Common ICU Pathologies

Question 1

Define Shock

Answer 1

Poor distribution of blood at microcirculatory level

Decrease in tissue perfusion progresses to a point at which is inadequate to meet cellular metabolic needs = cell death

Question 2

What are the types of shock (4)

Answer 2

Hypovolemic, cardiogenic, distributive, miscellaneous shock stages (obstructive, adrenal and drug OD)

Question 3

Define Hypovolemic

Answer 3

blood loss

Question 4

Define cardiogenic

Answer 4

heart damage

Question 5

define distributive

Answer 5

septic, anaphylactic and neurogenic

Question 6

What happens in Sepsis

Answer 6

body’s response to an infection that injures its own tissues and organs
release of pro-inflammatory mediators in response to an infection exceed the boundaries of the local environment

Question 7

Signs of sepsis

Answer 7

Pt has known infection + one of the symptoms of qSofa

Question 8

qSofa (3 things) KEYYYYY

Answer 8

Respiratory rate of >22/min
Altered mentation (GCS < 15, RASS <0)
systolic BP < 100 mmHG

Question 9

When is a pt defined as being septic?

Answer 9

if they have a score that is greater than or equal to 2 on the SOFA

Question 10

What are the sofa variables? (7 things)

Answer 10

PaO2/ FiO2 
GCS 
MAP 
administration of vasopressors with type and dose rate of infection 
serum creatinine or urine output
bilirubin 
platelet count

Question 11

What will we see happen to the Brain in sepsis

Answer 11

altered mental state

Question 12

what will we see happen to the skin in sepsis

Answer 12

mottled, cold, prolonged cap refill time

Question 13

what are some other things with sepsis

Answer 13

decrease urine output
increased resp rate and dyspnea
tachycardia
reduced pulse pressure

Question 14

Basis Septic pathway?

Answer 14

Vasodilation = decreased BP and Red cell deformity - tissue hypoperfusion - decreased oxygenation - organ failure

Question 15

what is the subset of sepsis

Answer 15

septic shock

Question 16

How can patients with septic shock be clinically defined

Answer 16

persistent hypotension requiring vasopressors to maintain MAP of >65 despite adequate circulating volume
having serum lactate level of >2 mmol/L

Question 17

What happens in septic shock

Answer 17

immune system out of control, inflammatory response occurs systematically causing widespread vasodilation and vascular permeability

Question 18

what is a common complication of septic shock

Answer 18

ARDS

Question 19

Define Multiorgan failure/dysfunction syndrome

Answer 19

presence of altered organ function/systems in acutely ill individuals ( 2 or more systems)

Question 20

Most common systems to fail

Answer 20

respiratory, GI, renal, kidney . liver and heart

Question 21

how does the respiratory system fail

Answer 21

secondary to pulmonary edema/increased capillary permeability. higher metabolic demands and diminished O2 delivery impair aerobic metabolism resulting in anaerobic metabolism and lactic acidosis

Question 22

how does the GI system fail

Answer 22

ischemic changes and GI bleeding

Question 23

how does the renal system fail

Answer 23

low urine output, low MAP, acute tubular necrosis (lack of O2 to kidneys), rising potassium levels

Question 24

how does the liver fail

Answer 24

hypoperfusion, elevated LFTS

Question 25

Problem list for pts with sepsis

Answer 25

brain injury
weakness, sensation and balance issues
affected aerobic capacity
reduced circulation to peripheries- potential limb loss, nerve and muscle damage
reduced respiratory function
fatigue
skin more susceptible to break downs and pressure areas

Question 26

Define ARDS

Answer 26

acute respiratory distress

trauma to lungs leading to inflammation and fluid build up in the lungs

Question 27

What happens to the lungs

Answer 27

increased pulmonary microvascular permeability
trauma to lungs, diffuse inflammatory reaction - fluid leaks into lungs from circulating blood
edema fills alveoli - extra fluid mixes with surfactant - can cause collapse of alveoli - impaired gas exchange and respiratory failure
Damage to alveoli and elastic tissure - stiff lung

Question 28

ARDS diagnosis criteria

Answer 28

acute within 7 days
bilateral opacities consistent with pulmonary edema on CT or XRAY
respiratory failure that is simply not fully explained by cardiac failure or fluid overload

Question 29

Rx of ARDS

Answer 29

intubation and protective ventilation to improve O2
pharmaceutical management
proning

Question 30

what is not effective for ARDs population

Answer 30

SECREATION CLEARANCE TECHNIQUES

Question 31

Define critical illness polyneuropathy

Answer 31

sensory and muscle dysfunction (40%)

Question 32

critical illness myopathy

Answer 32

only muscle affected no denervation (5%)

Question 33

critical illness neuropathy

Answer 33

neural root plexus or nerve damage (5%)

Question 34

What do we use for clinical testing of the neuropathy/myopathy

Answer 34

MMT, sensory exam, reflexes

Question 35

what are some typical S&S with neuropathy/myopathy

Answer 35

functional limitations 
weakness in distal limbs
weakness in respiratory muscles 
decreased DTR 
sensory loss

Question 36

define ventilator associated pneumonia

Answer 36

exactly what it sounds like dumbass a person who has pneumonia who has been on a ventilator for >48 hours

Question 37

how can we prevent ventilator associated pneumonia

Answer 37

HOB>30 degrees 
hand washing 
postural changes 
regular mouth care
tracheostemy for long term ventilation to allow epiglottic close and airway protection from oral secretions and germs

Question 38

when can we see secretion clearance techniques

Answer 38

pneumonia
NMSK weakness with secretion clearance issues 
COPD 
brochiectesis 
CF 
pain issues

Question 39

when will secretion clearance not assist us

Answer 39

shock
sepsis/organ failure 
ARDS 
CHF/acute heart failure, pulmonary edema 
PE 
pleural effusions