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Y3 - anaesthetic s > critical care > Flashcards

critical care Flashcards

1
Q

what is critical care

A

organ system support - single vs multiple

  • level 2 (HDU) - single organ support
  • level 3 (ICU) - multiple organ support

initial assessment - ABCDE

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2
Q

what are the 2 types of respiratory failure

A

1 - oxygenation failure
2 - oxygenation and ventilation failure (failing to clear CO2 aswell)

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3
Q

management of type 1 resp failure - ward based therapies

A

increase oxygen delivery

  • nasal cannula (2-4L/min)
  • Hudson mask (4-10L/min)
  • non rebreather mask (15L/min)
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4
Q

management of resp failure - ICU

A

high flow nasal cannula (warms and humidifies air, means you can deliver more /min) - up to 70L/min
NIV - non-invasive ventilator

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5
Q

what are the advantages of delivering large amounts of oxygen in type 1 resp failure

A

bulk flow of gas and pressure effect - contributes to improving their work of breathing and opening up areas
high flow rate - doesn’t matter how fast/deep patient is breathing, they will still be receiving the set amount of oxygen on the machine

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6
Q

when are high flow nasal cannulas used

A

type 1 resp failure
patients who are struggling a lot
hypoxic and needing more support than is available on the ward

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7
Q

how does NIV work

A

tight fitting mask
machine supplies pressure to support patient’s breathing

helps keep things open and reduce the work of breathing

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8
Q

m

A
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9
Q

main use of NIV

A

treatment of type 2 resp failure
predominantly COPD patients - CO2 retention

used as a means of avoiding intubation

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10
Q

what method can be used to manage severe resp failure

A

intubation and ventilation

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11
Q

how does intubation work

A

tube enters trachea
tube is cuffed and forms a seal - pressure of air applied is going straight into lungs and not escaping; protects airway from secretions etc

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12
Q

what are the advantages of being able to generate high pressures in severe resp failure

A

lungs require lots of pressure to open them back up again (more than NIV or patient can provide)

allows muscles time to rest and recover

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13
Q

what can be done by the ventilator

A

can alter amount of oxygen going in - precise %
closed system between lungs and ventilator - nothing done with room air

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14
Q

what are the 2 main outcomes following ventilation

A

infection/resp problem improves and tube is removed

patient requires prolonged ventilation

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15
Q

disadvantages of being intubated

A

can’t swallow
can’t eat/drink - NG tube for nutrition and drugs
can’t talk
pressure ulcers
dental hygiene issues

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16
Q

what is an alternative to prolonged ventilation

A

tracheostomy

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17
Q

advantages of tracheostomy

A

avoids need for sedation
can speak and eat

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18
Q

define shock

A

acute circulatory failure w/ inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia

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19
Q

what are the 5 types of shock

A

distributive (septic)
hypovolaemic
anaphylactic
neurogenic
cardiogenic

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20
Q

what happens in septic shock

A

abnormally dilated blood vessels
blood’s going to the wrong place
heart is still able to pump blood but fluid is in the wrong place

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21
Q

what can cause hypovolaemic shock

A

prolonged dehydration
blood loss

not enough blood to go around
body prioritises where the blood will go and other tissues suffer

22
Q

what happens in anaphylactic shock

A

abnormally dilated blood vessels - blood going to the wrong areas
degree of cardiac stunning - pump problem

23
Q

what is neurogenic shock

A

trauma to spinal cord
disruption of symp NS
abnormal vasodilation within peripheral tissues
blood in the wrong place

24
Q

what is cardiogenic shock

A

heart isn’t able to get blood out properly and therefore oxygen into the tissues

25
Q

how do we calculate cardiac output and stroke volume

A 
CO = HR X SV 
SV = preload/contractility/afterload
26
Q

managing cardiovascular failure

A

better monitoring and access

27
Q

how to improve access in CV failure

A

arterial line: introducer needle, guidewire, cannula
- go into artery (radial, brachial, femoral), introduce guidewire into needle, 25g cannula over guidewire

central line
- sits in IJV, can also be in SC vein or femoral

28
Q

benefits of arterial lines

A

better reading of BP - beat by beat reading, useful for arrythmias or unstable
repeated blood sampling - ABG etc

