Anaesthetics - critical care

Question 1

• Understand the term ‘critical illness’ and discuss.
• Identify the patients who may be at risk of developing critical illness.
• Discuss how these problems may be averted and discuss their early and subsequent management.
• Describe the potential consequences of failure to identify and manage these problems.
• Discuss the principles involved in the early management of the critically ill patient.

Answer 1

Lecture focuses on:

• Initial assessment and management of the critically ill patient.
• Respiratory and cardiovascular failure, their assessment and early management.
• Fluid management in the critically ill patient.
• Assessment and management of the unconscious patient.

Question 2

Critical care refers to

Answer 2

management of organ system failure (may be just single or multiple systems)

Question 3

Initial assessment of those potentially requiring critical care should always be

Answer 3

ABCDE

Question 4

Type 1 vs type 2 failure

Answer 4

Type 1 - oxygenation failure, hypoxia without hypercapnia, PaO2 <60 mmHg

Type 2 - oxygenation & ventilation failure, hypoxia and also hypercapnia, PaCO2 >50 mmHg

Question 5

Most important part of initial assessment of resp failure

Answer 5

Ensuring that the upper airway is patent and clear of obstructions

Question 6

Early management of resp failure

Answer 6

Supplemental oxygen
NIV

Endotracheal intubation and mechanical ventilation are employed when other less invasive manoeuvres have failed

Question 7

Intubating is last resort when less invasive measures have been exhausted. It guarantees 100% oxygen with its high pressure system but ventilating too long on a high pressure system like this can cause what

Answer 7

ARDS

Question 8

Cardiovascular failure is due to shock.

Shock is acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cell hypoxia

What are the 5 types of shock + describe

Answer 8

Hypovolaemic - blood volume too low

Cardiogenic - heart not pumping hard enough

Distributive (septic) - vascular tree abnormally dilated, blood not going back to heart

Neurogenic - disruption of autonomic pathways in spinal cord leading to decreased sympathetic function and increased parasympathetic so vessels dilate as sympathetic system isn’t firing to tell vessels to constrict

Anaphylactic - profound vasodilation from cytokine release

Question 9

CO =

Answer 9

HR x SV

Question 10

Drug types used for shock

Answer 10

Vasopressors (contract vessels to increase BP)
-noradrenaline

Inotropes (increase contractility) - for cardiogenic shock

• adrenaline
• dobutamine

Question 11

Initial assessment of shock

Answer 11

ABC - maintain airway and optimise oxygen with supplemental oxygen

Question 12

2 broad types of fluid used

Answer 12

Colloid - contains large molecules like albumin

Crystalloid - contains small molecules like NaCl

Question 13

How many ml fluid per kg of body weight

Answer 13

30ml/kg

Question 14

Potential causes of neurological failure/unconsciousness

Answer 14

Metabolic disruption, e.g. DKA

Trauma

Infection - meningitis, encephalitis, severe sepsis

Stroke

Question 15

Initial assessment of unconscious patient

Answer 15

ABCDE

GCS 8 or less