BCCCP key terms

The average arterial pressure over a cardiac cycle, roughly one-third systolic plus two-thirds diastolic, or measured from an arterial line. It approximates organ perfusion pressure and guides vasopressor titration in shock.

A state of inadequate tissue perfusion caused by the heart's inability to pump, often after myocardial infarction or with decompensated heart failure. It is characterized by low cardiac output, elevated filling pressures, and signs of hypoperfusion.

A first-line catecholamine vasopressor that increases vascular tone through alpha-1 agonism with modest beta-1 activity. It is used to correct hypotension in septic, cardiogenic, and other shock states after adequate fluid resuscitation.

Acute respiratory distress syndrome: acute onset hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure, a PEEP of at least 5 cm H2O, and PaO2/FiO2 of 300 or less. It is graded mild, moderate, or severe.

Airway pressure maintained at the end of expiration during mechanical ventilation that recruits and stabilizes alveoli, improves oxygenation, and reduces atelectrauma. Excess PEEP can impair venous return and cause barotrauma or hypotension.

A ventilation strategy using low tidal volumes (about 6 mL/kg predicted body weight), limited plateau pressures (30 cm H2O or less), and appropriate PEEP to reduce ventilator-induced lung injury in ARDS and other critically ill patients.

Air trapping that creates positive alveolar pressure at end-expiration without an applied PEEP setting, commonly from incomplete exhalation in obstructive lung disease or high minute ventilation. It can cause hyperinflation, hypotension, and difficult weaning.

The respiratory rate divided by tidal volume in liters, measured during spontaneous breathing. An RSBI below roughly 105 predicts a higher likelihood of successful extubation, though it should be interpreted with the overall clinical picture.

Placing a patient face down, usually for 12 to 16 hours per day, to improve oxygenation in moderate-to-severe ARDS by recruiting dorsal lung regions and reducing ventral overdistension. It has a mortality benefit in severe hypoxemia.

The pressure inside the skull from brain tissue, blood, and cerebrospinal fluid. Normal is roughly 5 to 15 mm Hg; sustained elevation above about 20 to 22 mm Hg risks herniation and ischemic injury and requires treatment.

The pressure gradient driving blood flow to the brain, calculated as mean arterial pressure minus intracranial pressure. Targets (often 60 to 70 mm Hg) guide blood pressure and ICP management after traumatic brain injury.

Continuous seizure activity or recurrent seizures without recovery of consciousness lasting at least 5 minutes. It is a medical emergency treated in stages with benzodiazepines followed by antiseizure drugs and, if refractory, anesthetic infusions.

Controlled cooling or maintenance of body temperature (commonly 32 to 36 degrees Celsius) after cardiac arrest or certain neurologic injuries to reduce secondary brain injury. It requires sedation, shivering control, and careful monitoring for complications.

Life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalized as an increase in SOFA score of at least 2 points. Septic shock adds vasopressor requirement and lactate above 2 mmol/L despite fluids.

The Sequential Organ Failure Assessment quantifies dysfunction of six organ systems: respiratory, coagulation, liver, cardiovascular, central nervous system, and renal. Higher scores predict mortality, and a rise of 2 points defines sepsis in infected patients.

Administering a beta-lactam antibiotic over several hours (or as a continuous infusion) so that free drug concentration exceeds the minimum inhibitory concentration for a larger fraction of the dosing interval. It improves killing of less susceptible organisms.

Dosing vancomycin to a 24-hour area under the concentration-time curve of roughly 400 to 600 mg·h/L (by Bayesian or two-level sampling) rather than trough-only targets, to balance efficacy against nephrotoxicity in serious MRSA infections.

Narrowing empiric broad-spectrum therapy once culture results and the clinical picture allow, to reduce resistance, toxicity, and cost. It is a core antimicrobial stewardship practice in critical care.

Potentially fatal shifts of fluid and electrolytes, especially hypophosphatemia, hypokalemia, and hypomagnesemia, occurring when nutrition is reintroduced to a malnourished patient. It requires slow caloric advancement and electrolyte monitoring and repletion.

A reversible neuropsychiatric syndrome in liver disease driven by ammonia and other toxins, ranging from subtle confusion to coma. Lactulose and rifaximin are mainstays, along with treating precipitants such as infection or bleeding.

