#ICUCard RENAL GFR 90-131 mL/min ((140-age)*Wt)/(72*Cr) Glomerular Filtration Rate (Cockcroft) CI Cr 90-131 mL/min (CrU * volume)/CrS Creatinine Clearance FENa 0.0-1.0 % ((U/P Na)/(U/P Cr))*100 Fractional Excretion of Na+ Na req mEq (125-Na)*0.6*Wt Required Sodium FE Urea 20-70 % ((UUN/BUN)(U/P Cr))*100 Fractional Excretion of Urea RFI 0.0-1.0 % (Na U(U/P Cr) Renal Failure Index BUN:CrS 13-20 % BUN/Cr S BUN / Creatinine (S) ratio TTKG 4.0-6.0 % (U/P K)/(U/P Osm) Trans Tubular Potassium Gradient Osm c 275-295 mOsm/kg Osmolality, calculated 2"(Na + K))+(glucose/18)+(BUN/2.8) OsmGap 0.0-10.0 mOsm/kg (Osm m)-(Osm calc) Osmolar Gap ACID-BASE AG S 8-16 mEq/L Na - (Cl + НСО3) Anion Gap (Serum) H_def 0 mEq Acid Deficit HCO3def O mEq Bicarbonate Deficit Wt*0.5(HCO3m-HCO3d) (m=measured. d=desired) Wt*0.5(HCO3d-HCO3m) Metabolic Acidosis ІнСО3 → /PCO2 pCO2 = 1.5 (HCO3)+8 (+-2)| Metabolic Alkalosis ТНСО3 → TPCO2 pCO2 = 0.9 (HCO3)+9 Respiratory Acidosis ТРСО2 → Тнсоз acute: HCO3 T 1mEq/L for each 10 T in pCO2 chronic: HCO3 T 3.5mEq/L for each 10 1 in pCO2 Respiratory Alkalosis IPCO2 → ІнСО3 acute: HCO3 + 2mEq/L for each 10 - in pCO2 chronic: HCO3 L 5mEq/L for each 10 J in pCO2 HHE pk + log (HCO3/(PCO2*0.03)) Henderson - Hasselbalch Equation КВЕ (24*PaCO2)/HCO3 Acid base Equation NUTRITION IBW 110-220 Ib Ideal Body Weight BMI 18.5-25 kg*m2 (Ht^2)*23 (men) (Ht^2)*21.5 (women) Wt/Ht^2 Body Mass Index BSA 1.3-2.5 m2 Body Surface Area (Wt^0.425)*(Ht^0.725)*(0.007184) NB 0 9 Nitrogen Balance NB = protein int g/6.25 - (24h UUN(g) + 2.5g) | BEE Harris Benedict Equation M= 66+ (13.7 x Wt kg) + (5 x Ht cm) - (6.8 x age) F= 655+(9.6 x Wt kg) +(1.8 x Ht cm) - (4.7 x age) EE 1200-2500 kcal/d Energy Expenditure СО*Hb*(((SaO2-SvO2)/100)*95) | Perform computations online with: > MediCalc® 7 Medical Calculator System™ VENTILATOR INTUBATION CRITERIA* RR > 35-40/min PaCO2 > 50mmHg (acute I pH). Pa02 < 70 mmHg on 100% mask A-a Gradient > 400 (100% FiO) MIP < -25 cmH20 A from normal, Bronchopulmonary toilet, A. Arturo Rodriguez, MD ICU-card is a trademark of ScyMed 6th Ed, 2007. All rights reserved. ©2007 ScyMed. Inc PO Box 20367 Houston TX 77225 Airway Protection, Inhalation injury (endoscopy/stridor). Head or spinal cord injury. Adult Resp. Distress Syndrome. EXTUBATION CRITERIA* Printed in USA RR < 30/min PaCO2 < 50 mmHg Pa02 > 60mmHg on FIO2 < 50% pH normal (for the patient) MIP > - 25 cm H20 PEEP < 5 cm H20 VT > 5mL/kg, VC > 10mL/kg MV < 10L/min, Shunt < 20% VD/VT < 0.6, Patient awake, alert, cooperative *Individual Patient assessment required DRUGS Adenosine: IVP: 6mg (1-3 sec) then 12mg Aminophylline: IV