(2) ICU Pathology Flashcards
1
Q
What is sepsis?
A
- life threatening caused by the bodies response to infection
- begins when immune system turns on itself
2
Q
Systemic Inflammatory Response Syndrome (SIRS) is 2 of the following:
A
- Temp >38 degrees or <36
- HR >90bpm
- WCC >11
- RR >20 bpm & PaCO2 <4.3
3
Q
How is sepsis diagnosed?
A
2 SIRS + confirmed/suspected infection
4
Q
How is severe sepsis diagnosed?
A
- Sepsis + signs of organ failure
- Hypotension
5
Q
How is septic shock diagnosed?
A
- Sepsis + persistent organ damage
- Hypotension
6
Q
What are the 6 stages of septic shock?
A
- Inadequate tissue perfusion
- Anaerobic metabolism
- Lactic acidosis
- Metabolic acidosis
- Cellular damage
- Organ failure
7
Q
What are the clinical signs or septic shock?
A
- fever/hypothermia
- unexplained tachycardia
- peripheral vasodilation
- unexplained shock
- changes mental state
- SOB & hypotension
8
Q
What is haemodynamics?
A
the study of blood flow
9
Q
What is thrombocytopenia?
A
abnormally low platelets observed
10
Q
What is in the 1 hour bundle for a patient in septic shock?
A
- measure lactate levels
- obtain blood cultures
- administer antibodies
- administer crystalloid
- apply vasopressors
11
Q
What is Acute Respiratory Distress Syndrome?
A
- aka leaky lung syndrome
- inflammation & increased permeability of alveolar capillary membrane
- severe resp distress & hypoxemia
12
Q
What is the PaO2/FiO2 ratio in someone with ARDS?
A
<25Kpa
13
Q
What happens during the exudative phase of ARDS?
A
- weight of alveoli increase
- become soggy & full liquid
- 30% chance pneumothorax
14
Q
What are the 3 phases of ARDS?
A
- Exudative
- Proliferative
- Fibrotic
15
Q
What happens during the proliferative phase of ARDS?
A
- compression atelectasis
- less surface area gas exchange
- lungs produce granulation tissue
16
Q
What happens during the fibrotic phase of ARDS?
A
- end stage, lung develops scarring
- not enough O2
- 87% chance pneumothorax
17
Q
What is the P/F ratio?
A
arterial O2 partial pressure to fractional inspired O2
18
Q
What are direct causes of ARDS?
A
- O2 toxicity
- pneumonia
- aspiration
- chest trauma
- burns
- smoking
19
Q
What are indirect causes of ARDS?
A
- shock
- sepsis
- cardiopulmonary bypass
- drugs
- multiple transfusions
20
Q
What are signs of ARDS?
A
- acute onset
- increased WOB & tachypnoea
- tachycardia
- PaO2/FiO2 <25
- Peak airway pressure <18mmHg
21
Q
What is seen on a CXr in ARDS?
A
- silhouette sign
- diaphragm & ribs difficult to see
- not a lot air in lungs
22
Q
What is the medical treatment for ARDS?
A
- Mechanical ventilation with high PEEP
- monitor intravascular volume
- prone positioning
- Extracorpeal life sport (ELS)
23
Q
What are complications for treatment in ARDS?
A
- organ failure
- pulmonary fibrosis
- ventilator pneumonia
- pneumothorax
24
Q
What is the function of the kidneys?
A
- remove waste & drugs
- BP regulation
- red blood cell production
- produce vit D
- fluid balance
25
How does kidney failure occur?
fail response to hypotension, hypoxia, multiple organ failure
26
What does dialysis help with?
helps body remove extra fluid and waste from the body
27
What is the normal amount of urine output?
1ml/kg/hr
28
What are causes of acute renal failure?
- blood loss
- severe burns
- kidney stone
- multi organ failure
29
What are causes of Chronic renal failure?
- diabetes
- anything blocks drainage
- intrinsic renal disease
30
What is erythropoietin?
red blood cell production in bone marrow
31
What are signs of renal failure?
- metabolic acidosis
- tachypnoea & hyperventilation as they look to compensate
- uraemia
- hypertension
- fluid retention
32
What should be present in a kidney function test?
urea and creatine
33
What are risks with dialysis?
- infection
- hypotension
- hypoxemia
34
What are the functions of the liver?
- production bile & proteins
- regulating blood levels & clotting
- clear blood drugs
- conversion glucose to glycogen
35
What happens as a result of acute failure?
Multiple organ failure
36
What are resp burns?
thermal damage by inhalation of hot gas
37
What causes resp burns?
- bronchospasm
- pulm oedema
- ulceration
- lung tissue burns
- infection
38
What are implications of resp burns for a physio?
- secretion clearance
- humidification
- maintain LV
- postural drainage contraindicated if oedema near head
39
What are signs of a head injury?
- reduced GCS
- pupils unreactive light
- change pupil size, muscle tone & vitals
- vomiting
40
What increases intracranial pressure?
- high paCO2
- low PaO2
- hypertension
- tachycardia
- fluid overload
- head down
41
What is the management for a head injury?
- ventilation
- protect airways
- monitor vitals
- head elevation and neck alignment
42
What are the two reasons of a heart and lung transplant?
- improve survival from disease
- improve QOL
43
What is the physio tx post transplant?
- secretion
- ROM
- weaning from FiO2
- mobility
- transfers
- ADLs
44
How does multiorgan failure occur?
- direct insult or SIRS
- hypoperfusion and reperfusion
45
What is the physio role in MOF?
- supportive
- limb care
- myopathies
46
What is the medical management of MOF?
- treat sepsis focus
- restore homeostasis and pH
- nutrition & fluid
47
What is mechanical ventilation?
technique in which gas moved towards and from lungs through external device connected directly to patient
48
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
49
How is the mechanical ventilation delivered?
- endotracheal tube
- tracheostomy
50
What are the 3 different ventilator modes?
- controlled mechanical ventilation
- synchronised intermittent mandatory ventilation (SIMV)
- pressure support (PS)
51
How does PS work?
- patient triggers each breath
- maintains pre selected pressure
52
How does SIMV work?
- support patients breath to set pressure
- if patient does not breathe, ventilator triggers breath
