BCCCP flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Mean arterial pressure formula

MAP equals diastolic pressure plus one-third of the pulse pressure, or (SBP + 2 × DBP)/3; a MAP of at least 65 mm Hg is the usual resuscitation target in shock.

Norepinephrine in septic shock

First-line vasopressor for septic shock, started near 0.05–0.1 mcg/kg/min and titrated to a MAP of 65 mm Hg or greater; preferred over dopamine because of lower arrhythmia risk.

Amiodarone post-arrest maintenance

After ACLS bolus doses for VF or pulseless VT, infuse 1 mg/min for 6 hours then 0.5 mg/min for 18 hours; the usual oral maintenance dose is 200 mg daily.

Severe ARDS Berlin definition

A PaO2/FiO2 ratio of 100 or less while receiving PEEP of at least 5 cm H2O, with bilateral opacities not fully explained by cardiac failure or volume overload.

Lung-protective tidal volume

Set tidal volume at 6 mL/kg of predicted body weight in ARDS and keep plateau pressure at or below 30 cm H2O; decrease toward 4 mL/kg if plateau remains elevated.

Predicted body weight calculation

Males: 50 + 2.3 × (height in inches − 60) kg. Females: 45.5 + 2.3 × (height in inches − 60) kg. It is used to set tidal volume, not actual body weight.

Cerebral perfusion pressure equation

CPP equals mean arterial pressure minus intracranial pressure; the usual target in traumatic brain injury is 60–70 mm Hg to preserve cerebral blood flow.

Nimodipine after aneurysmal SAH

Give 60 mg orally or by nasogastric tube every 4 hours for 21 days to reduce delayed cerebral ischemia; manage hypotension by dose reduction rather than stopping the drug.

Status epilepticus second-line dosing

After a benzodiazepine, give fosphenytoin 20 phenytoin equivalents/kg intravenously, or levetiracetam 60 mg/kg with a maximum of 4500 mg, to stop convulsive status epilepticus.

Sepsis-3 septic shock criteria

Sepsis with a vasopressor requirement to keep MAP at least 65 mm Hg and a serum lactate above 2 mmol/L despite adequate volume resuscitation; hospital mortality exceeds 40%.

Vancomycin AUC target

For serious MRSA infections, target an AUC24/MIC of 400–600 mg·h/L; trough-only monitoring of 15–20 mg/L is an alternative when AUC measurement is unavailable.

Initial sepsis crystalloid volume

Give 30 mL/kg of balanced crystalloid or 0.9% sodium chloride within the first 3 hours when sepsis is accompanied by hypotension or a lactate of 4 mmol/L or higher.

SBP diagnosis in ascites

Spontaneous bacterial peritonitis is diagnosed when the ascitic fluid polymorphonuclear cell count is at least 250 cells/mm³; treat with IV cefotaxime plus albumin.

Refeeding syndrome hallmark electrolyte

Hypophosphatemia defines refeeding syndrome and is often accompanied by hypokalemia and hypomagnesemia; start feeding at 10–20 kcal/kg/day, give thiamine first, and replete electrolytes.

Lactulose titration in encephalopathy

Titrate lactulose to two or three soft bowel movements per day in hepatic encephalopathy; rifaximin 550 mg twice daily is added for secondary prophylaxis after an overt episode.

KDIGO stage 3 AKI criteria

Serum creatinine 3.0 times baseline, or at least 4.0 mg/dL, or initiation of renal replacement therapy, or urine output below 0.3 mL/kg/h for 24 hours.

FENa below one percent

A fractional excretion of sodium under 1% suggests prerenal azotemia with intact tubular sodium avidity, but it is unreliable in patients on diuretics or with chronic kidney disease.

CRRT versus intermittent hemodialysis

Continuous renal replacement therapy is preferred when hemodynamic instability makes intermittent dialysis poorly tolerated, allowing gradual fluid removal and gentler solute clearance around the clock.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate, with a normal range of 8–12 mEq/L; adding potassium to the calculation raises the normal range to about 12–16.

Winter's formula

Expected PaCO2 equals 1.5 times the bicarbonate plus 8, with a margin of plus or minus 2; a measured value outside this range indicates a concurrent respiratory acidosis or alkalosis.

Free water deficit formula

Free water deficit equals 0.6 times body weight in kg times (serum sodium divided by 140, minus 1); replace slowly, lowering sodium by no more than 10 mEq/L per day.

DKA insulin infusion

Start regular insulin at 0.1 units/kg/h; hold insulin when potassium is below 3.3 mEq/L, and add dextrose when glucose falls below 200–250 mg/dL while continuing until the gap closes.

Corrected sodium in hyperglycemia

Add 1.6 mEq/L to the measured sodium for every 100 mg/dL that glucose exceeds 100 mg/dL; this estimates the sodium concentration if glucose were normal.

Thyroid storm drug sequence

Give a thionamide first (propylthiouracil 500–1000 mg load, then 250 mg every 4 hours); wait at least one hour before iodine, which blocks release of preformed hormone.

HIT alternative anticoagulant

Stop all heparin and start argatroban at 2 mcg/kg/min (0.5 mcg/kg/min in hepatic impairment) or bivalirudin, titrating to an aPTT 1.5 to 3 times baseline.

Warfarin major bleeding reversal

Give 4-factor prothrombin complex concentrate 25–50 units/kg based on INR plus vitamin K 5–10 mg intravenously; fresh frozen plasma is an alternative when concentrate is unavailable.

Idarucizumab reversal dose

Two 2.5 g intravenous doses, totaling 5 g, reverse dabigatran within minutes; use for life-threatening bleeding or urgent surgery, recognizing that anticoagulant effect may return.

Parkland burn resuscitation formula

Give 4 mL of lactated Ringer's per kg body weight per percent total body surface area burned in the first 24 hours, half in the first 8 hours, titrated to urine output.

Tranexamic acid trauma dosing

Give 1 g intravenously over 10 minutes within 3 hours of injury, followed by 1 g infused over 8 hours; it reduces mortality from hemorrhage and is ineffective when given later.

Rule of nines adult burn

Head and each arm are 9% each, anterior trunk 18%, posterior trunk 18%, each leg 18%, and perineum 1%; superficial partial-thickness burns are not counted for resuscitation estimates.

ICU sedation RASS target

Target a Richmond Agitation-Sedation Scale score of −2 to 0, favoring light sedation, because deeper sedation is associated with longer mechanical ventilation and more delirium.

Propofol infusion syndrome features

Occurs with high-dose or prolonged propofol infusion and causes metabolic acidosis, rhabdomyolysis, hyperkalemia, renal failure, bradycardia, and lipemia; discontinue propofol immediately when suspected.