Acute and Critical care Flashcards
Side effects following critical care
Post Intesive Care Syndrome = pICS
Physical deconditioning - Exhausted for 3 months HA infections Functional and cognitive impairment DElerium PTSD and anxiety
When do you do an emergency Circithyrotomy
When you cant intubate, cant ventillate (or oxygenate)
- Cannula first and if that fails, Surgical
C Spine check?
Canadian C spine > 65? Dangerous mechanism? Paraesthesia in extremities Unable to actively roatate neck 45 degrees?
If yes –> radiography
GCS
E4, V5 M6
Eyes
4 = open
3 = opens to command
2 = open to pain
Voice 5 = orientated 4 = confused 3 = talking confused / inappropriate words 2 = grunts 1 = no verbal response
Motor 6= follows command 5 = localises 4 = withdraws from pain 3= flex 2= extends 1 = no motor response
Monroe KEllie Doctrine
Volume inside cranium is fixed
Blood, CSF and brain and in equilibrium
Increase volume in one must be compensated by decrease volume in another
Treatment of brain swelling
Correct hypotension MAP >90 Treat sezirues Elevate head 30 degrees Mannitol to reduce brain swelling Corticosteroids if oedema
Cerebral perfusion pressure =
Mean arterial pressure - ICP
As ICP increases, CCP decreases
The response is to increase BP
causes Cerebral ischaemia, midline shift, hydrocephalius and herniation
Invasive cardiac monitoring?
Central venous pressure = measured through a central venous line aka PICC line if in arm (can also take bloods and deliver fluids and meds)
Invasive Arterial Pressure = art line/ a line
- can take ABGs from and monitor real BP
Hypovolaemic shock
Bleeding and dehydration = cool and pale
Give more fluid
Distributive
Warm, vasodialted –> Give Vasopressin eg Noradrenaine
Cardiogeneic
Pump failure, vascular defects, rhtym abnormalities
Give IONOTROPES
Obstrucive
Eg massive PE- treat obstructive cause
Adrenaline
B1 = HEART RATE
increased Heart rate and blood pressure
central only
Noradrenaline
A1 agonist= increase blood pressure - peripheral vessels
central only
vasopressor –> give in distributive shock
Dobuatamine and Dopexamine
B1 agonist = increase heart rate - ionotrope
and decrease BP
Salubtamol
b2 receptrors = lung
Phenylepherine and Metaraminol
A1 = increases blood pressure
decreases HR
Goal directed therapy in ICU
Normalise Lactate Urine Output >0.5ml/kg/hr MAP >65mmHg Central venous sats >70% Central venous pressure 8-12
Atropines affect on heart
Adenonsines affect on heart
Amiodarone
increase HR
decrease HR
Amiodarone - rhythm + for tachys
Dead space
Shunt
dead space = ventilated lung without perfusion
Shunt = blood but no ventillation
type 1 respiratory falure treatment ICU
CPAP
- 02 delivered with positie pressure
decreases work of breathing
Type 2 resp failure ICU - hypercapnea
e.g copd retainers, neuromuscular
bipap = NIV which is basically CPAP + additional pressure to support inspiration
If resp failure is refractory to other treatment / low GCS …
Mechanical ventillation and circulatory support
Requires endotracheal tube + sedation
Try get off ventillator day 5/6 and by day 8 consider Tracheoatomy to help with weaning
Renal replacement therapy indicaitons
1) Acute- potassium >6.5 despite medical mx or acidosis <7.2
2) Within 24 hrs urea >40 and creatinine >400
3) CKD stage 5
Indications for plasma exchange
used as therapy for some acute immune mediated conditions
- guillian barre, myasethenia gravis, SLE, vasculitis
Signs of liver failure
Encephalopathy
Bleeding (INR >1.5 as liver not making clotting factors)
Jaundice, N+V, ascites
Diagnosing death - cardiac death
- Establish CPR failed or DNACPR
- Observe for 5 minutes for an absence of a central pulse on palpation and absence of heart and breath sounds on auscultation or ECG
- Confirm brainstem has been damaged by examining for lack of pupillary light reflexes, corneal and motor response to suborbital pressure
- Time of death is stated when tests are completed
diagnosis needs 2 clinicians, one must be consultant
Must be no doubt its reversible or brainstem death
