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Year Three - Specialities > Anaesthesia - Critical Care > Flashcards

Anaesthesia - Critical Care Flashcards

1
Q

What is critical care?

A

The patient care for those suffering from organ failure

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2
Q

Where do we treat patients with single organ failure?

A

High dependency units

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3
Q

Where do we treat patients with multiple organ failure?

A

Intensive care units

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4
Q

What is respiratory failure?

A

A condition in which the respiratory system fails to maintain its main function, gas exchange

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5
Q

What is the clinical definition of respiratory failure?

A

PaO2 lower than 60mmHg

and/or

PaCO2 greater than 50mmHg

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6
Q

What is 60mmHg in kPa?

A

8 kPa

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7
Q

What is 50mmHg in kPa?

A

6.7 kPa

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8
Q

What are the two types of respiratory failure?

A

Respiratory Failure Type One

Respiratory Failure Type Two

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9
Q

What is type one respiratory failure?

A

It is defined as a PaO2 lower than 60mmHg with normal PaCO2

It is therefore oxygenation failure

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10
Q

Describe the pathophysiology behind type one respiratory failure

A

It occurs as a result of damage to lung tissue

This prevents adequate oxygenation of the blood; however, the remaining normal lung is still sufficient to excrete the carbon dioxide being produced

This is due to the fact that less functioning lung tissue is required for carbon dioxide excreter than is needed for oxygenation of the blood

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11
Q

Name four respiratory conditions associated with type one respiratory failure

A

Pulmonary Oedema

Pneumonia

Acute Respiratory Distress Syndrome

Chronic Pulmonary Fibrosing Alveolitis

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12
Q

What is type two respiratory failure?

A

It is defined as a PaO2 lower than 60mmHg with PaCO2 greater than 50mmHg

It is therefore oxygenation and ventilation failure

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13
Q

Describe the pathophysiology behind type two respiratory failure

A

It occurs as a result of reduced ventilatory effort resulting in the accumulation of carbon dioxide

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14
Q

Name five respiratory conditions associated with type two respiratory failure

A

COPD

Asthma

Guillain-Barre Syndrome

Cerebrovascular Disease

Opiate Overdose

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15
Q

What are six clinical features associated with respiratory failure?

A

Dyspnoea

Tachypnoea

Confusion

Tachycardia

Central Cyanosis

Pulmonary Hypertension

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16
Q

What are the three investigations used to diagnose respiratory failure?

A

Blood Tests

Arterial Blood Gas

Pulmonary Function Tests

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17
Q

Which two blood tests are used to diagnose respiratory failure? Why?

A

LFTs

U&Es

It may indicate the underlying cause of respiratory failure and identify any complications associated with it

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18
Q

How are arterial blood gases used to diagnose respiratory failure?

A

It measure oxygen and carbon dioxide levels

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19
Q

What are pulmonary function tests?

A

They are non-invasive tests that show how well the lungs are working

They specifically measure lung volume, capacity, rates of flow and gas exchange

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20
Q

How are pulmonary function tests used to diagnose respiratory failure?

A

They allow the underlying cause of respiratory failure to be identified

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21
Q

What does a normal FEV1 & FVC level indicate the underlying cause of respiratory failure is?

A

There are defects in respiratory control

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22
Q

What does a reduced FEV1: FVC level indicate the underlying cause of respiratory failure is?

A

Airflow obstruction

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23
Q

What does a decreased FEV1 & FVC level indicate the underlying cause of respiratory failure is?

A

Restrictive lung disease

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24
Q

In what two ways do we manage respiratory failure?

