Page 243 - Critical Care Notes

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■ Provide stress ulcer and DVT prophylaxis per institution policy and
protocols.
■ Provide analgesics for pain. Sedate as necessary.
■ Provide emotional support to patient and family. Relieve anxiety.
Medications
Sympathomimetics are administered to improve contractility, ↑ SV, and ↑ CO:
■ Dobutamine (Dobutrex)
■ Dopamine (Intropin)
■ Inamrinone (Amrinone)
■ Milrinone (Primacor)
■ Epinephrine (Adrenalin)
■ Milrinone (Primacor)
■ Digoxin (Lanoxin)
Vasodilators are administered to ↓ preload and afterload and to ↓ O 2 demand
on the heart:
■ Nitroglycerine (Tridil)
■ Nitroprusside (Nipride)
■ ACE inhibitors
Vasoconstrictors are administered to ↑ BP:
■ Norepinephrine (Levophed)
■ Phenylephrine (Neo-Synephrine)
Caution must be used in titrating medications to the patient’s hemodynamic
response.
Specific considerations for anaphylactic shock include:
■ Administer an antihistamine or epinephrine.
■ Administer corticosteroids or bronchodilators as indicated.
■ Infuse crystalloid fluids over 1–3 min if patient is severely hypotensive or
unresponsive to treatment.
Multiple Organ Dysfunction Syndrome (MODS)
MODS is defined as the physiological failure of two or more separate organ sys-
tems. The lungs are the most common organ to fail, followed by the kidneys
and heart. With MODS, homeostasis cannot be maintained without specific
interventions because of the body’s inability to activate its own defense mech-
anisms sufficiently.
Those at high risk for developing MODS include patients with:
■ Multiple trauma
■ Massive infection or sepsis

MULTISYS