(3) ICU Assessment & Treatment Flashcards
What are the sequential organ failure assessment score and APACHE II used for?
- identify ICU patients
- determine risk of acuity and mortality risk
What is the SOFA used for?
looks at extent of sepsis related organ failure/function
What areas does the SOFA cover?
- resp
- coagulation
- liver
- neuro
- cvs
- renal
What would we want to know from the nurses prior to seeing a patient?
- How is patient + updates
- any important events
- suctioning?
- patient coughing (productive?)
- pain?
What should be observed in the environment with the patient?
- patient in bed
- mode & method ventilation
- drains, lines, wires & attachments
- evidence of sc evidence
- level of consciousness
What is involved in Ax in an ICU patient?
- Airway
- Breathing
- Circulation
- Disability
- Exposure
What is investigated in Airway Ax?
- are they maintaining their own airway
- do they need an artificial airway
- invasive or NIV
What is involved in respiratory objective Ax?
- mode ventilation
- SpO2/FiO2
- ABG & CxR
- Auscultation & Palpation
- chest drains
- cough & sputum
What is involved in non-invasive ventilation objective Ax?
- Bipap or Cpap
- interface
- pressure & volume
- FiO2
- ABGs
What is involved in mechanical ventilation objective Ax?
- mode
- airway
- level of support
- pressure & volumes
- FiO2
- Nitric Oxide
What is involved in Ax of a patients cough?
- strong or weak
- moist or dry
- effective or ineffective
- sputum
- any haemoptysis
What are individuals with a peak flow cough of <270L/min at risk of?
secretion retention and need manual or mechanical assistance to avoid serious complications
What are the 3 phases of the cough?
- Inspiratory phase
- Compressive phase
- Expiration phase
What is the function of the nasopharynx?
humidification
What happens following impaired humidification?
slow cilia activity and impair mucous clearance
How can humidification be improved in a patient?
- Puritan cold water humidifier
- Heat and moisture exchanger
- saline nebs
- saline instillation
- overall hydration levels
What is looked out for in a CXR?
- Airways
- Bones
- Cardiac shadow
- diaphragms
- exposure & expansion
- lung fields
- gastric bubbles
What is hypernea?
normal rate, but deeper respirations
What is the aim of chest drains?
- provide method of removing air and fluid substances from pleural space
What is checked to assess a patients circulation?
- HR (rate & rhythm)
- BP (MAP)
- Temp
- Urine output
- Fluid balance
What is used to improve blood pressure?
- Noradrenaline
- adrenaline
- vasopressin
- dobutamine
- GTN
What medication is used to control heart rate?
beta blockers
What is a pulmonary artery catheter used for?
- diagnostic purposes
- detects HF/Sepsis
- monitor therapy
- evaluate effect of drugs
What does a low body temperature indicate?
body may be in shock
What does a high body temperature indicate?
sign of infection
How does the renal function contribute to maintenance of pH?
- removes products of metabolic breakdown
- maintain electrolyte balance
- maintain fluid balance
What is the central venous pressure (CVP) and what does it tell us?
- pressure within the right atrium
- info on body volume status and right ventricular function
What is involved in Ax to determine disability in a patient?
- Position
- GCS
- Richmond agitation-sedation scale
- full neuro Ax
- mobility
- transfers
What are the two ends of the Richmond agitation-sedation scale?
- +4 Combative
- -5 Unarousable
What is said about transfers/mobility in guidelines?
- early, individualised Ax with repetition on regular basis
- reviewed over duration rehab
- ROM, transfers and mobility N.B as able
What is the Chelsea Critical Care Physical Ax Tool?
- well validated in ICU
- includes cough and resp function
- daily Ax
What does the Post Intensive Care Syndrome (PICS) involve?
- Physical (intensive care acquired weakness)
- Cognitive (fatigue, memory)
- Psychological (anxiety, depression)
- Socioeconomic and family
What is investigated in bloods?
- haemoglobin
- infection markers
- clotting
What are extra attachments the patient may have?
- epidural
- stoma bag
- wound drains
What are treatment options available for a physio in an ICU setting (8)?
- positioning
- manual techniques
- manual hyperinflation
- mechanical hyperinflation
- suction
- active exercise
- NIV
- cough assist machine
What are the benefits of positioning?
- improve function inspiratory muscles
- postural drainage
- reduce O2 consumption
- optimise V/Q
- facilitate chest wall movement
- side lying (bad lung up)
What are the best and worst positions for patients?
- standing & high sitting best for V/Q optimisation
- supine and head tilt the worst
What ROM is aimed for in patients in ICU?
- 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
What is manual hyperinflation?
- also known as “bagging”
- increase TV and expiratory flow
- same physiology ACBT
What are contraindications of manual hyperinflation?
- High PEEP
- ARDS
- Raised ICP
What is ventilator hyperinflation?
- aka “mechanical ventilation”
- manipulate inspiratory rise time to create exp flow bias
- manipulates PC/PS/VT as appropriate to improve TV
What are the effects of mechanical ventilation on secretion clearance (7)?
- Airflow Bias Alterations
- Sedation
- decreased cough
- reduced FRC
- diaphragmatic atrophy
- loss inspiratory muscle tone
- gas trapping behind closed airways
When is an endotracheal tube (ETT) used?
- alters generation pressure
- damage to epithelium
- decreased cilia activity
What is the physio role in secretion clearance (5)?
- ACBT
- mobilise and exercise
- manual techniques
- humidification
- postural drainage
What is the physio role in volume loss (5)?
- controlled mobilisation
- positioning
- NIV
- VHI
- incentive spirometry
What is the physio role in increased WOB (3)?
- breathing control
- positioning
- ventilatory support
What are guidelines for rehab in the ICU?
-ESICM guidelines
- NICE guidelines on critical care rehab
What are examples of rehab/exercise a physio can perform with a patient in ICU (6)?
- tilt table
- standing frame
- rollator frame
- mobilising on ventilators etc
- axillary balloon pump
- mobilising on Bipap/NIV