Infusion: 0.3-0.5mg/kg/h (500mg/500mL NS) IV Infusion (smokers): 0.7 - 0.9mg/kg/h Amrinone: IV: 0.75mg/kg (over 2 - 3 min) then, IV Inf: 5.0-15.0ug/kg/min (500mg/500mL NS) Atenolol: IV: 5-10mg over 5 min. Atropine SO4: IVP: 1.0mg (asystole, total 3mg) IVP: 0.5-1.0mg (bradycardia, total 3mg) Bicarbonate, Sodium: IVP: 1.0mEq/kg then 0.5mEq/kg q10min Bretylium Tosylate: IVP: 5.0mg/kg in 1 min (total: 30-35mg/kg) IV Infusion: 1.0-2.0mg/min (2g/500mL D5W) Bumetanide: IV or IM: 0.5-1.0mg over 1-2min Calcium chloride (10%): IV: 2.0 - 4.0mg/kg q10min (as needed) Digoxin: IV/PO loading: 10-15ug/kg over 12-24hours (0.5mg IV over 5min -> 0.25mg q6h x2-4) Diazepam: IV: 2-10mg (not to exceed 5mg/min) Diltiazem: IV: 20mg or 0.25mg/kg (then 0.35mg/kg) IV Infusion: 5 - 15mg/h (250mg/500mL D5W-NS) Dobutamine: IV: 2 - 20ug/kg/min (250mg/500mL D5W-NS) Dopamine: (400mg/250mL D5W= 1600ug/mL) dopaminergic: 1 - 3ug/kg/min IV b-adrenergic: 3 - 10ug/kg/min IV a-adrenergic: > 10ug/kg/min IV Epinephrine: (1:1000) (1mg/250mL NS = 4ug/mL) IVP: 1.0 mg q3-5min (then 5mg or 0.1mg/kg) IV Infusion: 2 - 10ug/min Flumazenil: IV: 0.2mg over 30 sec (max 3.0mg/h) Furosemide: IV: 20-80mg over 1-2min Heparin: (25,000units/500mL= 50u/mL) NS-D5W IV Bolus: 5,000 units x1; IV Inf; 1000-1300 units/h Insulin: 100units/250mL NS = 0.4 units/mL ) IVP: 0.1 units/kg Isoproterenol: (1mg/250mL= 4ug/mL) NS-DsW IV Infusion: 2 - 10ug/min Labetalol: (200mg/200mL = 1 mg/mL) D5W-NS-RL IV: 20mg over 2min, -->40-80mg (max 300mg) Lidocaine: (2g/500mL = 4mg/mL) NS-D5W IVP: 1.0 - 1.5mg/kg (x2 q5-10min) IV Infusion: 2 - 4mg/min Magnesium: IV Infusion: 1-2g/100mL D5W (2min) Mannitol (20%): IV: 1.5 - 2.0g/kg over 30-60min Metoprolol: IV: 5mg q5min x 3 (slow push) Morphine SO4: IV: 1-3mg q5min (until response) Naloxone: IV: 0.4 - 2.0mg q2min pr (up to 10mg) Nifedipine: SL: 10mg (chew and swallow) Nitroglycerin: (200mg/500mL) NS-DSW IV Infusion: 10 - 300ug/min Nitroprusside Na+: (100mg/500mL= 200ug/mL) IV Infusion: 0.1 - 5.0ug/kg/min (use D5W only) Norepinephrine: (4mg/250mL= 16ug/mL) D5W IV Infusion: 0.5 - 1.0ug/min (up to 30ug/min) Procainamide: (1g/250mL = 4mg/mL) D5W only IV Infusion: 20mg/min (total: 17 mg/kg) IV maintenance Infusion: 1 - 4mg/min Streptokinase: IV: 1.5million units over 1h TPA: IV: 100mg (15mg bolus, then 50mg in 1h, then 35mg in 1h) IV: 2.5-5.0mg over 2 min (x4 q15-30min) *IM=intramuscular. IV=intravenous.PO=oral. SL=sublingual. DsW = dextrose 5% in water. NS = normal saline. *Check drug packet inserts for doses & info. ISBN 968-5325-27-8 50395 G0 O'1 8'0 でい (วอร) 008 007 0z 06 001 9L 08 0L SS 0s Sh 古 8c 9789685 325271 CU-card

