor­/ou­tdoor, falls
SHx: home setup, occupa­tion, children, hobbies

Objective Ax

Resp:
Cough, sputum, palpate, auscul­tation
Neuro:
Sensation (light touch, pain), power
UMN: spasti­city, babinski, clonus, hyperr­eflexia
LMN: hypotonia, hypore­flexia, atrophy, fascic­ula­tions
MSK:
MMT, atrophy
Function:
Sitting balance, etc
Gait:
As approp­riate
Circul­ation:
DVT, Cap refill

Room Prep

Where are we going/what do we need
Chair, IV pole, sheet, aid, which side
Do we need to monitor
Yes/No - what do we need
Bed Space
Wires, chairs, drains
Attach­ments
Drains, monito­ring, CVL, art line, EVD?, Femoral art line?