Acute and Critical care

Question 1

Side effects following critical care

Post Intesive Care Syndrome = pICS

Answer 1

Physical deconditioning - Exhausted for 3 months 
HA infections
Functional and cognitive impairment
DElerium
PTSD and anxiety

Question 2

When do you do an emergency Circithyrotomy

Answer 2

When you cant intubate, cant ventillate (or oxygenate)

- Cannula first and if that fails, Surgical

Question 3

C Spine check?

Answer 3

Canadian C spine
> 65?
Dangerous mechanism?
Paraesthesia in extremities 
Unable to actively roatate neck 45 degrees?

If yes –> radiography

Question 4

GCS

Answer 4

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

Question 5

Monroe KEllie Doctrine

Answer 5

Volume inside cranium is fixed
Blood, CSF and brain and in equilibrium
Increase volume in one must be compensated by decrease volume in another

Question 6

Treatment of brain swelling

Answer 6

Correct hypotension 
MAP >90 
Treat sezirues 
Elevate head 30 degrees
Mannitol to reduce brain swelling 
Corticosteroids if oedema

Question 7

Cerebral perfusion pressure =

Answer 7

Mean arterial pressure - ICP
As ICP increases, CCP decreases
The response is to increase BP
causes Cerebral ischaemia, midline shift, hydrocephalius and herniation

Question 8

Invasive cardiac monitoring?

Answer 8

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

Question 9

Hypovolaemic shock

Answer 9

Bleeding and dehydration = cool and pale

Give more fluid

Question 10

Distributive

Answer 10

Warm, vasodialted –> Give Vasopressin eg Noradrenaine

Question 11

Cardiogeneic

Answer 11

Pump failure, vascular defects, rhtym abnormalities

Give IONOTROPES

Question 12

Obstrucive

Answer 12

Eg massive PE- treat obstructive cause

Question 13

Adrenaline

Answer 13

B1 = HEART RATE
increased Heart rate and blood pressure
central only

Question 14

Noradrenaline

Answer 14

A1 agonist= increase blood pressure - peripheral vessels
central only
vasopressor –> give in distributive shock

Question 15

Dobuatamine and Dopexamine

Answer 15

B1 agonist = increase heart rate - ionotrope

and decrease BP

Question 16

Salubtamol

Answer 16

b2 receptrors = lung

Question 17

Phenylepherine and Metaraminol

Answer 17

A1 = increases blood pressure

decreases HR

Question 18

Goal directed therapy in ICU

Answer 18

Normalise Lactate 
Urine Output >0.5ml/kg/hr
MAP >65mmHg 
Central venous sats >70%
Central venous pressure 8-12

Question 19

Atropines affect on heart

Adenonsines affect on heart

Amiodarone

Answer 19

increase HR

decrease HR

Amiodarone - rhythm + for tachys

Question 20

Dead space

Shunt

Answer 20

dead space = ventilated lung without perfusion

Shunt = blood but no ventillation

Question 21

type 1 respiratory falure treatment ICU

Answer 21

CPAP
- 02 delivered with positie pressure
decreases work of breathing

Question 22

Type 2 resp failure ICU - hypercapnea

e.g copd retainers, neuromuscular

Answer 22

bipap = NIV which is basically CPAP + additional pressure to support inspiration

Question 23

If resp failure is refractory to other treatment / low GCS …

Answer 23

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

Question 24

Renal replacement therapy indicaitons

Answer 24

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

Question 25

Indications for plasma exchange

Answer 25

used as therapy for some acute immune mediated conditions

- guillian barre, myasethenia gravis, SLE, vasculitis

Question 26

Signs of liver failure

Answer 26

Encephalopathy
Bleeding (INR >1.5 as liver not making clotting factors)
Jaundice, N+V, ascites

Question 27

Diagnosing death - cardiac death

Answer 27

1. Establish CPR failed or DNACPR
2. Observe for 5 minutes for an absence of a central pulse on palpation and absence of heart and breath sounds on auscultation or ECG
3. 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