Perform computations online at: ScyMed.com 6th ED ICU-card «ICU, Formulas & Drugs» HEMODYNAMIC PATTERNS Condition SAP CVP PAP PCWP CO C(a-v)02 PVR SVR Hypovolemic shock ↓ ↓ ↓ ↓ ↓ ↑ ↑ ↑ Cardiogenic shock ↓ 1 ↑ 1 1 ↑ Septic shock ↓ ↓ ↓ ↓ ↑ ↓ ↓ ↓ Cardiac Tamponade . ↑ ↑ 1 ↓ → ↑ RV Infarction ↑ → → ↓ → →↑ Pulmonary Embolism ↓ ↑ ↑ →↑ ↓ ↑ ↑ Airways Obstruction →↑→↑ ↑ →→↑ ↑ → HEMODYNAMICS HEMODYNAMICS 4.25-6.12 L/min Cardiac Output CI 2.5-3.6 L/min/m2 HR*SV VO2/Ca-vO2 (fick) CO/BSA Cardiac Index EF 55-78 % SI/EDV Ejection Fraction HR 60-90 bpm CO/SV Heart Rate SV 69-87 mL/beat CO/HR Stroke Volume SI 41-60 mL/beat/m? Stroke Volume Index CI/HR BFVR 0.9-1.4 ratio CI/BVI Blood Flow:Volume Ratio BV 3-5.1 L PV/(1-Hct) Blood Volume PRESSURES MAP 70-105 mmHg (SP+2DP)/3 Mean Arterial Pressure MPAP 9-17 mmHg (PSP+2PDP)/3 Mean Pulmonary Arterial Pressure PP 20-70 mmHg SP-DP Pulse Pressure RPP 6000-12000 mmHg*bpm HR*SP Rate Pressure Product CPP 60-80 mmHg DP-PCWP Coronary Perfusion Pressure COP 23-29 mmHg (glob*1.4)+(alb*5.5) Colloid-Oncotic Pressure RESISTANCES SVR 770-1500 dyn*s/cm5 (MAP-CVP)*79.92//CO Systemic Vascular Resistance SVRI 1970-2390 dyn*s/cm5*m2 ((MAP-CVP)*79.92/CI PVR Systemic Vascular Resistance Index 20-120 dyn*s/cm5 ((MPAP-WP)*79.92)/CO Pulmonary Vascular Resistance PVRI 30-240 dyn*s/cm5*m2 (MPAP-WP)*79.92)/CI Pulmonary Vascular Resistance Index CARDIAC WORK LCWI 3.4-4.2 kg*m/m2 CI*MAP*0.0144 RCWI Cardiac Work Index, Left 540-660 9*m/m2 CI*MPAP*0.0144 Cardiac Work Index, Right LVSWI 50-62 g*m/m2 SI*MAP*0.0144 Ventricular Stroke Work Index, Left RVSWI 7.9-9.7 9*m/m2 SI*MPAP*0.0144 Ventricular Stroke Work Index, Right ELECTROCARDIOGRAPHY Q-T_c 0.34-0.42 Q-T interval correction (QT)(sqrtRR) 0.42-1.2 RR interval RR abbrev ni values units equation CONVERSION •Celsius =(°F - 32)/1.8 •Farenheit =(°C × 1.8) +32 French Units: 1 french unit = 1 mm x 3.14 mmHg & cmH2O: 1 mmHg = 1.36 cmH20 PULMONARY RR VT 10-16 resp/min 400-600 mL Respiratory Rate Wt*VT Tidal Volume VE 4.0-8.0 L/min VT*RR Minute Ventilation VD 80-300 mL (VT*(PaCO2-PECO2))/PaCO2 Dead Space (physiologic) FVC FEV1 >4.0 L Forced Vital Capacity >3.0 L FEV1/FVC = >60% Forced Espiratory volume 1s Qs/Qt 0.0-7.0 % Shunt, physiologic ((CcapO2-CaO2)/(Ccap02-CvOz))*(100) | A-a GRADIENT PA-aO2 5-25 mmHg A-a Gradient (((FIO)*(PB-PH20))-(PaCO2/R))-(Pa02) PA-a02 c 5-25 mmHg 2.5+(0.25*age) A-a Gradient, age-corrected PAO2 95-105 mmHg Alveolar Oxygen Tension ((FIO)*(PB-PH2O))-(PaCO2/R) | Pa02 80-100 mmHg arterial Oxygen Tension Measured. [estimated=100-(0.33*age)] PIO2 100-150 mmHg (FIO2)*(PB-PH2O) Inspired Oxygen Tension PB 0-760 mmHg Barometric Pressure FIO2 29.92* (<(1)-(6.87535*alt*10^-6))^5.2561) 19-21 % Fraction of inspired O2 PH2O 47 R 0.7-1 mmHg Water vapor (partial press.) ratio Respiratory Quotient OXYGEN CONTENT CaOz 17-20 mL/dL arterial Oxygen Content ((Hb*1.36)*(SaO2))+(Pa02*0.0031) CcapO2 21-21 mL/dL capillary Oxygen Content ((Hb*1.36)*(ScapO2))+(Pa2*0.0031) CvO2 12-15 mL/dL mixed venous O2 Content ((Hb*1.36)*(SvO2))+(PvO2*0.0031)| Ca-vO2 4-5 mL/dL (CaO2)-(CvO2) Pa02 Oxygen Content Difference, arterial-venous SaO2 80-100 mmHg arterial Oxygen Tension 96-99 #ICUcard PvO2 35-45 % arterial Oxygen Saturation mmHg mixed venous O2 Tension Sv02 60-80 PaCO2 35-45 % mixed venous O2 Saturation mmHg arterial CO2 Tension PACO2 35-45 mmHg Alveolar CO2 Tension PvCO2 40-50 mmHg mixed venous CO2 Tension PECO2 25-35 mmHg Expired CO2 Tension OXYGEN TRANSPORT 02 ext 20-30 % Ca-vO2/CaO2 Oxygen Extraction Rate DO2 750-1200 mL/min CO*Ca02*10 Oxygen Delivery DO2 | 550-650 mL/min/m2 C|*Ca02*10 VO2 Oxygen Delivery Index 200-280 mL/min CO*Ca-vO2 Oxygen Consumption VO2 l 115-165 mL/min/m2 CI*Ca-vO2 Oxygen Consumption Index VCO2 120-320 mL/min Wt*VCO2 Carbon dioxide Production

