Page 123 - Critical Care Notes

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■ Give antibacterials to which the known causative bacteria are sensitive. Consider:
■ Uncomplicated CAP: clarithromycin (Biaxin), azithromycin (Zithromax),
erythromycin, doxycycline (Vibramycin).
■ Complicated CAP: clarithromycin (Biaxin), azithromycin (Zithromax),
erythromycin, moxifloxacin (Avelox), levofloxacin (Levaquin), gemifloxacin
(Factive), gatifloxacin (Tequin).
■ Amoxicillin, cefotaxime, ceftriaxone, and fluoroquinolone may also be
considered.
Pulmonary Edema
Pulmonary edema is defined as abnormal accumulation of fluid in the alveoli,
lung tissues, or airway. “Flash” pulmonary edema (FPE) is a medical emergency
in which there is a sudden accumulation of fluid in the lungs. May occur follow-
ing pneumonectomy, AMI, mitral or aortic regurgitation, or HF.
Pathophysiology
Inadequate LV function → blood backs up into the pulmonary venous system
→↑ pressure in the pulmonary vasculature, ↑ COP → forces intravascular
fluid into alveoli and interstitial spaces of lungs → impaired gas exchange
→ respiratory distress.
Risk factors include:
■ Excess fluid in pulmonary capillaries (e.g., HF)
■ Cocaine-induced pulmonary vasoconstriction
■ Leakage of pulmonary capillary membrane (e.g., ARDS, pneumonia)
Clinical Presentation
■ Pink, foamy, and frothy sputum
■ Cough
■ Decreased cardiac output
■ Tachycardia
■ Weak peripheral pulses
■ Capillary refill >3 seconds
Symptoms of Vasoconstriction or Impending
Respiratory Failure
■ Peripheral cyanosis
■ Pallor, diaphoresis
■ Arrhythmias
■ Respiratory distress: SOB, decreased respiratory rate, crackles at lung base
■ Tachypnea
■ Decreased SpO 2 or PaO 2 with dyspnea
■ Decreased urine output
■ Lethargy, fatigue
■ Anxiety, agitation
■ Change in mental status
RESP