8. Critical Care

Question 1

What is your first approach to management of a critically unwell patient?

Answer 1

Hello how are you
Response
Airway patent?
Breathing?

Question 2

What action do you take when someone is unwell?

Answer 2

Look for obstruction
Listen for a noise
Clear and secure the airway

Question 3

What are the three most common sounds to hear and what causes them?

Answer 3

No sounds-complete obstruction

Snoring/gurgling- reduces GCS, foreign body

Stridor- anaphylaxis,burns, abscess, thermal?, tumour,post extubation

Question 4

What is the number called in all emergency situations?

Answer 4

2222

Question 5

How do you assess breathing in a critical situation?

Answer 5

Rate
Volume
Symmetry
Character
Work of breathing
Compromise

Question 6

What advanced assessments of breathing can be done?

Answer 6

Listen with stethoscope
CXR, ABG’s
Repeated observations (RR and eyeball assessment)
Pulse oximetry

Question 7

How do you manage someone who is struggling to breathe?

Answer 7

Increase oxygen

Use nebulisers

Question 8

What do you do for someone who is in severe respiratory failure?

Answer 8

Give anaesthetic and muscle relaxant and take over breathing using ventilation.

Question 9

How do you assess someone’s cardiac function for someone who is critically unwell?

Answer 9

Pulse (radial) thready or absent- bad
CRT (peripheral and central)
Temperature
Blood pressure patterns

Question 10

What is hypovolemic heamorrhage

Answer 10

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

Question 11

What happens during heamorrhagic hypovolemia?

Answer 11

Systolic falls due to left ventricular failure
Diastolic goes up (increased adrenaline)

Then both falls drastically.

Question 12

What are the five types of shock?

Answer 12

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)

Question 13

What occurs during septic shock

Answer 13

Systolic is well maintained
Diastolic drops due to vasodilation in the peripheries

Large pulse pressure- indicates sepsis or anaphylaxis or vasodilation drugs

Question 14

Describe cardiac physiology briefly

Answer 14

MAP= CO x SVR

CO= HR x SV

Low BP- decompensation

Question 15

How do you establish IV access?

Answer 15

Site, size, blood sampling

Short and thick cannulas

Question 16

What are the sites of access in very unwell patients

Answer 16

Femoral and jugular vein cannulation

Question 17

Why do you need IV access?

Answer 17

To deliver fluid and drugs

Question 18

Where else can you deliver drugs?

Answer 18

Intra-osseous access

Question 19

What do you check in the neurology aspect of disability?

Answer 19

Conscious levels, focal neurology, pupils, weakness

DEFG (blood glucose)

Question 20

What are the most common reasons for reduced consciousness?

Answer 20

Alcohol and drugs

Trauma

Question 21

What immediate investigations should be performed on someone with reduced conscious levels

Answer 21

Arterial blood gas and acid base status
Potassium
Glucose
Lactate

12 lead ECG
CXR
Targeted scans

Question 22

What is involved in the “E” stage (everything else)

Answer 22

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

Question 23

What are vasopressors?

Answer 23

Medicines that tighten blood vessels and raise blood pressure

Question 24

What are ionotropes?

Answer 24

Drugs that can increase or decreases contractility of the heart

Question 25

What are abnormal results for:

Blood pressure
Potassium
Glucose
Base excess

Answer 25

<100, >200.
<3 or >6 (ECG)
<3 or >20
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