Anaesthetics: Critical Care

Question 1

Na requirement

Answer 1

1-2mmol/g/day

Question 2

K requirement

Answer 2

0.5-1mmol/kg/day

Question 3

Fluid requirements

Answer 3

25-30ml/kg/day

Question 4

Glucose requirements

Answer 4

50-100g/day

Question 5

What are the 4 levels of care?

Answer 5

Level 0=Primary care
Level 1=Ward based
Level 2=HDU
Level 3=ITU

Question 6

What happens in HDU?

Answer 6

Single organ support

Question 7

What happens in ITU?

Answer 7

Multi-organ support

Question 8

Name some simple airway manoeuvres.

Answer 8

• Head tilt
• Chin lift
• Jaw thrust

Question 9

How can you identify a bad airway?

Answer 9

• Sometimes a patient just doesn’t look right

- Noisy breathing such as stridor and see-saw

Question 10

What type of patient should you always be considered about?

Answer 10

The silent patient

Question 11

Give examples of airway adjuncts which can be used?

Answer 11

• Guedel

- NP

Question 12

What are the 2 jobs of the lungs?

Answer 12

• Take in oxygen

- Expel carbon dioxide

Question 13

What is type 1 respiratory failure?

Answer 13

• Low oxygen

- Low or normal CO2

Question 14

What is type 2 respiratory failure?

Answer 14

• Low oxygen

- High CO2

Question 15

What is the most sensitive marker of the deteriorating patient?

Answer 15

Respiratory rate

Question 16

How can we provide oxygen to a patient?

Answer 16

• High flow nasal cannula
• CPAP
• Intubation and invasive ventilation (used when there is an issue with CO2 removal)
• ECMO

Question 17

What should you check when it comes to blood gases?

Answer 17

• pH
• CO2
• Bicarbonate
• pO2
• FiO2

Question 18

What do B-blockers do to the heart?

Answer 18

Slow down the heart

Question 19

What do fluids do to the heart?

Answer 19

Improve preload

Question 20

What do chronotones do to the heart?

Answer 20

Speed it up

Question 21

What do vasopressors do to the heart?

Answer 21

Drive contractility

Question 22

How can BP be assessed?

Answer 22

• BP cuff

- Arterial lines

Question 23

What is cardiac output equal to?

Answer 23

Heart rate x Stroke volume

Question 24

What is the fluid challenge target in sepsis?

Answer 24

30ml/kg before switching to vasopressors

Question 25

Why do fluids with big molecules work better?

Answer 25

Big molecules stay in the intra-vascular space for longer

Question 26

Give examples of types of fluid.

Answer 26

- Colloid | - Crystalloid

Question 27

What are vasopressors?

Answer 27

alpha-1 agonists

Question 28

What do vasopresssors do?

Answer 28

Constrict blood vessels (predominantly veins)

Question 29

What are inotropes/

Answer 29

Beta-1 agonists

Question 30

How are vasopressors and inotropes administered?

Answer 30

Via a central line

Question 31

How can you tell if drugs are working?

Answer 31

Measure urine output -Means kidneys are being perfused Conscious level -Means brain is being perfused Lactate produced in anaerobic metabolism is a marker of tissue hypoperfusion - >2 abnormal - >4 really bad

Question 32

How can GI failure be managed

Answer 32

Patient will die of starvation so: - Unblock any blockages - Create anastomosis - TPN

Question 33

How can kidney failure be managed?

Answer 33

Dialysis

Question 34

How can liver failure be managed?

Answer 34

Not much we can do about it

Question 35

How can brain failure be managed?

Answer 35

-Seizures can often occur in unconscious patients so we induce comas so we can continue to managed and protect their airways

Question 36

When is it recommended that we intubate patients?

Answer 36

When their GCS drops below 8