Basics

Question 1

Patients on level 1 care should have observations conducted how frequently?

Answer 1

Minimum 4 hourly

Question 2

At what level of care are the critical care outreach team informed of a patient?

Answer 2

level 1

Question 3

Name 3 ways in which a patient can qualify to be escalated to level 2 care

Answer 3

1. extended post-operative care
2. single organ support
   2a. basic respiratory support (non-invasive ventilation)
   2b. CV - central venous pressure monitoring/single IV vasoactive drug use
   2c. advanced CV support - multiple IV vasoactive drugs/CO monitoring
   2d. renal replacement therapy

Question 4

A patient undergoing major burns therapy would be under which level of care?

Answer 4

level 2

Question 5

What is the mortality rate for patients in level 3 care?

Answer 5

25% mortality

Question 6

At what point does a patient qualify to for escalation to level 3 care?

Answer 6

1. advanced respiratory support (invasive)

2. OR minimum 2 organs requiring support

Question 7

What is the nurse to patient ratio in ICU and on a normal ward?

Answer 7

1:1 in ICU and 1:10 in basic wards

Question 8

What are the working hours of the critical care outreach team?

Answer 8

Recently changed to 24 hours

Question 9

Where do the critical care outreach team provide their services?

Answer 9

All wards that have level 1 patients should inform the CCOT for input

Question 10

What is the purpose of the CCOT?

Answer 10

1. To provide critical care to patients in ward environments

2. To prevent & recognise acute deterioration in patients, allowing for timely transfer to CCU

Question 11

Name 5 methods the CCOT use to monitor patients

Answer 11

1. ABCDE management
2. history + clerking
3. NEWS recording
4. fluid maintenance + balance
5. bloods; radiology (CxR, ECHO etc)

Question 12

What 5 parameters are measured in the NEWS?

Answer 12

1. Temperature
2. Respiratory rate
3. Heart rate
4. Systolic BP
5. SpO2
6. AVPU

Question 13

A patient with a NEWS score of 3 in one parameter should be monitored how often?

Answer 13

Minimum 2 hourly for a minimum of 6 hours

Question 14

4 hourly observations should be performed for patients with what NEWS score?

Answer 14

NEWS score of 1-4 (score of 3 should not be from the same parameter)

Question 15

A patient with a NEWS score of 5 would trigger what response?

Answer 15

1. minimum 2 hourly observations
2. blood glucose measurement
3. assessment by the surgical or medical team
4. hourly fluid monitoring + balance
5. Sepsis screen (if positive then start sepsis bundle)

Question 16

With what NEWS score would you consider level 2 or 3 transfer?

Answer 16

NEWS of 7+

Question 17

Name all the signs of inflammation that can qualify a patient for SIRS

Answer 17

1. T>38 or 90
2. WCC>12 or 20
3. altered conscious level
4. BM >7.7 (if not diabetic)

Question 18

When does a patient only require one marker of inflammation to qualify for SIRS?

Answer 18

If the patient is neutropenic

Question 19

What is the classification of sepsis?

Answer 19

SIRS + clinical evidence of infection

Question 20

What is the clinical response to sepsis?

Answer 20

1. Blood culture + FBC
2. Urine output monitoring
3. Fluids (500ml/15mins)
4. Antibiotics
5. Lactate monitoring (>2mmol/l)
6. Oxygen (15L/min non-rebreathe)