Stimulated SA node AV node - Un-stimulated #PQ (mV) 0 ECG (lead II) QRS #QRS #SA node #AV node #Bundle of His Bundle branches #Purkinje fibers #QRS #ST

Dorsal vagal nucleus T1 spinal cord segment Sympathetic trunk Vagus n. (CN X) 含 - Cardiac plexus — Sinoatrial (SA) node #Atrioventricular (AV) #node - Myocardium

Arteriole Postsynaptic sympathetic fiber Norepinephrine VolL #Vascular smooth muscle Constriction Varicosity a, receptor Dilation #Epinephrine #Beta2receptor

Action potential a, adrenergic receptor Heart, glands, smooth muscle Inactivated: by #MAO by #COMT Capillary Diffusion into blood (raises NE in blood) Activates Inhibits Adrenal medulla #L-tyrosine Varicosities Epinephrine Bloodstream Inactivated (MAO) Ca NE #L-dopa #Dopamine #NE B2 adrenergic receptor CAMPT #PKAT a, adrenergic receptor Re- absorption #Norepinephrine (NE) #Epinephrine #adrenergic receptors 02 #adrenergic receptors 防z

Pressor area 1a Neuronal Sympathetic tonus t Vessel stretch Myogenic reaction 2a local Port Endothelin-1 1 (ETA) PGF2a, thromboxane Constriction ADH (V1), epinephrine (a1), angiotensin lI За Hormonal 1b Neuronal Sympathetic tonus Dilation Parasympathetic system (salivary glands, genitalia) Poz Adenosine, Pco,4 H*, K* etc. NOT PGE2, PGI21 2b local EDHF. Bradykinin, 4 kallidin Epinephrine (B2) 3b Hormonal Acetylcholine (M), АТР, #histamine (H1), endothelin-1 (ETB)

Voluntary action Emotion, temperature Coughing, sneezing, etc. Physical work Respiratory center in brainstem Coinnervation Medulla Rhythm generator IXth/Xth nerve Respiratory drive: Peripheral Central Mechanosensors in locomotor system Xth nerve Respiration Central chemosensors 个 In CSF: PC02, pH Carotid body IXth nerve Xth nerve Depth of respiration Alveolar ventilation Aortic body Peripheral chemosensors Mechanosensors in lung and respiratory muscles In blood: #PCO2 #pH P02

Lumen Luminal - membrane Nat-K+ ATPase 1 Primary active Nat and K+ transport Blood Na Nat 145 mmol/L Basolateral membrane Na 15 mmol/L 2 4[Na*] = Chemical driving force for Nat Nat -70 m/ -70 mV 3 Back diffusion of K+ creates membrane potential -70 mV 4 #Membranepotential = electrical driving force for Nat

Thiazide diuretics Carbonic anhydrase inhibitors (e.g., acetazolamide) Nat-Cl symport Na and HCO;- reabsorption Aldosterone antagonists (e.g., spironolactone) Nat channel (indirect effect) Loop diuretics (e.g., furosemide) Amiloride, #triamterene Nat-K+-2CF symport Na channel (direct effect) #NaCI reabsorption y - > H20 reabsorption + ECF volume y