A

Oxygen Replacement Therapy

Ventilatory Support

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25
What is the function of oxygen replacement therapy?
To maintain adequate tissue oxygenation
26
What PaO2 level and saturation level indicate adequate tissue oxygenation?
PaO2 - 60mmHg Saturation - 90%
27
What respiratory failure classification is treated with oxygen therapy? How
Type one respiratory failure It corrects hypoxemia
28
What are three forms of oxygen therapy?
Nasal Cannula Hudson Face Mask Non-Rebreather Face Mask
29
What percentage of oxygen is contained in room air?
21%
30
What percentage of oxygen is delivered by a nasal cannula?
30%
31
At what rate does a nasal cannula deliver oxygen?
2 - 4L per minute
32
What percentage of oxygen is delivered by a high flow nasal cannula?
40 - 60%
33
At what rate does a high flow nasal cannula deliver oxygen?
4 - 10L per minute
34
What percentage of oxygen is delivered by a Hudson face mask?
100%
35
At what rate does a Hudson face mask deliver oxygen?
60L per minute
36
What percentage of oxygen is delivered by a non-rebreather face mask?
60-80%
37
At what rate does a non-rebreather face mask deliver oxygen?
10-15L per minute
38
What are the mechanisms in which ventilation can be supported?
Non-Invasive Respiratory Support Invasive Respiratory Support
39
What is non-invasive respiratory support?
It is ventilatory support via a face mask – without tracheal intubation
40
How does a non-invasive respiratory support work?
It applies pressure to the patients’ airways, thus maintaining patency and reducing their work of breathing
41
What type of respiratory failure is treated with non-invasive respiratory support?
Mild to moderate type two respiratory failure, particularly those affected with associated COPD
42
What is invasive respiratory support?
It is ventilatory support via endotracheal tube intubation
43
What is an endotracheal tube?
An endotracheal tube is a plastic tube that is inserted through the mouth into the trachea It is then connected to a ventilator, which delivers oxygen to the lungs
44
How does invasive respiratory support work?
The endotracheal tube consists of an air-inflated balloon, which forms a seal in the patient’s upper airways This allows all gas to enter straight into the patient’s lungs and providing protection to the airway
45
What type of respiratory failure is treated with invasive respiratory support?
Severe type two respiratory failure, particularly those with persistent hypoxemia despite receiving maximum oxygen therapy and hypercapnia with impairment of conscious level
46
What are the four complications of respiratory failure?
Nosocomial Pneumonia Heart Failure Arrythmia Pericarditis
47
What is acute heart failure?
It is a condition in which the cardiovascular system fails to pump sufficient quantities of blood to meet the physiological demands of the body This causes a backflow of blood, resulting in increased blood volumes in the left atrium, pulmonary veins and lungs.
48
What are the two classifications of acute heart failure?
Systolic Heart Failure (HFrEF) Diastolic Heart Failure (HFpEF)
49
What is systolic heart failure?
It is inability of the ventricle to contract normally
50
How is the cardiac output and ejection fraction affected by systolic heart failure?
CO - decreased Ejection fraction - <40%
51
What are the four causes of systolic heart failure?
Ischaemic heart disease Dilated cardiomyopathy Myocarditis Arrhythmias
52
What is diastolic heart failure?
It is inability of the ventricle to relax normally, resulting in decreased volumes of blood filling the ventricles
53
How is ejection fraction affected by diastolic heart failure?
Ejection fraction - > 50%
54
What is diastolic heart failure progress into?
It commonly progresses into systolic heart failure
55
What are the four causes of diastolic heart failure?
Hypertrophic obstructive cardiomyopathy Restrictive cardiomyopathy Cardiac tamponade Constrictive pericarditis
56
What is high output heart failure?
This refers to a situation where a 'normal' heart is unable to pump enough blood to meet the metabolic needs of the body
57
What are the five causes of high output heart failure?
Anaemia Paget's disease Pregnancy Thyrotoxicosis Thiamine deficiency
58
What two drugs cause heart failure?
Verapamil Diltiazem
59
What is the most common cause of heart failure?
Ischaemic heart disease
60
What are the six symptoms of acute heart failure?
Dyspnoea on Exertion Cough with White/Pink Sputum Orthopnoea Paroxysmal Nocturnal Dyspnoea Peripheral Oedema Ascites
61
What are the five signs of acute heart failure on examination?
Tachycardia Tachypnoea 3rd Heart Sound Bilateral Basal Cracks Increased JVP
62
What two clinical features indicate right sided heart failure?
Increased JVP Peripheral oedema
63
What scoring system is used to diagnose acute heart failure?
Framingham Criteria for Congestive Heart Failure
64
What ‘Framingham Criteria for Congestive Heart Failure’ score indicates a diagnosis of heart failure?
2 major criteria OR 1 major criterion and 2 minor criteria
65
What are the five major criteria of the 'Framingham Criteria for Congestive Heart Failure’ ?
