Directly from the ACCP serious Care drugs Board overview 2012 direction, this new interactive on-line source is the most recent instrument within the ACCP s entire learn software. each subject is roofed in a concise, easy-to-use structure with many more desirable evaluate recommendations. Navigate helpful board evaluate content material simply with a effortless, interactive on-line structure; locate issues of curiosity speedy with complicated key-phrase seek services built-in with different ACCP on-line courses, together with CHEST; receive referenced articles fast with totally linked-out annotated bibliographies; use as a self-study source to organize for the severe care medication subspecialty board exam.
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Additional resources for ACCP Critical Care Medicine Board Review: 21st Edition
In the presence of a hypertensive emergency, the goal BP over the first hour should be a reduction in mean arterial pressure no greater than 20% to 25% (in consideration of the effects of BP lowering on the cerebrovascular blood flow autoregulation curve, which is likely to be shifted to the right in these patients). Exceptions to the 20% to 25% rule include unclipped or uncoiled aneurismal hemorrhage associated with hypertension and aortic dissection. There are many drugs used to treat hypertensive emergencies.
Delivering IRV using PACV and VACV generally requires heavy sedation with or without muscle paralysis, leading most practitioners to use APRV when selecting IRV. APRV APRV consists of CPAP, which is intermittently released to allow a brief expiratory interval. Conceptually, this mode is pressurecontrolled IRV during which the patient is allowed to initiate spontaneous breaths. An advantage over IRV is that patients are more comfortable, requiring less sedation. org/ 07/19/2012 ACCP Care Medicine Board Review:on21st Edition PAV is intended only for spontaneously breathing patients.
The issues that need to be addressed to guide optimal therapy are the BP goal, the timing of attainment, mode of administration, and type of antihypertensive. For hypertensive urgencies, the clinician should aim for a progressive lowering of the BP over 1 to 2 days. In some cases, an even longer time period may be appropriate. In the absence of end-organ damage, a rapid decrease in BP may cause more harm than good. Oral medications should be used, and the clinician should restart the patient’s regular medications.
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