8. Critical Care Flashcards
What is your first approach to management of a critically unwell patient?
Hello how are you
Response
Airway patent?
Breathing?
What action do you take when someone is unwell?
Look for obstruction
Listen for a noise
Clear and secure the airway
What are the three most common sounds to hear and what causes them?
No sounds-complete obstruction
Snoring/gurgling- reduces GCS, foreign body
Stridor- anaphylaxis,burns, abscess, thermal?, tumour,post extubation
What is the number called in all emergency situations?
2222
How do you assess breathing in a critical situation?
Rate Volume Symmetry Character Work of breathing Compromise
What advanced assessments of breathing can be done?
Listen with stethoscope
CXR, ABG’s
Repeated observations (RR and eyeball assessment)
Pulse oximetry
How do you manage someone who is struggling to breathe?
Increase oxygen
Use nebulisers
What do you do for someone who is in severe respiratory failure?
Give anaesthetic and muscle relaxant and take over breathing using ventilation.
How do you assess someone’s cardiac function for someone who is critically unwell?
Pulse (radial) thready or absent- bad
CRT (peripheral and central)
Temperature
Blood pressure patterns
What is hypovolemic heamorrhage
Type of shock caused by the body losing more than 20% of its blood or fluid supply. The heart cannot lump sufficient blood around the body
What happens during heamorrhagic hypovolemia?
Systolic falls due to left ventricular failure
Diastolic goes up (increased adrenaline)
Then both falls drastically.
What are the five types of shock?
Cardiogenic shock- (insufficient heart capability)
Hypovolemic shock- (loss of blood volume)
Anaphylactic shock- (allergies)
Septic shock- (infections)
Neurogenic shock- (caused by damage to nervous system)
What occurs during septic shock
Systolic is well maintained
Diastolic drops due to vasodilation in the peripheries
Large pulse pressure- indicates sepsis or anaphylaxis or vasodilation drugs
Describe cardiac physiology briefly
MAP= CO x SVR
CO= HR x SV
Low BP- decompensation
How do you establish IV access?
Site, size, blood sampling
Short and thick cannulas
What are the sites of access in very unwell patients
Femoral and jugular vein cannulation
Why do you need IV access?
To deliver fluid and drugs
Where else can you deliver drugs?
Intra-osseous access
What do you check in the neurology aspect of disability?
Conscious levels, focal neurology, pupils, weakness
DEFG (blood glucose)
What are the most common reasons for reduced consciousness?
Alcohol and drugs
Trauma
What immediate investigations should be performed on someone with reduced conscious levels
Arterial blood gas and acid base status
Potassium
Glucose
Lactate
12 lead ECG
CXR
Targeted scans
What is involved in the “E” stage (everything else)
Get further history (GP, family, SAS)
Examine tracheal deviation
Chest (lateralising signs, wheeze crackles)
JVP, heart added HS III, IV, murmurs, rubs
Abdomen: swelling pulsation
Skin: CNS, rashes, neck stiffness, lateralising signs
What are vasopressors?
Medicines that tighten blood vessels and raise blood pressure
What are ionotropes?
Drugs that can increase or decreases contractility of the heart
What are abnormal results for:
Blood pressure
Potassium
Glucose
Base excess
<100, >200.
<3 or >6 (ECG)
<3 or >20
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