29
Q

advantages of central lines

A

able to give different concentrated and potent drugs directly into the central circulation that would cause damage if given peripherally

multiple lumens - variety of different amounts of drug through one port

aseptic and can stay in 7-10 days - longer duration of access

access to central venous circulation - samples and pressure

30
Q

drugs to support CV failure

A

vasopressors - metaraminol, noradrenaline

inotropes - adrenaline, dobutamine

31
Q

what do vasopressors do

A

case vasoconstriction

improve preload by reducing venous volume and returning blood to the heart
increase afterload by causing arterial contraction and increasing the pressure the heart is able to generate

32
Q

how does metaraminol work

A

alpha 1 agonist
causes vasoconstriction
small amount of beta activity - positive contractility in the heart

can be given peripherally

33
Q

how does noradrenaline work

A

predominantly alpha agonsit

little bit of beta activity

far more potent than metaraminol - give through central line

shorter half life than metaraminol therefore more titratable

34
Q

when are vasopressors used

A

mostly for pts w/ septic shock

35
Q

when are inotropes used

A

pump dysfunction and contractility issues

36
Q

how does adrenaline work

A

both alpha and beta agonism

alpha - vasoconstriction

more beta effect than vasopressors - increased HR and contractility

37
Q

when is adrenaline used

A

2nd line agent in patients who are really struggling and need additional support

38
Q

when is dobutamine used and how does it work

A

pure beta agonist - increase HR and contractility

used when contractility support is needed but vasoconstriction isn’t an issue

used as supportive therapy in pts w/ heart failure as a bridge to recovery

39
Q

decisions when using fluids

A

colloids vs crystalloids

maintenance or resuscitation

how much - 30ml/kg limit in an acute setting before referring to senior/critical care

40
Q

what is a colloid

A

less commonly used now

fluid w/ large osmotically active molecules within it

artificial molecules can cause renal issues, risk of renal failure 2y to colloid use

41
Q

what is a crystalloid fluid

A

fluids with small molecules in

e.g. plasmolyte, Hartmans, 0.9% saline

some of the fluid stays in the intravascular tree but lots leaks into the tissues and cells

still used for resuscitation

42
Q

what is a problem with 0.9% saline

A

massive chlorine load - metabolic acidosis if used too much

serum chloride should be between 92-99mmol/L

0.9% saline has 154mmol/L of chlorine

43
Q

when are resuscitation and maintenance fluids used

A

maintenance - someone who can’t eat/drink, prevent dehydration

resuscitation - intravascularly deplete, markers of developing shock

44
Q

normal regime of fluid administration

A

250-500mlns at a time

use lower end in patients at risk of overload e.g. chronic heart failure etc

higher end for otherwise healthy person

45
Q

signs that a fluid challenge is working

A

HR come down

BP gets better

urine output

does the patient look and feel better

46
Q

what are the 4 types of neurological failure

A

metabolic

trauma

infection

stroke

47
Q

what is metabolic neurological failure

A

people who have come in with another disease process and have a reduced conscious level e.g. severe sepsis, inflammation, acute renal failure and uraemia, electrolyte disturbances

48
Q

what is traumatic neurological failure

A

e.g. traumatic head injuries

reduced conscious level that may or may not improve quickly

49
Q

what causes infectious neurological failure

A

CNS infections

meningitis, encephalitis

50
Q

why is neurological failure seen in critical care

A

problems with the patients ability to breathe, ventilate and protect the airway

51
Q

what can happen with traumatic brain injuries and swelling

A

brain swelling

if left unchecked can cause severe catastrophic neurological damage

up to and including coning

can be fatal

52
Q

management of traumatic head injuries to prevent swelling

A

ventilate the patient appropriately - reduce CO2 level to reduce intracranial pressure

give patient enough oxygen to reduce intracranial pressure

prevent fluid overload but give enough to have decent blood pressure going into the head

Y3 - anaesthetic s (5 decks)

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