Anaesthetics - critical care

Question 1

Describe the levels of care from 0-3

Answer 1

0 - primary care
1 - ward based
2 - HDU
3- ITU

Question 2

HDU

Answer 2

single organ support

Question 3

ITU

Answer 3

Multi organ support

Question 4

What comprises critical care?

Answer 4

HDU and ITU

Question 5

Exception to HDU/ITU rule

Answer 5

airway and breathing - if need invasive ventilation must go to ITU

Question 6

How can you recognise a bad airway?

Answer 6

see-saw breathing, stridor, tracheal tug

silent patient

Question 7

2 ways to ensure a definitive airway

Answer 7

endotracheal tube

tracheostomy tube

Question 8

Is sedation (GA) needed for Endotracheal or tracheostomy tube?

Answer 8

endotracheal - gag reflex

Question 9

Respiratory rate importance

Answer 9

top of NEWS chart

best indicator of a deteriorating patient

Question 10

If issue in respiratory failure is oxygen what can we give?

Answer 10

CPAP, ECMO, high flow nasal cannula, invasive ventilation

Question 11

If problem in respiratory failure is CO2 what can we do?

Answer 11

invasive ventilation

Question 12

Blood gases - important questions

Answer 12

what is the pH?
what is the CO2 and bicarbonate?
what is the pO2 and FiO2?

Question 13

CO=

Answer 13

SV x HR

Question 14

SV =

Answer 14

preload/contractility/afterload

Question 15

CO = SV x HR - what can we manipulate in this equation and how?

Answer 15

beta blockers slow HR

chronotropes (dopamine, epinephrine) increase HR

Question 16

SV = ….. –> what can we manipulate in this equation and how?

Answer 16

preload - fluids
contractility - inotropes
afterload - vasopressors

Question 17

In sepsis what is the rule of thumb for fluid given and when to switch to another means?

Answer 17

30ml/kg of fluid and then vasopressors

Question 18

Crystalloids or colloids better resuscitation fluids?

Answer 18

colloids

Question 19

vasopressors

Answer 19

cause constriction

Question 20

inotropes

Answer 20

increases heart contractility

Question 21

vasopressors and inotropes - alpha or beta agonist?

Answer 21

V = alpha 1 
I = beta 1

Question 22

Central line function in critical care

Answer 22

give concentrated drugs eg TPN, inotropes etc

aspirate blood samples

Question 23

How do you measure result of medications on perfusion?

Answer 23

urine output
capillary refill
conscious level
lactate

Question 24

Managing other organ failures

Answer 24

GI - TPN, electrolytes
Renal - dialysis
brain - O2, CO2, CCB for vasospasm, temperature, reduce ICP