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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
Q

What is the function of oxygen replacement therapy?

A

To maintain adequate tissue oxygenation

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26
Q

What PaO2 level and saturation level indicate adequate tissue oxygenation?

A

PaO2 - 60mmHg

Saturation - 90%

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27
Q

What respiratory failure classification is treated with oxygen therapy? How

A

Type one respiratory failure

It corrects hypoxemia

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28
Q

What are three forms of oxygen therapy?

A

Nasal Cannula

Hudson Face Mask

Non-Rebreather Face Mask

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29
Q

What percentage of oxygen is contained in room air?

A

21%

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30
Q

What percentage of oxygen is delivered by a nasal cannula?

A

30%

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31
Q

At what rate does a nasal cannula deliver oxygen?

A

2 - 4L per minute

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32
Q

What percentage of oxygen is delivered by a high flow nasal cannula?

A

40 - 60%

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33
Q

At what rate does a high flow nasal cannula deliver oxygen?

A

4 - 10L per minute

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34
Q

What percentage of oxygen is delivered by a Hudson face mask?

A

100%

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35
Q

At what rate does a Hudson face mask deliver oxygen?

A

60L per minute

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36
Q

What percentage of oxygen is delivered by a non-rebreather face mask?

A

60-80%

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37
Q

At what rate does a non-rebreather face mask deliver oxygen?

A

10-15L per minute

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38
Q

What are the mechanisms in which ventilation can be supported?

A

Non-Invasive Respiratory Support

Invasive Respiratory Support

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39
Q

What is non-invasive respiratory support?

A

It is ventilatory support via a face mask – without tracheal intubation

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40
Q

How does a non-invasive respiratory support work?

A

It applies pressure to the patients’ airways, thus maintaining patency and reducing their work of breathing

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41
Q

What type of respiratory failure is treated with non-invasive respiratory support?

A

Mild to moderate type two respiratory failure, particularly those affected with associated COPD

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42
Q

What is invasive respiratory support?

A

It is ventilatory support via endotracheal tube intubation

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43
Q

What is an endotracheal tube?

A

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

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44
Q

How does invasive respiratory support work?

A

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
Q

What type of respiratory failure is treated with invasive respiratory support?

A

Severe type two respiratory failure, particularly those with persistent hypoxemia despite receiving maximum oxygen therapy and hypercapnia with impairment of conscious level

46
Q

What are the four complications of respiratory failure?

A

Nosocomial Pneumonia

Heart Failure

Arrythmia

Pericarditis

47
Q

What is acute heart failure?

A

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
Q

What are the two classifications of acute heart failure?

A

Systolic Heart Failure (HFrEF)

Diastolic Heart Failure (HFpEF)

49
Q

What is systolic heart failure?

A

It is inability of the ventricle to contract normally

50
Q

How is the cardiac output and ejection fraction affected by systolic heart failure?

A

CO - decreased

Ejection fraction - <40%

51
Q

What are the four causes of systolic heart failure?

A

Ischaemic heart disease

Dilated cardiomyopathy

Myocarditis

Arrhythmias

52
Q

What is diastolic heart failure?

A

It is inability of the ventricle to relax normally, resulting in decreased volumes of blood filling the ventricles

53
Q

How is ejection fraction affected by diastolic heart failure?

A

Ejection fraction - > 50%

54
Q

What is diastolic heart failure progress into?

A

It commonly progresses into systolic heart failure

55
Q

What are the four causes of diastolic heart failure?

A

Hypertrophic obstructive cardiomyopathy

Restrictive cardiomyopathy

Cardiac tamponade

Constrictive pericarditis

56
Q

What is high output heart failure?

A

This refers to a situation where a ‘normal’ heart is unable to pump enough blood to meet the metabolic needs of the body

57
Q

What are the five causes of high output heart failure?

A

Anaemia

Paget’s disease

Pregnancy

Thyrotoxicosis

Thiamine deficiency

58
Q

What two drugs cause heart failure?

A

Verapamil

Diltiazem

59
Q

What is the most common cause of heart failure?

A

Ischaemic heart disease

60
Q

What are the six symptoms of acute heart failure?

A

Dyspnoea on Exertion

Cough with White/Pink Sputum

Orthopnoea

Paroxysmal Nocturnal Dyspnoea

Peripheral Oedema

Ascites

61
Q

What are the five signs of acute heart failure on examination?

A

Tachycardia

Tachypnoea

3rd Heart Sound

Bilateral Basal Cracks

Increased JVP

62
Q

What two clinical features indicate right sided heart failure?

A

Increased JVP

Peripheral oedema

63
Q

What scoring system is used to diagnose acute heart failure?

A

Framingham Criteria for Congestive Heart Failure

64
Q

What ‘Framingham Criteria for Congestive Heart Failure’ score indicates a diagnosis of heart failure?

