Emergency Medicine: Sepsis and Cardiac Arrest Care
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Questions and Answers

What is the primary goal of early goal-directed therapy (EGDT) in sepsis treatment?

  • To achieve a mean arterial pressure of 65 mmHg (correct)
  • To normalize lactate levels within 2 hours
  • To administer antibiotics within 1 hour of diagnosis
  • To identify and treat underlying infection source
  • What is the recommended ratio for chest compressions to rescue breaths during CPR?

  • 10:1
  • 15:2
  • 30:2 (correct)
  • 20:2
  • What is the primary purpose of hand hygiene in infection control?

  • To clean the hands before eating
  • To moisturize the hands
  • To wear gloves
  • To reduce the transmission of pathogens (correct)
  • Which of the following is a characteristic of short-acting sedatives used in the ICU?

    <p>They are typically used for less than 24 hours</p> Signup and view all the answers

    What is the recommended mode of ventilation for patients with acute respiratory distress syndrome (ARDS)?

    <p>Assist-control (AC) mode</p> Signup and view all the answers

    What is the primary goal of post-cardiac arrest care?

    <p>To optimize neurological function</p> Signup and view all the answers

    What is the recommended target temperature for targeted temperature management (TTM) in post-cardiac arrest care?

    <p>32-36°C</p> Signup and view all the answers

    What is the primary purpose of inotrope therapy in sepsis treatment?

    <p>To increase cardiac output</p> Signup and view all the answers

    What is the recommended duration for ventilator weaning in ICU patients?

    <p>Until the patient is able to breathe spontaneously</p> Signup and view all the answers

    What is the primary purpose of antimicrobial therapy in sepsis treatment?

    <p>To eradicate the underlying infection</p> Signup and view all the answers

    Study Notes

    Sepsis Treatment

    • Early recognition and management are crucial in reducing mortality:
      • Identify and treat underlying infection source
      • Administer early goal-directed therapy (EGDT) within 3 hours of diagnosis:
        • Fluid resuscitation with crystalloids or colloids
        • Vasopressor therapy (e.g., norepinephrine) if hypotensive
        • Inotrope therapy (e.g., dobutamine) if cardiac dysfunction
      • Monitor and adjust treatment based on patient response

    Cardiac Arrest Care

    • Follow American Heart Association (AHA) guidelines:
      • Call for help and start CPR (30:2 ratio) immediately
      • Use automated external defibrillator (AED) if available and follow device instructions
      • Continue CPR until return of spontaneous circulation (ROSC) or termination of resuscitation efforts
      • Post-cardiac arrest care:
        • Targeted temperature management (TTM) at 32-36°C for 24 hours
        • Neurological assessment and management

    Infection Control

    • Hand hygiene:
      • Wash hands with soap and water or use alcohol-based hand sanitizer
      • Perform hand hygiene before and after patient contact, and after contact with contaminated surfaces
    • Personal protective equipment (PPE):
      • Wear gloves, gowns, and masks according to hospital policy
      • Use PPE when entering patient rooms and when handling contaminated materials
    • Isolation precautions:
      • Implement contact, droplet, and airborne precautions as indicated by infection type
      • Use dedicated equipment and supplies to minimize cross-contamination

    ICU Medication

    • Sedation and analgesia:
      • Use short-acting medications (e.g., propofol, fentanyl) to facilitate weaning and minimize long-term effects
      • Monitor and adjust medication based on patient response and sedation scores
    • Vasopressors and inotropes:
      • Titrate medications to achieve desired hemodynamic goals
      • Monitor for adverse effects, such as tachyarrhythmias and hypertension
    • Antimicrobial therapy:
      • Use broad-spectrum antibiotics initially, then narrow spectrum based on culture results
      • Monitor for antibiotic resistance and adjust therapy accordingly

    Ventilator Management

    • Modes of ventilation:
      • Assist-control (AC) mode: delivers set tidal volume and rate
      • Synchronized intermittent mandatory ventilation (SIMV) mode: delivers set tidal volume and rate, with patient-initiated breaths allowed
      • Pressure support (PS) mode: augments patient-initiated breaths with set pressure
    • Ventilator settings:
      • Tidal volume: 6-8 mL/kg ideal body weight
      • Respiratory rate: 10-20 breaths per minute
      • Positive end-expiratory pressure (PEEP): 5-15 cmH2O
    • Weaning:
      • Gradually reduce ventilator support to facilitate spontaneous breathing
      • Monitor for signs of respiratory failure and adjust weaning plan accordingly

    Sepsis Treatment

    • Crucial for reducing mortality: early recognition and management
    • Identify and treat underlying infection source
    • Administer early goal-directed therapy (EGDT) within 3 hours of diagnosis:
      • Fluid resuscitation with crystalloids or colloids
      • Vasopressor therapy (e.g., norepinephrine) if hypotensive
      • Inotrope therapy (e.g., dobutamine) if cardiac dysfunction
    • Monitor and adjust treatment based on patient response

    Cardiac Arrest Care

    • Follow American Heart Association (AHA) guidelines
    • Call for help and start CPR (30:2 ratio) immediately
    • Use automated external defibrillator (AED) if available and follow device instructions
    • Continue CPR until return of spontaneous circulation (ROSC) or termination of resuscitation efforts
    • Post-cardiac arrest care:
      • Targeted temperature management (TTM) at 32-36°C for 24 hours
      • Neurological assessment and management

    Infection Control

    • Hand hygiene: wash hands with soap and water or use alcohol-based hand sanitizer
    • Perform hand hygiene before and after patient contact, and after contact with contaminated surfaces
    • Personal protective equipment (PPE): wear gloves, gowns, and masks according to hospital policy
    • Isolation precautions:
      • Implement contact, droplet, and airborne precautions as indicated by infection type
      • Use dedicated equipment and supplies to minimize cross-contamination

    ICU Medication

    • Sedation and analgesia: use short-acting medications (e.g., propofol, fentanyl) to facilitate weaning and minimize long-term effects
    • Sedation and analgesia: monitor and adjust medication based on patient response and sedation scores
    • Vasopressors and inotropes: titrate medications to achieve desired hemodynamic goals
    • Vasopressors and inotropes: monitor for adverse effects, such as tachyarrhythmias and hypertension
    • Antimicrobial therapy: use broad-spectrum antibiotics initially, then narrow spectrum based on culture results
    • Antimicrobial therapy: monitor for antibiotic resistance and adjust therapy accordingly

    Ventilator Management

    • Modes of ventilation:
      • Assist-control (AC) mode: delivers set tidal volume and rate
      • Synchronized intermittent mandatory ventilation (SIMV) mode: delivers set tidal volume and rate, with patient-initiated breaths allowed
      • Pressure support (PS) mode: augments patient-initiated breaths with set pressure
    • Ventilator settings:
      • Tidal volume: 6-8 mL/kg ideal body weight
      • Respiratory rate: 10-20 breaths per minute
      • Positive end-expiratory pressure (PEEP): 5-15 cmH2O
    • Weaning: gradually reduce ventilator support to facilitate spontaneous breathing
    • Weaning: monitor for signs of respiratory failure and adjust weaning plan accordingly

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    Description

    Quiz on recognizing and managing sepsis, and providing care for cardiac arrest patients, including early goal-directed therapy and American Heart Association guidelines.

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