Anaesthesiology - Critically Ill patient Flashcards

1
Q

Define critical illness

A

Life-threatening multisystem process that carries significant morbidity or mortality

Preceded by a period of physiological deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define top five early and late signs of physiological deterioration before critical illness

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Function of early warning scoring system

A

Combine signs from routine physiological observations

Link to a pre-determined response (e.g. increase frequency of monitoring, or escalation of care)

Assessment by medical emergency team (MET) or Critical Care Outreach Service (CCOS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline MEWS system and function

A

MEWS - Modified early warning score system

Function: early detectiuon of patients with physiological impairment

Combined assessment of SBP, HR, RR, Temp., and neurological state AVPU (Alert, Voice, Pain, Unresponsive)

Score of 5 or more is a/w increased likelihood of ICU admission or death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline ABCDE apporach to critical illness

A

□ Airway (A): look for features of airway obstruction → Mx to ensure airway patency
□ Breathing (B): look for adequacy of breathing
□ Circulation (C): look for features of shock or cardiac arrest
□ Disability (D): assess conscious level
□ Exposure (E): to allow complete examination of patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Airway

  • Look, Listen, Feel signs
A

Look:
- See-saw respirations: paradoxical chest and abdominal movements
- Use of accessory muscles of respiration
- Central cyanosis (late feature)

Listen:
Noisy breathing for partial obstruction
- Stertor (snoring): low-pitched inspiratory sound indicating turbulent flow above larynx
- Stridor: high pitched monophonic sound heard during breathing indicating obstruction of large airway
- Wheeze: high pitched expiratory monophonic or polyphonic sound indicating obstruction of small airways
- Other sounds: gurgling (fluid in mouth/upper airway), rattling (secretions in airway), crowing (laryngospasm)

Silence for complete obstruction or apnoea

Feel:
- expired air at mouth/nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

qSOFA score components

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of paradoxical breathing

A

Paradoxical breathing: Chest trauma, diaphragmatic dysfunction, upper airway blockage, severe electrolyte imbalances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Breathing assessment

Look, Listen, Feel signs

A

Look:
- Features of respiratory distress incl. use of accessory muscles, tracheal tug, abdominal breathing, sweating, central cyanosis
- Rate, depth, rhythm and symmetry of breathing
- Impedance to normal breathing incl chest deformity and abdominal distension
- Other relevant features: ↑JVP, chest drains

Listen for:
- Noisy breathing indicating airway abnormalities
- Auscultate breath sounds for any chest pathologies

Feel the chest for
- Tracheal deviation indicating tension pneumothorax or massive pleural effusion
- Symmetry of chest expansion
- Surgical emphysema or crepitus
- Percussion notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Circulation assessment

Look, Listen, Feel signs

A

Look for
- Pale/cyanosed/mottled limbs indicating poor peripheral perfusion
- Collapsed central/peripheral veins indicating hypovolaemia
- Engorged central veins indicating ADHF, cardiac tamponade, tension pneumothorax or acute severe asthma
- Signs of ↓CO incl ↓GCS, oliguria
- Signs of blood/ECF loss, eg. bleeding

Listen for:
- S3/4 indicating ventricular dysfunction
- Heart murmur indicating valvular heart disease
- Pericardial rub indicating pericarditis
- Very quiet heart sound indicating severe emphysema or pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Disability assessment

Look, Listen, Feel signs

A

Pupil size and symmetry
□ Pinpoint reactive → opioid, pontine lesion
□ Mid-sized fixed → midbrain lesion
□ Dilated fixed → severe global ischaemia or hypoxia, hypoglycaemia and ↓CNS function
□ Unil dilated fixed → uncal herniation, CN3 palsy

GCS, APVU assessment (Alert, Voice, Pain, Unresponsive)

Haemstick for hypoglycaemia

Drug charts for drug- induced causes, drug toxicology

Neuroimaging for primary intra-cranial causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly