ABA Critical Care cheat sheet

Berlin ARDS criteria: onset within 1 week, bilateral opacities not fully explained by effusion, collapse, or nodule, PEEP ≥5 cmH2O, and PaO2/FiO2 ≤300; mild 201–300, moderate 101–200, severe ≤100.

Lung-protective ventilation: tidal volume 6 mL/kg predicted body weight (range 4–8), plateau pressure ≤30 cmH2O, and driving pressure (plateau minus PEEP) ≤15 cmH2O.

Predicted body weight: male 50 + 2.3 × (height in inches − 60) kg; female 45.5 + 2.3 × (height in inches − 60) kg.

Severe ARDS: prone positioning for ≥12–16 h/day reduces mortality; consider neuromuscular blockade only for refractory cases.

Auto-PEEP is suggested by expiratory flow that does not return to zero or an end-expiratory hold pressure above set PEEP; manage with lower respiratory rate, longer expiratory time, and lower tidal volume.

Rapid shallow breathing index = respiratory rate divided by tidal volume in liters; values <105 favor successful spontaneous breathing trial.

Noninvasive ventilation contraindications include altered mentation, hemodynamic instability, facial trauma, upper airway obstruction, and high aspiration risk.

Cuff pressure target is 20–30 cmH2O; higher pressures risk tracheal ischemia and lower pressures risk microaspiration.

MAP = DBP + 1/3(SBP − DBP), or (SBP + 2×DBP)/3; septic shock targets MAP ≥65 mmHg.

Norepinephrine is first-line vasopressor in septic shock; vasopressin is added to reduce norepinephrine dose, and epinephrine is used for refractory shock.

Cardiogenic shock: norepinephrine plus dobutamine when hypoperfusion persists; avoid fluid loading after pulmonary edema develops.

Cardiac tamponade: Beck triad (hypotension, muffled heart sounds, elevated JVP), pulsus paradoxus, and echo showing diastolic collapse.

Passive leg raise and stroke volume variation predict fluid responsiveness better than CVP alone; a >10% rise in stroke volume or cardiac output suggests responsiveness.

STEMI: aspirin plus reperfusion; nitrates are contraindicated in right ventricular infarction, severe aortic stenosis, or sildenafil use within 24–48 h.

Post-cardiac arrest: target MAP 65–80 mmHg, avoid hyperoxia and hypocapnia, and use targeted temperature control for comatose survivors.

Atrial fibrillation with rapid ventricular response in ICU: treat triggers, correct electrolytes, and use rate control; unstable patients need synchronized cardioversion.

Glasgow Coma Scale: eye 1–4, verbal 1–5, motor 1–6; score ≤8 generally indicates need for airway protection.

Cerebral perfusion pressure = MAP − ICP; typical target CPP 60–70 mmHg, with ICP usually kept <20–22 mmHg.

Status epilepticus: benzodiazepine first, then levetiracetam, fosphenytoin, or valproate; refractory cases need propofol, midazolam, or pentobarbital infusion.

Acute ischemic stroke: IV thrombolysis within 4.5 h of last known well; mechanical thrombectomy up to 24 h in selected large-vessel occlusion.

Aneurysmal subarachnoid hemorrhage: nimodipine reduces delayed cerebral ischemia; avoid hypotension and treat hydrocephalus.

CAM-ICU assesses delirium by acute change or fluctuation, inattention, altered consciousness, and disorganized thinking.

Osmotic therapy for cerebral edema: mannitol 0.25–1 g/kg or hypertonic saline; monitor sodium and osmolality.

Targeted temperature management after cardiac arrest: maintain 32–36°C for comatose patients, prevent shivering, and rewarm slowly.

KDIGO AKI: serum creatinine rise ≥0.3 mg/dL within 48 h, ≥1.5× baseline within 7 days, or urine output <0.5 mL/kg/h for 6 h.

Anion gap = Na − (Cl + HCO3); normal 8–12 mmol/L; delta-delta = (measured AG − normal AG)/(normal HCO3 − measured HCO3).

Winter formula: expected PaCO2 = 1.5 × HCO3 + 8 ± 2; higher or lower values indicate an additional respiratory disorder.

Hyponatremia correction limit: ≤8–10 mmol/L in 24 h to reduce osmotic demyelination risk, especially in chronic hyponatremia.

Hyperkalemia with ECG changes: IV calcium first for membrane stabilization, then insulin/glucose, beta-agonist, and dialysis for refractory cases.

CRRT indications include refractory hyperkalemia, severe acidosis, volume overload, uremic complications, and hemodynamic instability.

Serum osmolality = 2 × Na + glucose/18 + BUN/2.8; measured minus calculated osmolality >10 suggests unmeasured osmoles.

FENa = (urine Na × plasma Cr)/(plasma Na × urine Cr) × 100; <1% suggests prerenal state, but diuretics can raise it.

Sepsis-3: suspected infection plus SOFA increase ≥2; septic shock requires vasopressors for MAP ≥65 mmHg and lactate >2 mmol/L despite adequate fluids.

Septic shock: give 30 mL/kg IV crystalloid within 3 h, reassess dynamically, and start antibiotics within 1 h for shock or high likelihood of sepsis.

Neutropenic fever: ANC <500 cells/µL plus temperature ≥38.3°C once or ≥38.0°C sustained; start anti-pseudomonal beta-lactam promptly.

Ventilator-associated pneumonia prevention: head-of-bed elevation 30–45°, daily sedation interruption, oral care, and avoiding unnecessary antibiotic exposure.

