Define oliguria
UOP under 30 ml/hr
Technically: under .5 ml/kg/hr
–So 70 kg pt under 35 ml/hr
Name pre-renal causes of oliguria
Prerenal etiologies of oliguiria
- septic/hemorrhagic/hypovolemic shock
- MI
- CHF
Intrinsic renal causes of oliguria
Renal causes of oliguria:
- iodinated contrast
- med induced nephropathy (diuretics, NSAIDs, ACEi, abx)
Main culprits of med induced nephropathy
- Diuretics
- Abx
- ACEi (lisinopril)
- NSAIDs
Post-renal causes of oliguria
Post-renal
- renal calculi
- BPH
- foley dysfunction (kinked)
Name the major categories of dyspnea etiologies
Etiologies of dyspnea
- Pulmonary: upper or lower airway
- Cardiac: MI, CHF, arrhythmia
- Systemic: sepsis, metabolic acidosis, abdominal pressure
- Neurogenic: CNS depression, drugs
- Psychiatric: anxiety
4 sepsis criteria
2+ of SIRS w/ known or suspected infection
SIRS criteria:
- T over 100.4 or under 96.8
- Tachy to HR > 90
- Tachypenic: RR > 20 or pCO2 under 32
- WBC >12k or under 4K
So temp, HR, RR, WBC
–what’s not here = BP!!!
Mild pain
(a) First line
(b) Second line
Mild pain
a) First line = acetaminophen (tylenol
(b) Second line = NSAIDS (ibuprophen, naproxen, ketorolac)
Moderate pain Rx safe in cirrhotics and ESRD
Online one is oxycodone
(+ acetaminophen = percocet)
While codeine, hydrocodone, morphine all contraindicated in liver and kidney failure
2 meds for severe pain
Severe pain
- hydromorphone (dilaudid): 4-7x more potent than morphine
- fentanyl: 10x stronger than IV morphine
Acetaminophen
(a) Starting dose
(b) Max daily dose
(a) 650mg regardless of mode (PO, PR, IV)
(b) Max daily dose: 3-4 g/day
Name the 3 different NSAIDs
NSAIDS
- Ibuprophen = advil, motrin
- Naproxen = aleve, naprosen
- Ketorolac = Toradol
Pain meds for moderate pain
Moderate pain
- tramadol (synthetic codeine)
- codeine (really anti-tussive)
- hydrocodine (oral opioid)
- morphine
- oxycodone
Narco vs. Vicodin
Narco = Hydrocodone (oral opioid) at diff doses (5, 7.5, 10mg) + acetaminophen 325
Vicodine = Same as above but + acetaminophen 300
Narco vs. Percocet
Narco = Hydrocodone (oral opioid) at diff doses (5, 7.5, 10mg) + acetaminophen 325
Percocet = Oxycodine (1.5x strength of hydrocodone/morphine) + acetaminophen 325
IV to PO conversion of morphine
Rule of thumb: 1mg IV morphine = 3mg PO morphine
Pain med to use w/ specific caution in psych patient
Tramadol (synthetic codeine) also inhibits reuptake of NE and 5-HT => watch out for serotonin syndrome in pts also on SSRI, SNRI, MAOI, TCA
