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Year 4 - Acute Care > Acute pain and ICU > Flashcards

Acute pain and ICU Flashcards

1
Q

What are some CVS manifestations of pain

A

tachycardia, hypertension, increased SVR, increased myocardial oxygen consumption

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2
Q

What are some respiratory manifestations of pain

A

decreased lung volumes, atelectasis, decreased cough, sputum retention, infection, hypoxaemia

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3
Q

What are some GI manifestations of pain

A

decreased gastric and bowel motility

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4
Q

What are some GU manifestations of pain

A

urinary retention

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5
Q

what scale can be used to rate pain

A

simple verbal rating scale

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6
Q

what is the simple verbal rating scale

A 
0 = no pain at rest or on movement
1 = no pain at rest, slightly on movement
2 = intermittent at rest, moderate on movement 
3 = continuous at rest, severe on movement
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7
Q

In post-op patients, how do you move along the analgesic ladder

A

from top to bottom

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8
Q

in palliative patients, how do you move along the analgesic ladder

A

from bottom to top

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9
Q

what are special circumstances to consider when treating pain

A

drug dependency
chronic pain
renal failure

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10
Q

if a patient is on methadone, can you give normal opioids?

A

yes

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11
Q

what type of analgesia should be avoided in patients with renal failure

A

NSAIDs

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12
Q

what types of analgesia won’t accumulate in those with renal failure

A

paracetamol

fentanyl

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13
Q

what is the mechanism of action of paracetamol

A

inhibits prostaglandin synthesis in the CNS

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14
Q

what is the dosing of paracetamol

A

1g 6 hourly

reduce if <50kg

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15
Q

What is the mechanism of action of NSAIDs

A

COX-1/2 inhibition

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16
Q

what are contraindications to NSAIDs

A 
peptic ulcer disease / GI bleeding
asthma 
heart failure 
hypertension 
renal impairment 
dehydration 
pregnancy 
coagulopathy 
aspirin/NSAID allergy
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17
Q

how can opioids be administered

A

PO, SC, IM, IV, intrathecal, epidural

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18
Q

what is the mechanism of action of opioids

A

agonist of mu receptors

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19
Q

list strong opioids

A 
morphine 
oxycodone
diamorphine 
fentanyl 
methadone
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20
Q

list weak opioids

A

codeine

tramadol

21
Q

who should you not give tramadol to

A

epileptics

22
Q

common side effect of opioids (especially codeine)

A

constipation

N+V

23
Q

what is PCA

A

Patient controlled analgesia
prescribed by Dr, administered by patient
must be prescribed on kardex AND on a separate PCA chart

24
Q

what is the usual prescription of PCA

A

1mg bolus morphine with a 5 min lockout

ie 12mg in an hour

25
Q

where is analgesia delivered to in the epidural route

A

in the epidural space (outside the dura mater)

26
Q

what are advantages to epidural analgesia

A

excellent control
lower incidence of DVT
earlier mobilisation
earlier recovery of GIT function

27
Q

what are disadvantages of epidural analgesia

A

special staff required
hypotension
contraindicated if on anticoagulants
spinal haematoma/abscess

28
Q 
What drug class are the following anti-emetics:
cyclizine
ondansetron 
prochlorperazine 
metoclopramide 
hyoscine
A

cyclizine = antihistamine
ondansetron = 5HT3 antagonist
prochlorperazine + metoclopramide = antidopaminergic
hyoscine = anticholinergic

29
Q

indications for central venous catheter insertion

A

measuring CVP
haemodialysis
cardiac pacing
administration of inotropes

30
Q

common sites for CVC insertion

A

IJV
subclavian vein
femoral vein
antecubital fossa (PICC)

31
Q

what is the correct placement of a CVC

A

the tip should be sitting at the entrance to the right atrium

32
Q

what is a normal CVP value

A

0-8cmH2O

33
Q

what are inotropes

A

drugs that affect cardiac contractility

positive and negative

34
Q

what is a vasopressor

A

substance which increases SVR

35
Q

how should inotropes always be administered

A

through a CVC

36
Q

examples of (positive) inotropes

A

adrenaline

dobutamine

37
Q

action of adrenaline

A

it is a catecholamine which acts as an agonist of alpha and beta receptors

38
Q

action of dobutamine

A

synthetic catecholamine
B1 agonist
increases cardiac contractility with minimal effect on HR and vascular tone

39
Q

examples of vasopressors

and main MOA

A 
Primarily alpha agonists
noradrenaline 
metaraminol 
ephidrine 
adrenaline
40
Q

action of noradrenaline

A

powerful alpha 1 agonist used to increase SVR

41
Q

what are the different levels of critical care

A

Level 0 = ward based
1 = ward based with critical care support
2 = HDU (single organ system failing)
3 = ICU (multiorgan support, invasive ventilation)

42
Q

what are the different types of ventilation

A

invasive and non-invasive

43
Q

what is involved in invasive ventilation

A

performed via an ETT or other airway device

44
Q

what is non-invasive ventilation

A

performed via a tight fitting mask

either: CPAP or BiPAP

45
Q

in the acute setting (eg COPD exacerbation, type 2 resp failure), what would you use, CPAP or BiPAP

A

BiPAP

46
Q

When would you use CPAP

A

OSA

Type 1 resp failure (pulmonary oedema - unresponsive acute HF)

47
Q

what is an intra-aortic balloon pump

A

inflatable balloon inserted percutaneously via the femoral artery
provides counter pulsation to improve myocardial oxygen supply and reduced myocardial work
improves outcomes in post MI and cardiogenic shock

48
Q

what are patients at risk of post resuscitation

A

re arrest

hypoxic brain injury

49
Q

how many doctors are needed to confirm brainstem death

A

2

Year 4 - Acute Care (7 decks)

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