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ICU Protocols Memphis VA Medical Center

ICU Protocols Memphis VA Medical Center. G. Umberto Meduri, M.D. W. Andrew Bell, Pharm.D., BCPS. The ICU Team . ICU Attending Pulmonary and Critical Care Fellow Internal Medicine Resident Medicine Interns Medicine Students ICU Pharmacist Pharmacist Resident Critical Care Nurse

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ICU Protocols Memphis VA Medical Center

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  1. ICU Protocols Memphis VA Medical Center G. Umberto Meduri, M.D. W. Andrew Bell, Pharm.D., BCPS

  2. The ICU Team • ICU Attending • Pulmonary and Critical Care Fellow • Internal Medicine Resident • Medicine Interns • Medicine Students • ICU Pharmacist • Pharmacist Resident • Critical Care Nurse • Respiratory Therapist • Nutritionist, Physical Therapist, Palliative Care

  3. ICU Protocols Antibiotic treatment of pneumonia Antibiotic treatment for other infections Fluid resuscitation and ScvO2-guided therapy Vasopressors Mechanical ventilation Sedation and analgesia Glucose control Gastrointestinal and thromboembolic prophylaxis Weaning from mechanical ventilation Recombinant human activated protein C (rhAPC) Prolonged glucocorticoid treatment in patients with shock Prolonged glucocorticoid treatment in pts with severe ARDS

  4. Guidelines • ATS / IDSA Pneumonia Guidelines • 2007 Community-acquired pneumonia • 2005 Health care associated pneumonia • Surviving Sepsis Campaign 2008 • SCCM 2002 Analgesia, Sedation, & Neuromuscular Blockade Guidelines • ASHP 1999 Stress Ulcer Prophylaxis Guidelines • Chest 2008 DVT Prophylaxis Guidelines

  5. Sepsis Protocol

  6. Severe Sepsis - Screening

  7. [continued] ScvO2 = central venous oxygen saturation

  8. Health Care Associated Pneumonia YES Nursing home Hospitalized last 90 days Within last 30 days Hemo dialysis Home wound care YES IV Rx CAP with Risks factors for Pseudomonas aeruginosa Bronchiectasis Structural lung disease No Chronic glucocorticoid use Repeated antibiotics

  9. ALI-ARDS Protocol

  10. Gastrointestinal Prophylaxis • All patients enrolled in the study should receive stress ulcer prophylaxis (SUP) with either a H2 antagonist or PPI AJHP 1999; 56: 347-379

  11. Thromboembolic Prophylaxis LMWH = Low molecular weight heparin

  12. Albumin 5% 500ml over 30 min

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