(2) ICU Pathology Flashcards
What is sepsis?
- life threatening caused by the bodies response to infection
- begins when immune system turns on itself
Systemic Inflammatory Response Syndrome (SIRS) is 2 of the following:
- Temp >38 degrees or <36
- HR >90bpm
- WCC >11
- RR >20 bpm & PaCO2 <4.3
How is sepsis diagnosed?
2 SIRS + confirmed/suspected infection
How is severe sepsis diagnosed?
- Sepsis + signs of organ failure
- Hypotension
How is septic shock diagnosed?
- Sepsis + persistent organ damage
- Hypotension
What are the 6 stages of septic shock?
- Inadequate tissue perfusion
- Anaerobic metabolism
- Lactic acidosis
- Metabolic acidosis
- Cellular damage
- Organ failure
What are the clinical signs or septic shock?
- fever/hypothermia
- unexplained tachycardia
- peripheral vasodilation
- unexplained shock
- changes mental state
- SOB & hypotension
What is haemodynamics?
the study of blood flow
What is thrombocytopenia?
abnormally low platelets observed
What is in the 1 hour bundle for a patient in septic shock?
- measure lactate levels
- obtain blood cultures
- administer antibodies
- administer crystalloid
- apply vasopressors
What is Acute Respiratory Distress Syndrome?
- aka leaky lung syndrome
- inflammation & increased permeability of alveolar capillary membrane
- severe resp distress & hypoxemia
What is the PaO2/FiO2 ratio in someone with ARDS?
<25Kpa
What happens during the exudative phase of ARDS?
- weight of alveoli increase
- become soggy & full liquid
- 30% chance pneumothorax
What are the 3 phases of ARDS?
- Exudative
- Proliferative
- Fibrotic
What happens during the proliferative phase of ARDS?
- compression atelectasis
- less surface area gas exchange
- lungs produce granulation tissue
What happens during the fibrotic phase of ARDS?
- end stage, lung develops scarring
- not enough O2
- 87% chance pneumothorax
What is the P/F ratio?
arterial O2 partial pressure to fractional inspired O2
What are direct causes of ARDS?
- O2 toxicity
- pneumonia
- aspiration
- chest trauma
- burns
- smoking
What are indirect causes of ARDS?
- shock
- sepsis
- cardiopulmonary bypass
- drugs
- multiple transfusions
What are signs of ARDS?
- acute onset
- increased WOB & tachypnoea
- tachycardia
- PaO2/FiO2 <25
- Peak airway pressure <18mmHg
What is seen on a CXr in ARDS?
- silhouette sign
- diaphragm & ribs difficult to see
- not a lot air in lungs
What is the medical treatment for ARDS?
- Mechanical ventilation with high PEEP
- monitor intravascular volume
- prone positioning
- Extracorpeal life sport (ELS)
What are complications for treatment in ARDS?
- organ failure
- pulmonary fibrosis
- ventilator pneumonia
- pneumothorax
What is the function of the kidneys?
- remove waste & drugs
- BP regulation
- red blood cell production
- produce vit D
- fluid balance
How does kidney failure occur?
fail response to hypotension, hypoxia, multiple organ failure
What does dialysis help with?
helps body remove extra fluid and waste from the body
What is the normal amount of urine output?
1ml/kg/hr
What are causes of acute renal failure?
- blood loss
- severe burns
- kidney stone
- multi organ failure
What are causes of Chronic renal failure?
- diabetes
- anything blocks drainage
- intrinsic renal disease
What is erythropoietin?
red blood cell production in bone marrow
What are signs of renal failure?
- metabolic acidosis
- tachypnoea & hyperventilation as they look to compensate
- uraemia
- hypertension
- fluid retention
What should be present in a kidney function test?
urea and creatine
What are risks with dialysis?
- infection
- hypotension
- hypoxemia
What are the functions of the liver?
- production bile & proteins
- regulating blood levels & clotting
- clear blood drugs
- conversion glucose to glycogen
What happens as a result of acute failure?
Multiple organ failure
What are resp burns?
thermal damage by inhalation of hot gas
What causes resp burns?
- bronchospasm
- pulm oedema
- ulceration
- lung tissue burns
- infection
What are implications of resp burns for a physio?
- secretion clearance
- humidification
- maintain LV
- postural drainage contraindicated if oedema near head
What are signs of a head injury?
- reduced GCS
- pupils unreactive light
- change pupil size, muscle tone & vitals
- vomiting
What increases intracranial pressure?
- high paCO2
- low PaO2
- hypertension
- tachycardia
- fluid overload
- head down
What is the management for a head injury?
- ventilation
- protect airways
- monitor vitals
- head elevation and neck alignment
What are the two reasons of a heart and lung transplant?
- improve survival from disease
- improve QOL
What is the physio tx post transplant?
- secretion
- ROM
- weaning from FiO2
- mobility
- transfers
- ADLs
How does multiorgan failure occur?
- direct insult or SIRS
- hypoperfusion and reperfusion
What is the physio role in MOF?
- supportive
- limb care
- myopathies
What is the medical management of MOF?
- treat sepsis focus
- restore homeostasis and pH
- nutrition & fluid
What is mechanical ventilation?
technique in which gas moved towards and from lungs through external device connected directly to patient
What are indications for mechanical ventilations (6)?
- inadequate gas exchange
- trend failing ventilation
- resp failure
- supplemental O2 not adequate
- decreased neuromuscular function
- disorder alveoli/airways
How is the mechanical ventilation delivered?
- endotracheal tube
- tracheostomy
What are the 3 different ventilator modes?
- controlled mechanical ventilation
- synchronised intermittent mandatory ventilation (SIMV)
- pressure support (PS)
How does PS work?
- patient triggers each breath
- maintains pre selected pressure
How does SIMV work?
- support patients breath to set pressure
- if patient does not breathe, ventilator triggers breath