Acid-suppressive therapy, usually a proton pump inhibitor or histamine-2 receptor antagonist, given to high-risk critically ill patients (mechanical ventilation, coagulopathy, prior bleeding) to prevent upper gastrointestinal bleeding. Low-risk patients generally do not benefit.

A sudden decline in kidney function defined by a rise in serum creatinine of at least 0.3 mg/dL within 48 hours, a 1.5-fold rise within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Slow, continuous extracorporeal removal of solute and fluid used in hemodynamically unstable critically ill patients with acute kidney injury or severe electrolyte and acid-base derangements. It allows gradual, better-tolerated correction than intermittent dialysis.

Enhanced kidney elimination of drugs, often with creatinine clearance above 130 mL/min, seen in young, hyperdynamic, or septic patients. It can cause subtherapeutic antibiotic levels and requires higher doses or prolonged infusions.

Neurologic injury, including central pontine myelinolysis, caused by overly rapid correction of chronic hyponatremia. Guidelines generally limit correction to about 8 to 10 mmol/L in the first 24 hours to reduce risk.

A metabolic acidosis with elevated unmeasured anions, calculated as sodium minus chloride minus bicarbonate (normal roughly 8 to 12 mEq/L). Common causes include ketoacidosis, lactic acidosis, renal failure, and toxic ingestions.

Treatment of elevated serum potassium using intravenous calcium for cardiac membrane stabilization, insulin with glucose and beta-agonists to shift potassium intracellularly, and removal via diuretics, binders, or dialysis. ECG changes guide urgency.

An intravenous fluid containing electrolytes in proportions closer to plasma (for example, lactated Ringer's or Plasma-Lyte) than normal saline, with a lower chloride load. It may reduce hyperchloremic acidosis and has shown modest outcome benefits in some critically ill populations.

A hyperglycemic emergency with ketosis and high anion gap metabolic acidosis, often from insulin deficiency and a precipitating illness. Treatment includes isotonic fluids, intravenous insulin, potassium replacement, and finding the trigger.

Severe hyperglycemia with marked hyperosmolality and dehydration but minimal ketosis, typically in older patients with type 2 diabetes. Management emphasizes aggressive fluid resuscitation, insulin, and electrolyte monitoring.

An immune-mediated, prothrombotic reaction to heparin in which antibodies activate platelets, causing thrombocytopenia (often a 50% fall) and thrombosis. Heparin must be stopped and a non-heparin anticoagulant started.

A clinical pretest probability tool for heparin-induced thrombocytopenia based on degree of thrombocytopenia, timing, thrombosis, and other causes. A low score makes HIT unlikely; intermediate or high scores warrant antibody testing.

A metabolic emergency after rapid destruction of cancer cells, producing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia that can cause renal failure and arrhythmias. Prevention with fluids and urate-lowering therapy is key.

A burn resuscitation formula giving 4 mL of crystalloid per kg body weight per percent total body surface area burned in the first 24 hours, half in the first 8 hours from injury. Urine output guides adjustment.

A strategy for severely injured or hemorrhaging patients emphasizing early hemorrhage control, permissive hypotension before control, balanced blood product transfusion, and avoidance of large crystalloid volumes and hypothermia.

Sustained intra-abdominal pressure above 20 mm Hg with new organ dysfunction, often after trauma, burns, or massive fluid resuscitation. It impairs ventilation, venous return, and renal perfusion and may require decompressive laparotomy.

A validated 10-point scale from -5 (unarousable) to +4 (combative) used to titrate sedation in critically ill adults. Light sedation targets (often 0 to -2) shorten ventilation and ICU stay.

The Confusion Assessment Method for the ICU, a bedside tool assessing acute onset or fluctuation, inattention, altered consciousness, and disorganized thinking to detect delirium in ventilated and non-ventilated patients.

A rare, potentially fatal complication of prolonged high-dose propofol infusion marked by metabolic acidosis, rhabdomyolysis, hyperkalemia, renal failure, and cardiac dysfunction. Dose limits and monitoring of triglycerides and acid-base status reduce risk.

A toxic syndrome from serotonergic drug excess or interactions, causing mental status change, autonomic hyperactivity, and neuromuscular abnormalities such as clonus and hyperreflexia. Treatment is discontinuation, supportive care, and sometimes cyproheptadine.