ABG 1 Hour Post Intubation

MICU Admission

Ventilator

Check EET position

ABG 1 hour post intubation

·  Goal PCO2 (COPD?)

·  Goal PO2

Sedation

Pain control

GI PPX

TV at 8ml/kg (or 6mg/kg goal for ARDS)

Others

General

Electrolyte protocol

Bowel Regimen

DVT PPX

Code Status

Med Rec

Infectious

UA

Urine Cx

Blood Cx

Sputum Cx

CXR

Start ABX

COPD

Methylpred 125mg IV x 1

Methylpred 60mg IV q6h

FSBG

Moxifloxacin

CXR

Brain Bleed/Edema

Na/Osm q4h (goal 145-150)

3% NS @ 25cc/hr

Mannitol @ 1mg/kg IV x1

Mannitol 0.5 mg/kg IV q6h

q1h neuro checks

Hyperventilation to pCO2 30-35 initially then return to normal after several days

MAP goal 80-110

Maintain CPP at 60 (CPP = ICP – MAP)

Asthma

Magnesium level

Continuous nebs

Duonebs

Methyl pred 60mg IV x1

Methyl pred 40mg IV q6h for 48 hours

CXR

Arrest/Anoxic brain injury

EEG

CT head

Sepsis

CVP 8-12 (central line)

MAP >65 ( a-line)

UOP (strict I/Os)

Trend lactates

Echo

Pulmonary (diagnosis)

·  Mode with goals for CO2/O2/TV/Plateua pressures and CVP (in ARDS)

·  Meds and nebs (Albuterol sulfate 6. Puf inhalation q6h standing and q2h prn)

·  CXR for ET position

·  ABG frequency and plan if respiratory

CV (diagnosis

·  Acute

o  Central Line

o  Aline

o  IVF/Meds/Pressors

o  CV Goals (CVP, MAP vs Systolic)

o  Stress-dose steroids if on steroids chronically or if pressor unresponsive > 90 minutes

·  Chronic

o  Meds

Renal (diagnosis)

·  Diaylsis or renal consult

·  ABG if metabolic and plans for recheck/bicarb

·  IVF

ID (diagnosis)

·  Culture data

·  Empiric ABX with plan for narrowing

·  If intubated

o  HOB 45 degrees in intubated patients to reduce VAP

o  Mouth care

GI

·  PPX

·  TFs (start early unless possible early extubation)

Heme

·  PPX

·  Transfuse if HCT < 21 unless bleeding

Endo

·  ICU insulin protocol

Neuro

·  Sedation strategy

·  Pain control strategy

Code Status