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A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and complains of a headache and nausea. He reports he ran out of blood pressure meds three days ago, but also appears to be confused to the date and situation. What is the most appropriate treatment approach?

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Rapidly lower the diastolic pressure to 100 with IV antihypertensive meds, then continue to gradually reduce the diastolic pressure to 85 with oral antihypertensive meds.

The maximum initial decrease should be no more than 25% reduction from initial presenting value. Reducing the blood pressure too quickly can lead to cerebral edema or renal failure.

A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding indicate that this intervention is having it's intended effect?

ScvO2 of 72%

Early goal directed therapy for sepsis includes early fluid resuscitation at 30 ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5 kg/hr

72 male patient in ICU for 6 days on the ventilator for treatment of a COPD exacerbation. He has been receiving VTE prophylaxis and subcutaneous Heparin since admission. Today his platelet count decreased significantly to 43,000 and was found to have new DVT on his right upper extremity. What do you suspect is the most likely cause of these findings?

HIT

The hallmark sign of HIT is a significant decrease in platelet count over a 24 hours period (>50%) within 5-10 days of administering Heparin. The other hallmark sign is a new development of DVT despite being on VTE prophylaxis.

TRALI:

is a complication from a blood transfusion reaction, which causes acute lung injury typically within 6 hours of a blood transfusion.

2 Hallmark signs of HIT:

Decrease in platelet count over a 24 hr period.

New development of DVT despite being on VTE prophylaxis.

Values in Early compensated Hypovolemic shock?

CO 4.0 L/min, HR 135, SV 65, SVR 1700, MAP 65
In hypovolemic states, circulating volume is depleted therefore preload and contractility are decreased which leads to a decrease in SV and CO. HR and SV increase as compensatory measure to preserve CO, MAP and cerebral perfusion.

Post-renal failure values:

Urine output < 200; urine sodium 30; BUN: Creatinine ratio 15:1; urine specific gravity 1.010

BUN: Creatinine ratio is 15:1, but both the BUN & creatinine are elevated. Urine sodium is typically 1-40 mEq/L.

What to do in the event of HIT:

Stop Heparin and administer an alternative direct thrombin inhibitor.

Warfarin is contraindicated in HIT? T/F