(3) ICU Assessment & Treatment

Question 1

What are the sequential organ failure assessment score and APACHE II used for?

Answer 1

• identify ICU patients
• determine risk of acuity and mortality risk

Question 2

What is the SOFA used for?

Answer 2

looks at extent of sepsis related organ failure/function

Question 3

What areas does the SOFA cover?

Answer 3

• resp
• coagulation
• liver
• neuro
• cvs
• renal

Question 4

What would we want to know from the nurses prior to seeing a patient?

Answer 4

• How is patient + updates
• any important events
• suctioning?
• patient coughing (productive?)
• pain?

Question 5

What should be observed in the environment with the patient?

Answer 5

• patient in bed
• mode & method ventilation
• drains, lines, wires & attachments
• evidence of sc evidence
• level of consciousness

Question 6

What is involved in Ax in an ICU patient?

Answer 6

• Airway
• Breathing
• Circulation
• Disability
• Exposure

Question 7

What is investigated in Airway Ax?

Answer 7

• are they maintaining their own airway
• do they need an artificial airway
• invasive or NIV

Question 8

What is involved in respiratory objective Ax?

Answer 8

• mode ventilation
• SpO2/FiO2
• ABG & CxR
• Auscultation & Palpation
• chest drains
• cough & sputum

Question 9

What is involved in non-invasive ventilation objective Ax?

Answer 9

• Bipap or Cpap
• interface
• pressure & volume
• FiO2
• ABGs

Question 10

What is involved in mechanical ventilation objective Ax?

Answer 10

• mode
• airway
• level of support
• pressure & volumes
• FiO2
• Nitric Oxide

Question 11

What is involved in Ax of a patients cough?

Answer 11

• strong or weak
• moist or dry
• effective or ineffective
• sputum
• any haemoptysis

Question 12

What are individuals with a peak flow cough of <270L/min at risk of?

Answer 12

secretion retention and need manual or mechanical assistance to avoid serious complications

Question 12

What are the 3 phases of the cough?

Answer 12

1. Inspiratory phase
2. Compressive phase
3. Expiration phase

Question 13

What is the function of the nasopharynx?

Answer 13

humidification

Question 14

What happens following impaired humidification?

Answer 14

slow cilia activity and impair mucous clearance

Question 15

How can humidification be improved in a patient?

Answer 15

• Puritan cold water humidifier
• Heat and moisture exchanger
• saline nebs
• saline instillation
• overall hydration levels

Question 16

What is looked out for in a CXR?

Answer 16

• Airways
• Bones
• Cardiac shadow
• diaphragms
• exposure & expansion
• lung fields
• gastric bubbles

Question 17

What is hypernea?

Answer 17

normal rate, but deeper respirations

Question 18

What is the aim of chest drains?

Answer 18

• provide method of removing air and fluid substances from pleural space

Question 19

What is checked to assess a patients circulation?

Answer 19

• HR (rate & rhythm)
• BP (MAP)
• Temp
• Urine output
• Fluid balance

Question 20

What is used to improve blood pressure?

Answer 20

• Noradrenaline
• adrenaline
• vasopressin
• dobutamine
• GTN

Question 21

What medication is used to control heart rate?

Answer 21

beta blockers

Question 22

What is a pulmonary artery catheter used for?

Answer 22

• diagnostic purposes
• detects HF/Sepsis
• monitor therapy
• evaluate effect of drugs

Question 23

What does a low body temperature indicate?

Answer 23

body may be in shock

Question 24

What does a high body temperature indicate?

Answer 24

sign of infection

Question 25

How does the renal function contribute to maintenance of pH?

Answer 25

- removes products of metabolic breakdown - maintain electrolyte balance - maintain fluid balance

Question 26

What is the central venous pressure (CVP) and what does it tell us?

Answer 26

- pressure within the right atrium - info on body volume status and right ventricular function

Question 27

What is involved in Ax to determine disability in a patient?

Answer 27

- Position - GCS - Richmond agitation-sedation scale - full neuro Ax - mobility - transfers

Question 28

What are the two ends of the Richmond agitation-sedation scale?

Answer 28

- +4 Combative - -5 Unarousable

Question 29

What is said about transfers/mobility in guidelines?

Answer 29

- early, individualised Ax with repetition on regular basis - reviewed over duration rehab - ROM, transfers and mobility N.B as able

Question 30

What is the Chelsea Critical Care Physical Ax Tool?

Answer 30

- well validated in ICU - includes cough and resp function - daily Ax

Question 31

What does the Post Intensive Care Syndrome (PICS) involve?

Answer 31

- Physical (intensive care acquired weakness) - Cognitive (fatigue, memory) - Psychological (anxiety, depression) - Socioeconomic and family

Question 32

What is investigated in bloods?

Answer 32

- haemoglobin - infection markers - clotting

Question 33

What are extra attachments the patient may have?

Answer 33

- epidural - stoma bag - wound drains

Question 34

What are treatment options available for a physio in an ICU setting (8)?

Answer 34

- positioning - manual techniques - manual hyperinflation - mechanical hyperinflation - suction - active exercise - NIV - cough assist machine

Question 35

What are the benefits of positioning?

Answer 35

- improve function inspiratory muscles - postural drainage - reduce O2 consumption - optimise V/Q - facilitate chest wall movement - side lying (bad lung up)

Question 36

What are the best and worst positions for patients?

Answer 36

- standing & high sitting best for V/Q optimisation - supine and head tilt the worst

Question 37

What ROM is aimed for in patients in ICU?

Answer 37

- Passive better than nothing - shoulder and hips to minimum 90 degrees - particular attention to TAs - move all major joints - check for areas of increased pressure

Question 38

What is manual hyperinflation?

Answer 38

- also known as "bagging" - increase TV and expiratory flow - same physiology ACBT

Question 39

What are contraindications of manual hyperinflation?

Answer 39

- High PEEP - ARDS - Raised ICP

Question 40

What is ventilator hyperinflation?

Answer 40

- aka "mechanical ventilation" - manipulate inspiratory rise time to create exp flow bias - manipulates PC/PS/VT as appropriate to improve TV

Question 41

What are the effects of mechanical ventilation on secretion clearance (7)?

Answer 41

- Airflow Bias Alterations - Sedation - decreased cough - reduced FRC - diaphragmatic atrophy - loss inspiratory muscle tone - gas trapping behind closed airways

Question 42

When is an endotracheal tube (ETT) used?

Answer 42

- alters generation pressure - damage to epithelium - decreased cilia activity

Question 43

What is the physio role in secretion clearance (5)?

Answer 43

- ACBT - mobilise and exercise - manual techniques - humidification - postural drainage

Question 44

What is the physio role in volume loss (5)?

Answer 44

- controlled mobilisation - positioning - NIV - VHI - incentive spirometry

Question 45

What is the physio role in increased WOB (3)?

Answer 45

- breathing control - positioning - ventilatory support

Question 46

What are guidelines for rehab in the ICU?

Answer 46

-ESICM guidelines - NICE guidelines on critical care rehab

Question 47

What are examples of rehab/exercise a physio can perform with a patient in ICU (6)?

Answer 47

- tilt table - standing frame - rollator frame - mobilising on ventilators etc - axillary balloon pump - mobilising on Bipap/NIV