A

2 major criteria

OR

1 major criterion and 2 minor criteria

65
Q

What are the five major criteria of the ‘Framingham Criteria for Congestive Heart Failure’ ?

A

PAINS

Paroxysmal Nocturnal Dyspnoea

Acute Pulmonary Oedema

Increased Heart Size/
Increased Central Venous Pressure

Neck Vein Dilatation

S3 Gallop

66
Q

What are the four minor criteria of the ‘Framingham Criteria for Congestive Heart Failure’ ?

A

PAIN

Pleural Effusion

Ankle Oedema (Bilateral)

Increased Heart Rate, which is greater than 120bpm

Nocturnal Cough

67
Q

What are the three investigations used to diagnose acute heart failure?

A

Blood Tests

Echocardiogram (ECHO)

Chest X-Ray (CXR)

68
Q

What two blood tests are used to diagnose heart failure?

A

BNP blood test

Sodium

69
Q

What is BNP?

A

A hormone that is released from the heart ventricles when the myocardium is stretched beyond normal range

70
Q

What is the function of BNP?

A

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
Q

What BNP result indicates heart failure? Why?

A

Elevated

This indicates that the heart is overloaded beyond its normal capacity to pump effectively

72
Q

What investigation is conducted after a high BNP result to confirm heart failure?

A

ECHO

73
Q

What sodium level indicates heart failure?

A

Decreased

74
Q

What do ECHO scans assess?

A

They are used to assess cardiac function, allowing measurement of the LV ejection fraction

75
Q

What is the LV ejection fraction?

A

This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction

76
Q

What is a normal LV ejection fraction?

A

50-80%

77
Q

What LV ejection fraction indicates mild HF?

A

40-50%

78
Q

What LV ejection fraction indicates moderate HF?

A

30-40%

79
Q

What LV ejection fraction indicates severe HF?

A

< 30%

80
Q

What five signs indicate heart failure on a CXR?

A

Alveolar Oedema

Kerley B Lines

Cardiomegaly

Dilated Upper Lobe Vessels

Pleural Effusion

81
Q

What are the two ways in which we manage heart failure conservatively?

A

We advise patients to sit upright

We administer oxygen in patients with saturation level less than 95%

82
Q

Why do we advise heart failure patients to sit upright?

A

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
Q

In which patients do we take caution in administrating oxygen to?

A

COPD patients

84
Q

What are the three pharmacological management options for heart failure?

A

Diuretics

Vasopressors

Inotropes

85
Q

What diuretic is used to treat heart failure?

A

Furosemide

86
Q

How do diuretics work to treat heart failure?

A

They reduce the circulating volume and therefore allow the heart to pump more effectively

87
Q

What two vasopressors are used to treat heart failure?

A

Metaraminol

Noradrenaline

88
Q

What is the first line vasopressor drug?

A

Noradrenaline

89
Q

How do vasopressors work to treat heart failure?

A

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
Q

What two inotropes are used to treat heart failure?

A

Adrenaline

Dobutamine

91
Q

How do inotropes work to treat heart failure?

A

They are drugs that strengthen the force of heart contractions

92
Q

When do we administer inotropes for heart failure?

A

They are only administered in high dependency and intensive care units

This is because they require close monitoring

93
Q

What drug is contraindicated in heart failure?

A

Pioglitazone

94
Q

How do we proceed if pharmacological management of acute heart failure fails?

A

CPAP

95
Q

What is an arterial line?

A

It is a catheter inserted into an artery

96
Q

What are the two functions of an arterial line?

A

Blood pressure measurement

To allow regular blood sampling

97
Q

What is a central line?

A

It s a catheter inserted into a central vein

98
Q

What four veins are used for central lines?

A

IJV

Subclavian vein

Axillary vein

Femoral vein

99
Q

What are the two functions of central lines?

A

To allow the administration of highly potent drugs directly into central circulation

To allow regular blood sampling

100
Q

What are the two main classifications of fluid resuscitation products?

A

Colloid

Crystalloid

101
Q

What are colloids?

A

They are solutions that consist of large osmotically active molecules

102
Q

List five colloid fluid examples

A

Albumin

Dextran,

Hydroxyethyl starch

Haemaccel

Gelofusine

103
Q

What are crystalloids?

A

They are solutions that consist of small osmotically active molecules

104
Q

List five crystalloid fluid examples

A

Plasmalyte 148

0.9% saline sodium chloride

Packed red cells

Hartmann’s solution

5% dextrose solution

105
Q

What is more commonly prescribed - colloid, crystalloid?

A

Crystalloid

106
Q

What is the first line fluid used in resuscitation?

A

Plasmalyte 148

107
Q

What volume of fluid is given in healthy patients at one time?

A

500mls

108
Q

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?

A

250mls

109
Q

When is a referral advised during fluid resuscitation?

A

In cases where 30ml/kg doesn’t relieve fluid resuscitation

Year Three - Specialities (15 decks)

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