GI Prophylaxis

Indications:

Coagulopathy, plt < 50K, INR >1.5, or PTT >2 x control

Mechanical ventilation for >48 hours

h/o GI ulceration or bleeding within past year

●TBI, traumatic SCI, burn injury 

Two or more of the following minor criteria:

  • sepsis
  • ICU >1week
  • occult GI bleeding x >=6 days
  • glucocorticoid therapy (>250 mg hydrocortisone or equivalent)

 

Reference:

“Stress Ulcer Prophylaxis In The Intensive Care Unit.” Uptodate.com, 2017. 30 Oct. 2017.

Rapid Sequence Intubation

-consists of simultaneous administration of fast-acting sedative to induce immediate unresponsiveness and a NMBA to achieve optimal intubating conditions, with goal of attaining control of airway in critically ill patient at risk of aspiration of stomach contents.

– limits ICP elevation, preferred method for intubation of patient with elevated ICP

– presence of coma does not justify proceeding without pharmacologial agents, although patient unresponsive, laryngoscopes and intubation provoke reflexes that elevate ICP unless pre-treatment and induction agents are used.


REFERENCE:

ENLS 2017 Airway. Neurocritical Care.