Critical Care Flashcards
Sepsis Pathophsyiology
life threatening - results from dysregulated inflammatory response to infection
causes widespread inflammatory response with systemic vasodilation and increased vascular permeability
- results in reduced BP
- inflammatory markers enter the tissues
Can lead to septic shock - blood pressure low, dangerous levels, requires medication to regulate it
Can cause death
Sepsis Diagnostic Criteria
2 or more - deranged respiratory function profound hypotension deranged kidney function reduced platelet count deranged liver function altered mental function
Sepsis Bedside Criteria
RR > 22
altered cognition and mental status
SBP < 100
Acute Respiratory Distress Syndrome
diffuse, inflammatory lung injury results of local or distant insult
- systemic inflammation
- causes increased vascular permeability
- fluid enters lung tissues and air spaces
- interferes with surfactant production - increased surface tension
- lungs becomes less compliant
- as fluid fills lungs, increase in weight, become even less compliant
- requires more pressure to keep airways open
- reduced aerated tissue and increased physiological deadspace
- over time lungs become thickened and fibrotic, thickening of the alveolar wall and capillary wall
- results in shunting - where blood flows to poorly ventilated areas of the lungs and where gas exchange cannot occur = hypoxaemia
CXR - looks like pulmonary oedema with bilateral infiltrates from the lung tissues
ARDs Risk Factors
Direct
- pneumonia
- aspiration gastric contents
- lung contusion
- fat embolism
- near drowning
- inhalation/reperfusion injury
Indirect
- non-pulmonary sepsis
- multiple trauma
- massive transfusion
- pancreatitis
- cardiopulmonary bypass
Medical Management
Controlled ventilation
Prone positioning - air into non-dependent lung, prone makes posterior lung non-dependent, greater surface area in posterior lung, increases amount of tissue being ventilated = improved VQ ratio
Pharmacology
Treat underlying causes and complications
ICU Acquired Weakness
Critically ill patients experience respiratory and peripheral muscle wasting and weakness
- due to immobility and disuse atrophy
Pathophysiological Mechanisms
- circulatory inflammatory mediators and intracellular inflammatory mediators
- causes reaction within the muscle
- results in catabolism and dysfunction
- results in muscle weakness
Physiological Adaptations Bed Rest - Healthy Individuals
muscle atrophy 1-1.5% loss per day VO2 max decreases by 0.9% per day bone demineralisation 2% of bone mass per month increased HR decreased SV
Prevention and Treatment ICU AW
wean from mechanical ventilation where possible
minimise exposure to corticosteroids and neuromuscular blocking agents
control gylcaemia with insulin therapy
maintain nutrition
maintain electrolyte haemostasis
minimise immobility
minimise delirium
Implications for Physio
Pulmonary Complications - atelactasis - secretion retention - respiratory muscle weakness Circulatory Complications - venous stasis - prevents DVTs - orthostatic hypotension Musc and Neuro Complications - disuse atropy - contractures and increased tone - ICU acquired weakness
Clinical Implications
pain reduced lung volumes impaired airway clearance impaired gas exchange abnormal breathing pattern dyspnoea musculoskeletal dysfunction respiratory muscle dysfunction reduced exercise tolerance
Subjective Assessment
same as any other patient
from patient, nursing staff, family and friends
Objective Assessment
CNS function respiratory function CVS GI Renal musculoskeletal bloods medication attachments ICU specific function
Respiratory Physio ICU - Aims
facilitate airway clearance
optimise lung volumes
enhance gas exchange
reduce work of breathing
Passive techniques Respiratory Physio
positioning manual hyperinflation ventilator hyperinflation percussion vibration suctioning respiratory muscle training weaning from mechanical ventilation non-invasive ventilation
