1.2. Anaesthetics - Critical Care

Question 1

What is Level 0 Critical Care?

Answer 1

Patients whose needs can be met though the Normal Ward

Question 2

What is Level 1 Critical Care?

Answer 2

1. Patients at risk of their condition deteriorating

2. Patient with Higher Levels of care, whose needs can be met on Advice and Support from the Critical Care Team

Question 3

What is Level 2 Critical Care?

Answer 3

Patients requiring Detailed Observation / Intervention:

1. Single Failing Organ System
2. Postoperative Care
3. Higher Levels of Care

Question 4

What is Level 3 Critical Care?

Answer 4

Patients requiring:

1. Advanced Respiratory Support alone
2. Basic Respiratory Support + Support of at Least 2 Organ Systems
3. Support for Multi-Organ Failure

Question 5

At what Critical Care Level can Patients be referred to the High Dependency Unit?

Answer 5

Level 1 / 2

Question 6

At what Critical Care Level can Patients be referred to the Intensive Care Unit?

Answer 6

Level 2 / 3

Question 7

What Respiratory Support is Available in the ICU / ITU?

Answer 7

1. Sophisticated NIV - Continuous Positive Airway Pressure (CPAP) / Assisted Spontaneous Ventilation
2. Invasive Ventilatory Support - Endotracheal Tubes
3. Advanced Respiratory Support:
4. a) Inhaled Nitrus Oxide (NO)
5. b) High Frequency Oscillatory Ventilation (HFOV)
6. c) Extra-Corporeal Membrane Oxygenation (ECMO)

Question 8

When might Ventilatory Support be needed?

Answer 8

1. Severe Pneumonia
2. Pulmonary Embolism
3. Congestive Cardiac Failure
4. Life-Threatening Bronchospasm
5. Systemic Inflammatory Response Syndrome (SIRS)

Question 9

When will Airway Protection be needed?

Answer 9

1. Decreased Conscious Level (Coma)
2. Acual / Impending Acute Airway Compromise (Traumatic / Infective)
3. Sedation to allow Treatment of Delirious Patients underlying Disorder

Question 10

What types of Cardiovascular Support are there?

Answer 10

1. Invasive Monitoring with Appropriate Fluid Resuscitation
2. Inotropic / Vasoactive Support
3. Intra-Aortic Balloon Counter Pulsation
4. Extracorporeal Support - AV Extra-Corporeal Membrane Oxygenation (ECMO) / Ventricular Assist Device (VAD)

Question 11

What forms of Renal Support are there?

Answer 11

1. Dialysis - rarely undertaken due to dramatic physiological changes in context of limited reserve
2. Continuous Veno-Venous Haemo (dia) filtration (CVVHDF)
3. Slow Continuous Ultrafiltration (SCUF)
4. Slow Continuous Low-Efficiency Dialysis

Question 12

When is Renal Support Needed?

Answer 12

Normally Secondary - Acute Renal Failure Secondary to Sepsis / other Shock States

Question 13

What Hepatic Support is available?

Answer 13

1. Molecular Adsorbents Recirculating System (MARS) - Dialysis of the Liver
2. Long-Term Transplant is the Only Option
3. Acute Decrompression of Chronic Failure

Question 14

What Neurological Support is available?

Answer 14

1. Airway protection
2. Mointoring of ICP - Bolts / Continuous EEG
3. Treatment of ICP - Physiological Parameter / Osmotherapy / Mannitol / Theraputic Hypothermia

Question 15

When is Neurological Support Needed?

Answer 15

1. Trauma
2. Spintaneous Intracranial Haemorrhage
3. Status Epiliepticus
4. Meningitis

Question 16

When should patients be referred to the ICU?

Answer 16

1. Reversible Organ Dysfunction / Failure
2. Supportive Treatment to allow Definitive Treatment to Work
3. Patients who ate beyond Capabilities of other Levels of Care