CC Flashcards
4 reasons for admission to CCU
resp support
invasive monitoring eg BP, cardiac function
renal support
dec conscious lvl
… must be reversible ! eg pneumonia, cardiac failure…
list some aims of itu
maintain perfusion
remove and treat problems
allow body to recover
2 ways that airways may be opened for patients
endotracheal tube and tracheostomy
endotracheal tube is given via mouth or nose down trachea into lung, why do patients lose the ability to communicate
goes through voicebox
what is the significance of the blue line on endotracheal tubes
allows for x ray imaging to see placement
why are endotracheal tubes placed where the bronchi split
to inflate both lungs
why is the biggest tube that is suitable for the size of a patients neck used
easier to breathe
disadvantages of endotracheal tube
dry mouth, oral hygiene hard, moisture lesions due to tape, not for long term
tracheostomy uses a tube that as a similar diameter to endotracheal tubes but is shorter, what might be some other benefits of tracheostomy
makes breathing easier
mouth can shut so no longer dry
reduces need for sedation
temporary
what machine is used to support the pressure in the lungs
ventilator
true or false it is better for ventilated patients if lungs are not overinflated and alveoli are kept only semi inflated
true
what is the tidal volume that is used for ventilation and what is it based on
6ml/kg of predicted body weight
true or false, systemic vascular resistance dictates arterial blood pressure
true
cardiac function is measured indirectly using blood pressure from which 2 areas
central venous and arterial
what different techniques exist to measure cardiac function from the left side of the heart ()
lidco
picco
oesophageal doppler
swan ganz
2 sites for central line
internal jugular, subclavian
give one adverse effect that may occur if central lines are placed too close to the lungs
pneumothorax
give some different reasons for circulatory failure
inadequate preload
maldistribution
anaphylaxis
septic shock
myocardial failure
give some causes for inadequate preload
dehydration
circulatory loss through trauma
how can inadequate preload be measured
cvp and straight leg raise: tilt patient on bed and reassure, bp will raise in 2-3 mins
how does straight leg raise detect inadequate preload
if bp rises when legs are lifted not enough circulating volume
treatment for inadequate preload
fluid with crystalloid balanced salt solution
may need to give albumin too if low
fluid with crystalloid balanced salt solution
maldistribution
treatment for low afterload
vasoconstrictor (vasopressor)
which heart receptors are inotropic and involved in muscle contractility
b1
which receptors in the heart work on vasoconstriction of blood vessels
a1 and a2
which receptor of the heart works on vasodilatation of blood vessels and bronchodilatation
b2
NAd increases svr so can be used for low afterload give its AEs
angina and ischaemia due to increased oxygen consumption, hr
giving industrial doses of NAd can cause vasoconstriction of fingers and digits that can lead to
necrosis
why does the gut stop working on high doses of NAd
doesnt have enough blood to absorb anything
dopamine can be used as a vasoconstrictor but why is it not used as much anymore
increased morbidity compared to adrenaline
low dose dopamine works on which receptors in vascular tissue to cause vasodilatation
D1
high dose dopamine works on which receptors of the heart
B1
adverse effects of dopamine
tachycardia
arrythmias
myocardial ischaemia
vasopressin or the synthetic version argipressin causes profound vasoconstriction and acts on which receptors
V1
how can myocardial failure be measured
low CO
treatment for what condition would be appropriate with an inotrope
myocardial failure
example of an inotrope that can be used that is also a racemic mixture
dobutamine
what does dobutamine do to the heart
increases contractility by agonising a and b receptors
dobutamine AEs
tachycardia
arrythmias
can lead to increased myocardial oxygen consumption
ischaemia
tolerance
adrenaline increases contractility and hr and is an agonist for which receptors in the heart
a1, b1, b2
adrenaline AEs
tachycardia
myocardial ischaemia
arrythmias
sudden death
vasodilators aim to decrease afterload by enabling the heart to beat more efficiently and is usually something nitrate donating, eg
gtn, isosorbide dinitrate
sedation and analgesia aims to keep patients patients comfortable and rousable however may require sedation holidays, what are these and why are they a good thing
stopping drug every morning, prevents accumulation, gets off ventilator quicker and avoids associated pneumonia
opioid infusions may be used as analgesia, morphine may be used but name other more renal/ hepatic dysfunction friendly options
fentanyl and alfentanil
give a non opioid analgesic that may be used for itu patients
paracetamol
list 2 agents that may be used for sedation
propofol and benzodiazepine
3 different antipsychotic drugs that may be used for delirium
haloperidol
olanzapine
quetiapine
alpha 2 adrenergic agonists activate central inhibitory x receptors to exhibit a depressive effect on cns function in order to work an antipsychotics
a2
instead of alpha 2 adrenergic agonists what drug may be useful in withdrawal states
clonidine
dexmedetomidine
non depolarising agents are used as paralysing agents however patients must have adequate analgesia and sedation on board, why are paralysing agents limited in use
difficulty in ventilation and neuroinjury
renal support for patients is continuous instead of intermittent, what can be used to achieve this
filtration, dialysis or mixture of both
when to consider sepsis
RR 22, altered mental state, systolic less than 100
give 2 complications of uti in elderly patients
sepsis and severe confusion
septic shock means vasopressor therapy is needed to maintain MAP (mean arterial pressure) equal or above x hg
65
septic shock is associated with a lactate above x mmol/l despite adequate fluid resus
2
can phosphate and magnesium be administered through the same line
no - will precipitate
if there is acidosis, how would you rule out a respiratory cause?
if CO2 is also low and bicarbonate is low
why is CO2 low in metabolic acidosis
respiratory system compensates by breathing
what elec if given too fast will kill
potassium!
strong sols given peripherally –> extravasation, tissue necrossi
is cockroft-gault creatnine valid for septic patients
no px needs to be stable
what to consider for renal impairment
does drug accumulate, does drug worsen impairment, does metabolite accumulate
what affect does benzylpenicillin have on the CNS
irritation of brain meninges
what is needed after critical care
rehabilitation, support groups
what to give instead of oral antidiabetics in reduced consciousness
continuous infusion
causes of ST depression
digoxin, hypokalaemia, NSTEMI
why may hydrocortisone be given with NAd
reduces the amount of NAd needed
