Anaesthetics: Critical Care Flashcards
Na requirement
1-2mmol/g/day
K requirement
0.5-1mmol/kg/day
Fluid requirements
25-30ml/kg/day
Glucose requirements
50-100g/day
What are the 4 levels of care?
Level 0=Primary care
Level 1=Ward based
Level 2=HDU
Level 3=ITU
What happens in HDU?
Single organ support
What happens in ITU?
Multi-organ support
Name some simple airway manoeuvres.
- Head tilt
- Chin lift
- Jaw thrust
How can you identify a bad airway?
- Sometimes a patient just doesn’t look right
- Noisy breathing such as stridor and see-saw
What type of patient should you always be considered about?
The silent patient
Give examples of airway adjuncts which can be used?
- Guedel
- NP
What are the 2 jobs of the lungs?
- Take in oxygen
- Expel carbon dioxide
What is type 1 respiratory failure?
- Low oxygen
- Low or normal CO2
What is type 2 respiratory failure?
- Low oxygen
- High CO2
What is the most sensitive marker of the deteriorating patient?
Respiratory rate
How can we provide oxygen to a patient?
- High flow nasal cannula
- CPAP
- Intubation and invasive ventilation (used when there is an issue with CO2 removal)
- ECMO
What should you check when it comes to blood gases?
- pH
- CO2
- Bicarbonate
- pO2
- FiO2
What do B-blockers do to the heart?
Slow down the heart
What do fluids do to the heart?
Improve preload
What do chronotones do to the heart?
Speed it up
What do vasopressors do to the heart?
Drive contractility
How can BP be assessed?
- BP cuff
- Arterial lines
What is cardiac output equal to?
Heart rate x Stroke volume
What is the fluid challenge target in sepsis?
30ml/kg before switching to vasopressors
Why do fluids with big molecules work better?
Big molecules stay in the intra-vascular space for longer
Give examples of types of fluid.
- Colloid
- Crystalloid
What are vasopressors?
alpha-1 agonists
What do vasopresssors do?
Constrict blood vessels (predominantly veins)
What are inotropes/
Beta-1 agonists
How are vasopressors and inotropes administered?
Via a central line
How can you tell if drugs are working?
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
How can GI failure be managed
Patient will die of starvation so:
- Unblock any blockages
- Create anastomosis
- TPN
How can kidney failure be managed?
Dialysis
How can liver failure be managed?
Not much we can do about it
How can brain failure be managed?
-Seizures can often occur in unconscious patients so we induce comas so we can continue to managed and protect their airways
When is it recommended that we intubate patients?
When their GCS drops below 8
