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Anaesthetics yan > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What is critical care?

A
  • Initial assessment - ABCDE
  • Organ system support
    • Single vs multiple
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2
Q

What are the different levels of critical care?

A
  • Level 1 care
    • Ward based care
  • Level 2 care
    • Used to be called high dependency unit (HDU)
    • Single organ support
  • Level 3 care
    • Intensive care
    • Multiple organ support
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3
Q

What are the different classifications of respiratory failure?

A
  • Type 1
    • Oxygenation failure
  • Type 2
    • Oxygenation and ventilation
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4
Q

Describe the management of type 1 respiratory failure?

A
  • Give oxygen
    • On ward can give 0-15L/min
      • Nasal canuli (2-4L/min, 25-30% oxygen)
      • Hudson mask (4-10L/min, 40% oxygen)
      • Trolley mask (15L/min, 90% oxygen)
    • In critical care
      • High flow nasal canuli (humidifies air so can give more oxygen than normal ward, 70L/min, 100% oxygen)
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5
Q

How much oxygen can be given in a ward?

A

0-15L

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6
Q
  • Nasal canuli (2-4L/min, 25-30% oxygen)
  • Hudson mask (4-10L/min, 40% oxygen)
  • Trolley mask (15L/min, 90% oxygen)
A
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7
Q

How much oxygen can be given in critical care?

A
  • High flow nasal canuli (humidifies air so can give more oxygen than normal ward, 70L/min, 100% oxygen)
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8
Q

Describe the management of type 2 respiratory failure?

A
  • Non-invasive ventilator – applies pressure to airways to keep them open and reduce work of breathing
  • Invasive ventilator – stops air from escaping, protects the airway from secretions
    • Need NG tube for feeding, cannot talk
  • Tracheostomy – for long term, allows patient to swallow
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9
Q

What is shock?

A

Shock = acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia

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10
Q

What are the different classifications of shock?

A
  • Distributive (septic)
    • Blood going to wrong places
  • Hypovolemic
    • Aetiology – blood loss, trauma, surgery
  • Anaphylactic
    • Blood vessels abnormally dilated so blood going to wrong places, but also pump failure (unlike distributive)
  • Neurogenic
    • Disruption of sympathetic nervous system causes abnormal vasodilation – blood in wrong places
  • Cardiogenic
    • ‘Heart failure’ – heart cannot pump blood around the body
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11
Q

What is distributive shock also called?

A

Septic shock

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12
Q

What is septic shock?

A
  • Blood going to wrong places
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13
Q

What is the cause of hypovolaemic shock?

A
  • Aetiology – blood loss, trauma, surgery
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14
Q

What is anaphylactic shock?

A
  • Blood vessels abnormally dilated so blood going to wrong places, but also pump failure (unlike distributive)
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15
Q

What is neurogenic shock?

A
  • Disruption of sympathetic nervous system causes abnormal vasodilation – blood in wrong places
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16
Q

What is cardiogenic shock?

A
  • ‘Heart failure’ – heart cannot pump blood around the body
17
Q

What is cardiogenic shock also called?

A

Heart failure

18
Q

What formula relates CO, HR and SV?

A
  • CO = HR x SV
19
Q

What are markers of potential stroke volume?

A
  • SV = Preload/contractility/afterload (markers)
20
Q

Describe the management of CV failure?

A
  • AV line or central line
    • Gives absolute measurement of BP, allows repeated blood sampling for gases
  • Vasopressors
    • Effect – cause vasoconstriction, increasing preload
    • Indication – septic shock (distributive issues)
    • Drugs
      • Metraminol
      • Noradrenaline
  • Inotropes
    • Effect – increases heart rate and contractility, also causes vasoconstriction
    • Indication - cardiogenic
    • Drugs
      • Adrenaline
      • Dobutamine – only increases HR and contractility, not vasoconstrictor (B agonist)
  • Fluids
    • Colloids (fluid with large osmotically active particles) or crystalloids (fluids with small molecules, such as saline or dextrose)
    • Maintenance or resuscitation
      • 30mg/kg is the limit
21
Q

What does an AV or central line allow?

A
  • Gives absolute measurement of BP, allows repeated blood sampling for gases
22
Q

What are the effectos of vasopressors?

A
  • Effect – cause vasoconstriction, increasing preload
23
Q

What is a consequence of vasocontriction on CVS physiology?

A

Increases preload

24
Q

What are indications for vasopressors?

A
  • Indication – septic shock (distributive issues)
25
Q

What drug is used for septic shock (distributive issues)?

A

Vasopressors

26
Q

What are examples of vasopressors?

A
  • Metraminol
  • Noradrenaline
27
Q

What are the effects of inotropes?

A
  • Effect – increases heart rate and contractility, also causes vasoconstriction
28
Q

What is an indication for inotropes?

A
  • Indication - cardiogenic shock
29
Q

What are examples of inotropes?

A
  • Adrenaline
  • Dobutamine – only increases HR and contractility, not vasoconstrictor (B agonist)
30
Q

What drug is used for cardiogenic shock?

A

Inotropes

31
Q

What are the different categories of fluids?

A
  • Colloids (fluid with large osmotically active particles) or crystalloids (fluids with small molecules, such as saline or dextrose)
32
Q

What are colloids and crystalloids?

A

Colloids - fluid with large osmotically active particles

Crystalloids - fluids with small molecules, such as saline or dextrose

33
Q

What is the maximum amount of fluid that can be given?

A

30mg/kg

34
Q

What are the different classifications of neurological failure?

A
  • Metabolic
    • Other problem has caused reduced conscious level, such as severe sepsis, renal failure, electrolyte failure or inflammation
  • Trauma
  • Infection
    • Meningitis and encephalitis
  • Stroke
35
Q

Describe the management of neurological failure?

A
  • Optimise patients ventilation
  • Fluid management to get blood into head
36
Q

What are complications of neurological failure?

A
  • Problems breathing, protecting airway

Anaesthetics yan (6 decks)

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