Acute and critical care Flashcards
What basic airway manoeuvres can be done if the airway is compromised?
Head tilt, chin lift and jaw thrust
How do you assess airway?
Is there any signs of airway compromise - cyanosis, use of accessory muscles
Is there any abnormal airway nosies - stridor, snoring, gurgling
Inspect the mouth - is there any obstructing the airway such as secretions or foreign object
When do you put the crash call out?
If the patient loses consciousness/there are no signs of life
How do you assess breathing?
Review respiratory rate and oxygen saturations, inspection of breathing effort, assess tracheal deviation
What investigations would you do in breathing?
ABG if hypoxic
CXR if suspecting lung pathology
What interventions can be done in breathing?
Patient position - sit them upright if conscious
Oxygen - 15L via non-rebreathe mask unless COPD where you consider venturi mask
Others based on clinical findings - bronchodilators, antibiotics, steroids
How do you assess circulation?
Review heart rate and blood pressure, review fluid balance (urine output, recent fluids, check ankles and sacrum for oedema, JVP), temperature and capillary refill time, auscultate the heart
What investigations might you want to do for circulation?
IV cannula (at least 1 wide bore), FBC, U+E, LFTs, VBG/ABG, ECG, blood cultures if suspecting sepsis
What interventions might you do for someone in circulation?
If hypovolaemic patients require fluid resuscitation - 500ml bolus followed by assessing for fluid overload
If haemorrhage they may require transfusion of red cells, platelets and fresh frozen plasma
How do you assess disability?
ACVPU, pupils, blood glucose (+ketones)
What interventions might you be required to do in disability?
Maintain the airway if GCS<8 or they are unresponsive/only responding to pain, correct hypoglycaemia
How to you assess exposure?
Ask if they have any pain anywhere, inspect skin for rashes, bruising, signs of infection, palpate abdomen, inspect calves, review any drains/lines, body temperature, assess for sepsis
How do you do the A-E assessment in trauma?
CABCDE (control catastrophic haemorrhage before doing the A-E assessment)
How do you control bleeding in step wise approach?
Clear any clots obscuring the bleeding source –> direct pressure –> more direct pressure –> indirect pressure by occluding proximal arteries –> tourniquet –> haemostatic agents
In burns patients how might the airway be managed?
Always consider early intubation as direct thermal injury in the upper airway causes oedema which may progress to complete airway obstruction within minutes
What is a flail chest?
Fracture of 2 or more ribs in 2 or more places which leads to floating sections of ribs and leads to ventilatory failure
What are the signs of a bleeding patient?
Sweaty, anxious, pallor, tachycardia, tachypnoea, >CRT, narrow pulse pressure, hypotension
What interventions can be done in someone with pelvic fracture?
Pelvic binder should be used in any haemodynamically unstable blunt trauma patients (assume there is a pelvic fracture)
What is permissive hypotension?
Maintain lower than normal target BP to avoid disruption of unstable clot by higher pressure and worsening of bleeds
What’s the difference between a spinal and epidural anaesthesia?
Spinal = through ligaments and dura, single bolus, rapid onset, effective in lumbar region
Epidural = between ligaments and dura, continuous infusion, slower onset, large dose required, effective in thoracic and lumbar region
Why is adrenaline used in local anaesthetic?
Causes vasoconstriction which reduces bleeding and prolonged anaesthetic effect due to reduced absorption
Name some local anaesthetics and their uses
Lidocaine - immediate onset, minor ops
Bupivacaine - 10 minute onset, regional/spinal
What is used for short and long term sedation?
Short term = IV midazolam
Long term = IV propofol and alfentanil
Which type of NIV is used for what time of respiratory failure?
CPAP for type 1 and BiPAP for type 2
What are the causes of type 1 respiratory failure?
Alveolar collapse e.g. pneumonia, LV heart failure
How does CPAP work?
Holds open the alveoli and fluid is forced out of the lungs
What is the main cause of type 2 respiratory failure?
COPD
How does BiPAP work?
BiPAP adds inspiratory pressure to further expand the lungs to improve ventilation as well as preventing alveolar collapse
What is the function of anticholingeric medications for cardiovascular support?
They inhibit the parasympathetic nervous system and increase heart rate - used to treat bradycardias e.g. atropine
What is the function of beta-adrenoreceptor agonists for cardiovascular support?
Stimulates myocardial cells and increases heart rate and contractility e.g. dobutamine
What is the function of alpha agonists for cardiovascular support?
Stimulate alpha receptors which are found in peripheral vessels –> vasoconstriction –> increased BP
e.g. metaraminol, noradrenaline
When is a combined alpha and beta agonist used?
When both BP and HR are low e.g. ephedrine or adrenaline
What is an example of a serotonin receptor antagonist antiemetic and what are its uses?
Ondansetron
Useful in drug related N+V, gut infection, radiotherapy/chemotherapy
What is an example of a dopamine receptor antagonist antiemetic and what are its uses?
Metoclopramide, domperidone, prochlorperazine, haloperidol
Useful in drug related N+V and decreased gut motility e.g. opioids
Contraindicated in GI obstruction
Haloperidol is used in metabolic causes of N+V e.g. hypercalcaemia
Prochlorperazine is primarily used in vertigo
What is an example of a histamine receptor antagonists antiemetic and what are its uses?
Cyclizine, promethazine
Useful in motion sickness, vertigo
Cyclizine is 1st line in most cases and used in N+V associated with bowel obstruction
What muscle relaxant is used in rapid sequence induction?
Suxamethonium
What is used to measure carbon monoxide levels in the blood?
Carboxyhaemoglobin (measured using ABG and co-oximetry)
What kind of airway can prevent aspiration?
Tracheal tube is the only airway that can prevent aspiration
How long do you need to fast for before surgery (clear fluids and solids)?
2 hours for clear liquids, 6 hours for solids
When does someone require a CT head following a fall?
GSC <12 on initial assessment, GSC <15 at 2 hours post injury, suspected skull fracture (panda eyes, CSF leak from ear or nose, battle’s sign), seizure, focal neurological deficit, more than 1 episode of vomiting
What are the symptoms of carbon monoxide poisoning?
N+V, cherry red skin, tachycardia, 100% oxygen saturations on pulse oximetry
What dose of adrenaline is given in anaphylaxis?
0.5mg IM
