BUMC Basics.pdf - Anesthesia Home

62
- Altered mental status
- Platelets 15
mcg/kg/min or NE/Epi >0.25 mcg/kg/min for MAP>60
Goals in sepsis:
• MAP 65 to 90 (MAP = [SBP+(DBPx2)]/3)
• CVP 10 to 12 (>12 if intubated)
• SvO2>70 (can draw random ScvO2: early goal directed
therapy suggests to transfuse to Hct>30 percent, then
redraw; if 65 or SBP>90 OR
• CVP≥8 or ≥12mmHg if intubated OR
• Total fluid bolus of 45 ml/kg have been given including
all fluid boluses in ER and on floor within 6 hours of
arriving in the ICU.
• If still hypotensive, then initiate pressors.
• Establish central access
Pressors:
• Start with Levophed gtt: titrate to keep MAP>65
• Can then escalate based on specific patient
• Vasopressin can be added at 0.01-0.04 Units/min,
neosynephrine starting at 100-180 mcg/min, or dopamine
starting at 5 mcg/kg/min. Addition of vasopressin to high
doses of levophed have shown to cause increases in