PAINS Paroxysmal Nocturnal Dyspnoea Acute Pulmonary Oedema Increased Heart Size/ Increased Central Venous Pressure Neck Vein Dilatation S3 Gallop
66
What are the four minor criteria of the 'Framingham Criteria for Congestive Heart Failure’ ?
PAIN Pleural Effusion Ankle Oedema (Bilateral) Increased Heart Rate, which is greater than 120bpm Nocturnal Cough
67
What are the three investigations used to diagnose acute heart failure?
Blood Tests Echocardiogram (ECHO) Chest X-Ray (CXR)
68
What two blood tests are used to diagnose heart failure?
BNP blood test Sodium
69
What is BNP?
A hormone that is released from the heart ventricles when the myocardium is stretched beyond normal range
70
What is the function of BNP?
It relaxes the smooth muscles in blood vessels, which reduces the systemic vascular resistance and makes it easier for the heart to pump blood It acts on the kidneys to promote the excretion of water in urine, which reduces circulating volume and improves cardiac function
71
What BNP result indicates heart failure? Why?
Elevated This indicates that the heart is overloaded beyond its normal capacity to pump effectively
72
What investigation is conducted after a high BNP result to confirm heart failure?
ECHO
73
What sodium level indicates heart failure?
Decreased
74
What do ECHO scans assess?
They are used to assess cardiac function, allowing measurement of the LV ejection fraction
75
What is the LV ejection fraction?
This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction
76
What is a normal LV ejection fraction?
50-80%
77
What LV ejection fraction indicates mild HF?
40-50%
78
What LV ejection fraction indicates moderate HF?
30-40%
79
What LV ejection fraction indicates severe HF?
< 30%
80
What five signs indicate heart failure on a CXR?
Alveolar Oedema Kerley B Lines Cardiomegaly Dilated Upper Lobe Vessels Pleural Effusion
81
What are the two ways in which we manage heart failure conservatively?
We advise patients to sit upright We administer oxygen in patients with saturation level less than 95%
82
Why do we advise heart failure patients to sit upright?
This is due to the fact that when lying flat, the fluid in the lung’s spreads to larger area However, when sitting upright, gravity results in the movement of fluid to the base of the lung, leaving the upper lungs clear for gas exchange
83
In which patients do we take caution in administrating oxygen to?
COPD patients
84
What are the three pharmacological management options for heart failure?
Diuretics Vasopressors Inotropes
85
What diuretic is used to treat heart failure?
Furosemide
86
How do diuretics work to treat heart failure?
They reduce the circulating volume and therefore allow the heart to pump more effectively
87
What two vasopressors are used to treat heart failure?
Metaraminol Noradrenaline
88
What is the first line vasopressor drug?
Noradrenaline
89
How do vasopressors work to treat heart failure?
They are drugs involved in the contraction of blood vessels to raise blood pressure They improve cardiac function by reducing preload and increasing afterload
90
What two inotropes are used to treat heart failure?
Adrenaline Dobutamine
91
How do inotropes work to treat heart failure?
They are drugs that strengthen the force of heart contractions
92
When do we administer inotropes for heart failure?
They are only administered in high dependency and intensive care units This is because they require close monitoring
93
What drug is contraindicated in heart failure?
Pioglitazone
94
How do we proceed if pharmacological management of acute heart failure fails?
CPAP
95
What is an arterial line?
It is a catheter inserted into an artery
96
What are the two functions of an arterial line?
Blood pressure measurement To allow regular blood sampling
97
What is a central line?
It s a catheter inserted into a central vein
98
What four veins are used for central lines?
IJV Subclavian vein Axillary vein Femoral vein
99
What are the two functions of central lines?
To allow the administration of highly potent drugs directly into central circulation To allow regular blood sampling
100
What are the two main classifications of fluid resuscitation products?
Colloid Crystalloid
101
What are colloids?
They are solutions that consist of large osmotically active molecules
102
List five colloid fluid examples
Albumin Dextran, Hydroxyethyl starch Haemaccel Gelofusine
103
What are crystalloids?
They are solutions that consist of small osmotically active molecules
104
List five crystalloid fluid examples
Plasmalyte 148 0.9% saline sodium chloride Packed red cells Hartmann’s solution 5% dextrose solution
105
What is more commonly prescribed - colloid, crystalloid?
Crystalloid
106
What is the first line fluid used in resuscitation?
Plasmalyte 148
107
What volume of fluid is given in healthy patients at one time?
500mls
108
What volume of fluid is given at one time in individuals at increased risk of fluid overload, such as those with chronic heart failure, etc?
250mls
109
When is a referral advised during fluid resuscitation?
In cases where 30ml/kg doesn’t relieve fluid resuscitation

Year Three - Specialities (15 decks)

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