Clostridioides difficile colitis: oral vancomycin or fidaxomicin; avoid antiperistaltic agents and use contact precautions.

Fungal infection risk in ICU: consider Candida when multiple risk factors exist; echinocandin is first-line for candidemia.

Lactate clearance: serial lactate reduction suggests resuscitation response; persistent hyperlactatemia warrants reassessment for ischemia, infection, or liver dysfunction.

Immunocompromised ICU patients: early broad-spectrum antibiotics, PJP prophylaxis when indicated, and caution with live vaccines.

HIT: 4T score estimates pretest probability; stop heparin and start argatroban or bivalirudin; avoid platelet transfusion unless bleeding.

DIC: thrombocytopenia, prolonged PT/PTT, low fibrinogen, and elevated D-dimer; treat the underlying cause and transfuse for bleeding.

Massive transfusion: balanced 1:1:1 RBC:FFP:platelet ratio; give tranexamic acid within 3 h in trauma with suspected bleeding.

Restrictive transfusion: Hgb threshold 7 g/dL; consider 8 g/dL in acute coronary syndrome or active bleeding.

Warfarin reversal: vitamin K plus four-factor PCC for major bleeding; dabigatran reversal uses idarucizumab.

TTP: ADAMTS13 deficiency causes microangiopathic hemolysis and thrombosis; treat with plasma exchange plus steroids; avoid platelet transfusion unless life-threatening bleeding.

Sickle cell acute chest syndrome: exchange transfusion to lower HbS, plus antibiotics and oxygen.

Heparin-induced thrombocytopenia paradoxically causes thrombosis; warfarin should be delayed until platelets recover.

DKA: glucose >250 mg/dL, ketones, pH <7.3, HCO3 <18, anion gap; treat with fluids, insulin, and potassium replacement.

HHS: glucose >600 mg/dL, effective osmolality >320 mOsm/kg, minimal ketosis, and profound dehydration; fluid resuscitation is central.

Start insulin infusion in DKA only when potassium ≥3.3 mmol/L; add dextrose when glucose <200–250 mg/dL to continue insulin.

Thyroid storm: thionamide first, iodine at least 1 h later, beta-blocker, and glucocorticoids; treat triggers.

Myxedema coma: IV levothyroxine plus stress-dose hydrocortisone until adrenal insufficiency is excluded.

Adrenal crisis: hydrocortisone 100 mg IV then 50 mg every 6 h; use dexamethasone if ACTH stimulation testing is planned.

Stress hyperglycemia target in ICU is commonly 140–180 mg/dL; avoid hypoglycemia <70 mg/dL.

Pheochromocytoma crisis: alpha-blockade before beta-blockade to avoid unopposed vasoconstriction.

Trauma primary survey: airway with cervical spine protection, breathing, circulation, disability, exposure; treat immediate threats before imaging.

Lethal triad: hypothermia, acidosis, and coagulopathy; damage-control resuscitation includes warming, hemorrhage control, and balanced transfusion.

Abdominal compartment syndrome: bladder pressure >20 mmHg plus new organ dysfunction; decompress with laparotomy or percutaneous drainage.

Rhabdomyolysis: CK often >5,000 U/L; aggressive fluids and urine output 200–300 mL/h reduce kidney injury risk.

Burn resuscitation: Parkland formula 2–4 mL/kg/%TBSA lactated Ringer over 24 h, with half in first 8 h; titrate to urine output.

Transplant immunosuppression: tacrolimus causes nephrotoxicity and neurotoxicity; monitor levels and drug interactions.

Acute graft rejection: fever, graft tenderness, oliguria, and rising creatinine; diagnosis requires biopsy.

Post-transplant prophylaxis: PJP prophylaxis for several months and CMV surveillance or prevention based on serostatus.

Enteral nutrition: start within 24–48 h in critically ill patients; trophic feeding may be used in shock with escalating vasopressors.

Refeeding syndrome: hypophosphatemia, hypokalemia, hypomagnesemia; give thiamine before feeding and monitor electrolytes.

Stress ulcer prophylaxis: PPI or H2 blocker for high-risk patients with mechanical ventilation >48 h, coagulopathy, or prior GI bleed.

Variceal hemorrhage: octreotide plus prophylactic antibiotics and endoscopic band ligation; avoid overtransfusion.

Acetaminophen toxicity: N-acetylcysteine is most effective within 8 h; use Rumack-Matthew nomogram for acute overdose risk.

Salicylate toxicity: alkaline diuresis with sodium bicarbonate and hemodialysis for severe toxicity; avoid intubation unless necessary because it can worsen acidosis.

Toxic alcohol poisoning: fomepizole blocks alcohol dehydrogenase; hemodialysis removes parent alcohol and metabolites.

Organophosphate poisoning: atropine for muscarinic effects and pralidoxime for nicotinic effects; decontaminate.

Decision-making capacity requires understanding, appreciation, reasoning, and expressing a choice; capacity is decision-specific.

ABCDEF bundle: Assess/treat pain, Both SAT and SBT, Choice of analgesia/sedation, Delirium monitoring, Early mobility, Family engagement.

Central line bundle: hand hygiene, maximal sterile barrier, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.

Hand hygiene remains the single most effective infection prevention measure in ICU.

Goals-of-care meetings should establish patient values, prognosis, treatment options, and acceptable outcomes; document decisions.

Withdrawal of life-sustaining treatment includes symptom control, family support, and protocolized extubation; ethical distinction from euthanasia.

Incident reporting and root cause analysis improve patient safety; voluntary reporting underestimates adverse events.

ICU triage during scarcity should use objective scores and avoid categorical exclusion based on disability alone.