Neuro

• Pain control - fentanyl up to 200
• Avoid Tylenol if c/f infxn, can mask fevers
• Sedation - propofol up to 20, but wean for extubating/spontaneous breathing trial

• Hemodynamic stability - pressor requirements
• Causes of pressor requirement - hypotension from sedation (e.g. propofol/precedex), shock (hypovolemic vs distributive (septic/vasoplegic))

• Vent settings with relevant ABG - any changes?
• Plan for vent wean - did patient pass their BEST? Needs to be able to follow commands to extubate.
• If trached, STAR vs. SWAT?
• > 14 days of ETT → trach (ETT cuff causes pressure necrosis).

• Nutrition
• Start "trickle feeds" at 10 and advance to goal (45, 60 cc/hr)
• Hold tube feeds with high pressor requirements due to risk of non-occlusive mesenteric ischemia
• Diarrhea is common with tube feeds but should rule out C. diff
• Can add fiber, immodium otherwise
• Electrolyte repletion: K > 4, Phos > 3, Mg > 2, ionized Ca > 4.5 (may be low after blood product transfusion due to EDTA chelation)
• PUD prophylaxis indications - positive pressure ventilation, GI bleed/ulcer, coagulopathy, TBI, burn
• IV Pepcid/famotidine (H₂ blocker); PO protonix/pantoprazole (PPI)

• Insulin
• Glucoses (goal glycemic target for insulin therapy 140-180); repeated glucoses > 200 may indicate need to increase sliding scale or insulin dose

• AKI, Foley, etc.
• Renal replacement therapy/fluid balance goals (FBG) - patients advance along these options as their blood pressure becomes less labile/can tolerate fluid shifts
• CVVHD - continuous "gentle"/best-tolerated BP-wise, can adjust fluid removal to no removal, net even, -50 to -200 cc/hr, etc.
• SLED - intermittent "long" dialysis overnight ~ 8 hrs
• HD - normal dialysis, ~ 4 hrs

• Hct, bleeding
• Coags
• DVT prophylaxis (SQH; lovenox for trauma pts; vs. no chemical prophylaxis)
• Some attendings like to have Dopplers q 7 days

• Patients on CVVHD have artificially lower temperatures so will not always see a fever
• antibiotics (have an end date in mind)

• Locations of lines
• Patients cannot go to the floor with: arterial lines, Cordis (large bore introducer catheters), femoral trialysis. Normal triple lumen central lines are OK.