critical care Flashcards

Question

how do we calculate cardiac output and stroke volume

Answer 1

``` CO = HR X SV SV = preload/contractility/afterload ```

Answer 2

better monitoring and access

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

vasopressors - metaraminol, noradrenaline inotropes - adrenaline, dobutamine

Answer 7

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

Answer 8

**alpha 1 agonist** causes vasoconstriction small amount of beta activity - positive contractility in the heart can be given peripherally

Answer 9

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

Answer 10

mostly for pts w/ septic shock

Answer 11

pump dysfunction and contractility issues

Answer 12

both alpha and beta agonism alpha - vasoconstriction more beta effect than vasopressors - increased HR and contractility

Answer 13

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

Answer 14

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

Answer 15

colloids vs crystalloids maintenance or resuscitation how much - 30ml/kg limit in an acute setting before referring to senior/critical care

Answer 16

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

Answer 17

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

Answer 18

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

Answer 19

maintenance - someone who can't eat/drink, prevent dehydration resuscitation - intravascularly deplete, markers of developing shock

Answer 20

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

Answer 21

HR come down BP gets better urine output does the patient look and feel better

Answer 22

metabolic trauma infection stroke

Answer 23

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

Answer 24

e.g. traumatic head injuries reduced conscious level that may or may not improve quickly

Answer 25

CNS infections meningitis, encephalitis

Answer 26

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

Answer 27

brain swelling if left unchecked can cause severe catastrophic neurological damage up to and including coning can be fatal

Answer 28

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