321 Approach to the Patient with Critical Illness Flashcards
It is the presence of multisystem end-organ hypoperfusion
Shock
What are the clinical indicators of shock?
Reduced mean arterial pressure (MAP) Tachycardia Tachypnea Cool skin and extremities Acute altered mental status Oliguria
Clinical evidence of diminished cardiac output
Narrow pulse pressure
Cool extremities with delayed capillary refill
Clinical evidence of increased cardiac output
Widened pulse pressure (particularly with a reduced diastolic pressure)
Warm extremities with bounding pulses
Rapid capillary refill
It is a better predictor of fluid responsiveness
Change in right atrial pressure as a function of spontaneous respiration
It is the most common cause of high-cardiac-output hypotension
Sepsis
Other causes of high cardiac hypotension
Liver failure, Severe pancreatitis Burns and other trauma that elicit the systemic inflammatory response syndrome (SIRS) Anaphylaxis Thyrotoxicosis Peripheral arteriovenous shunts
Reasons for the institution of endotracheal intubation and mechanical ventilation
Acute hypoxemic respiratory failure
Ventilatory failure
It often occurs as a consequence of an increased load on the respiratory system in the form of acute metabolic (often lactic) acidosis or decreased lung compliance due to pulmonary edema
Ventilatory Failure
This type of respiratory failure occurs with alveolar flooding and sub- sequent intrapulmonary shunt physiology
TYPE I: ACUTE HYPOXEMIC RESPIRATORY FAILURE
This type of respiratory failure is seen in sepsis, gastric aspiration, pneumonia, near drowning, multiple blood transfusions, and pancreatitis
TYPE I: ACUTE HYPOXEMIC RESPIRATORY FAILURE
This syndrome is defined by acute onset (≤1 week) of bilateral opacities on chest imaging that are not fully explained by cardiac failure or fluid overload and of shunt physiology requiring positive end-expiratory pressure (PEEP)
ARDS
This type of respiratory failure is a consequence of alveolar hypoventilation and results from the inability to eliminate carbon dioxide effectively
TYPE II RESPIRATORY FAILURE
The mechanisms involved in this type of respiratory failure are categorized by impaired central nervous system (CNS) drive to breathe, impaired strength with failure of neuromuscular function in the respiratory system, and increased load(s) on the respiratory system
TYPE II RESPIRATORY FAILURE
Examples of conditions in this type of respiratory failure are drug overdose, brainstem injury, sleep disordered breathing, and severe hypothyroidism, myasthenia gravis, Guillain-Barré syndrome, amyotrophic lateral sclerosis, myopathy, electrolyte derangements, and fatigue
TYPE II RESPIRATORY FAILURE
What is the mainstays of therapy for type II respiratory failure?
Reverse the underlying cause(s) of ventilatory failure
Subclassification of overall load on the respiratory system
Resistive Loads (bronchospasm)
Loads due to reduced lung compliance (e.g., alveolar edema, atelectasis, intrinsic positive end-expiratory pressure [auto-PEEP]
Loads due to reduced chest wall compliance (e.g., pneumothorax, pleural effusion, abdominal disten- tion)
Loads due to increased minute ventilation requirements (e.g., pulmonary embolus with increased dead-space fraction, sepsis)
This form of respiratory failure results from lung atelectasis
TYPE III RESPIRATORY FAILURE