ASSESSMENT AND LIFE SUPPORT
PRINCIPLES OVERVIEW
◉ A pt comes in w/ a femur fx and a rod is placed. Post-op he
develops dyspnea and fever. HR 140, RR 30, SpO2 92% on non-
rebreather. He is transferred to the ICU where you intubate, place a
central line, and start resuscitating him. Hb 8.2, lactate 3.2, SVO2 is
52%.
Why is his SVO2 low? How can we improve it?
Answer: Decreased O2 delivery and increased consumption.
(normal is 65-70)
Administer packed RBCs - 1U of blood will change his Hb from 8.2 to
9.2. O2, fluid, and VT would not work.
◉ A young pt after an MVA comes to the ER hypotensive and
tachycardic. CXR is clear. He has a contusion on his chest wall and
torso. He is unconscious. What will give you the best insight on what
is causing his shock?
, Hb
SCV
Urine Output
FAST exam
Answer: FAST exam
◉ 41 y/o pt in the SICU following debridement of b/l lower
extremities for necrotizing fasciitis is intubated on AC. Temp 102, HR
116, RR 16, BP 92/46. ABG shows pH 7.23, PO2 133, PCO2 38, Na
139, K 3.7, Cl 102, Bicarb 16, lactate 4. Dx is metabolic acidosis w/
anion gap d/t infection.
What is the most appropriate intervention?
Increase VT
Continue resuscitation
Decrease RR
Administer bicarb
Answer: Continue resuscitation. Don't need to increase VT bc the pt
doesn't have respiratory acidosis. If you decrease the RR, the pt will
go into respiratory acidosis.
◉ A pt has obstructive uropathy. A catheter is placed d/t the
obstructive kidney injury. After the cath is placed, he has massive