Critical Care Flashcards
What is level 1 care?
Ward based care
Patient doesn’t require organ support
What is an example of level 1 care?
IV cannulation
Oxygen by facemask
What is level 2 care?
High dependency unit
Patient requires organ support for ONLY ONE organ
Excludes mechanical ventilation
how many nurses are assigned to each patient in level 2 care?
HDU - 1 nurse to 2 patients
what is an example of level 2 care?
Invasive blood pressure monitoring
renal haemophiltration
What is level 3 care?
Intensive care unit
Includes mechanical ventilation
Organ support for TWO OR MORE organs
What is the nurse: patient ratio in level 3 care?
1 nurse to 1 patient
What is type 1 respiratory failure?
When there is a ventilation-perfusion mismatch (V/Q).
Low V/Q - when there is enough blood but not enough air (asthma)
High V/Q - when there is enough air but not enough blood (pulmonary embolism)
What are the oxygen and carbon dioxide levels lie in type 1 respiratory failure?
Oxygen - low
Carbon dioxide - normal
What is type 2 respiratory failure?
this is caused by alveolar hypoventilation - the lungs can’t oxygenate and blow off CO2
What are the carbon dioxide and oxygen levels like in type 2 respiratory failure?
Oxygen - low
Carbon dioxide - high
(2 things wrong)
What are causes of type 2 respiratory failure?
COPD Motor neurone disease Guillan-Barre syndrome Pulmonary fibrosis Opiates Rib fracture
What are types of non-invasive oxygen therapy?
Nasal Cannula (ward based or high flow) Simple face mask Face mask (non-rebreather) Non-invasive ventilation Positive end expiratory pressure
What are types of invasive ventilation?
ECHMO
Endotracheal tube
Tracheostomy
How much oxygen can you give through a nasal cannula on a NORMAL ward?
2-4L/min (25-30% air)
How much oxygen can you give through a normal face mask?
4-10L/min (40% oxygen max)
How much oxygen can you give through a non-rebreather/trauma mask?
up to 15L/min (90% oxygen max)
What are venter masks?
These deliver an EXACT amount of oxygen - used in COPD patients who are at risk of retaining C02 if oxygen flow is too high.
How much oxygen can you give through a HIGH FLOW nasal cannula?
Critical care -
Up to 60L/min
(it adds a small amount of positive pressure)
Which methods of oxygenation can be used on the normal ward?
Normal nasal cannula
Normal face mask
Non-rebreather mask
What are the two types of non-invasive ventilation?
CPAP
BiPAP
What is CPAP?
Contours positive airway pressure.
What is BiPAP?
Bilevel positive airway pressure - a cycle of alternating pressures.
What is the point of non-invasive pressure?
Applied a positive pressure to keep the lungs and airways open.
Which methods are used in severe respiratory failure?
Endotracheal tube
ECHMO
Tracheostomy
The ETT and Trash are both required to be connected to a ventilator at all times.
When is a tracheostomy indicated?
If the person requires long term invasive ventilation, as endotracheal tube doesn’t allow for talking, eating etc.
What is extracorporeal membrane oxygenation?
When blood is removed from the body to be oxygenated and for carbon dioxide to be removed.
what is shock?
Acute circulatory failure resulting in inadequate tissue perfusion leading to cellular hypoxia.
What are the main 4 types of shock?
Distributive - septic (main)
cardiogenic - pump/heart failure
Hypovolaemic - dehydration or trauma
Obstructive - pneumothorax, PE
Others - neurogenic, anaphylactic (both causing dilation in the wrong places)
what is septic shock?
this is a severe drop in arterial blood pressure which leads to inadequate tissue perfusion.
what is cardiac output?
Heart rate x stroke volume
What is an arterial line?
A cannula which is inserted into an artery.
Takes blood pressure
can take Arterial blood gas
NEVER used for giving medication.
where are arterial lines inserted?
Mostly radial artery
sometimes brachial artery
What is a central line?
A long thin tube with 3-5 lumens inserted into a vein, the tip sits in the vena cava.
How long can a central line be kept in for?
7-10 days.
What are central lines used for?
Can give drugs
take blood samples
measure central venous pressure
which drugs are given through a central line?
Drugs that would irritate the body if it was given through the periphery: Ionotropes potassium based amiodarone noradrenaline
Where are the central lines put in?
Internal jugular vein
subclavian vein
femoral vein
which medication is given when there is a heart pump failure?
Ionotropes - supports contractility.
what is dobutamine?
Beta agonist - only causes increase in heart rate and contractility. (doesn’t affect periphery)
Only used if you’re confident the problem is directly of the heart).
What is metaraminol?
Alpha 1 agonist
Slight beta agonist
causes vasoconstriction of blood vessels and heart
when is metaraminol used?
In septic shock
can be given peripherally or centrally.
what is noradrenaline?
Alpha agonist with a little bit of beta agonist, more potent than metaraminol.
Only given through central line
when is noradrenaline used?
in septic shock
what do inotropes do?
Alter the contractility of a muscle - can increase or decrease depending on whether the inotrope is positive or negative.
what are colloids?
Not used much anymore.
Fluid with large osmotic molecules.
what are crystalloids?
Small molecule fluids, 0.9% saline, plasma, dextrose
what are examples of fluid maintenance vs fluid resuscitation?
Maintenance - giving fluid because person can’t eat/drink
resuscitation - giving fluid for septic shock
how much fluid can you give at one time?
250-500mls.
who might be at risk of fluid overload?
Chronic heart failure patients.
what is a fluid challenge?
when you give as much fluid as possible as quick as possible then wait to see if they improve.
If they don’t - call it quits and use medication (vasopressors and inotropes).
What are vasopressors?
medications which cause vasoconstriction, increase blood pressure.
What are vasopressors?
medications which cause vasoconstriction, increase blood pressure.
