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A&E, T&O & ICU > Critical Care > Flashcards

Critical Care Flashcards

1
Q

define shock

A

inadequate blood flow to the tissues to meet demands

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2
Q

MAP equation

A

MAP = CO x TPR

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3
Q

CO equation

A

CO = HR x SV

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4
Q

list signs of shock

A

neuro - confusion, agitation, LOC
kidney - reduced UO
tissues - raised lactate, poor perfusion

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5
Q

list 4 main types of shock & 2 lesser types of shock

A

hypovolaemic
distributive
cardiogenic
obstructive
(neurogenic)
(high output)

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6
Q

what is hypovolaemic shock

A

reduced pre load and CO leading to intravascular volume depletioj

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7
Q

how is intravascular volume depleted in hypovolaemic shock

A

blood loss
third space loss - interstitial space relocation
GI losses eg D&V

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8
Q

what is a good indicator of perfusion in a sick ?shock person

A

mental status - shows good perfusion to brain

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9
Q

at what % of blood loss does BP start to change

A

30-40% !!

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10
Q

do you need to be hypotensive to be shocked

A

NO - it is common to be shocked but not necessary

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11
Q

what is distributive shock

A

vascular dilation reduces TPR (loss of vascular tone)

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12
Q

causes of distributive shock

A

sepsis
anaphylaxis
acute adrenal insufficiency

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13
Q

what is cardiogenic shock

A

cardiac pump failure reducing CO

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14
Q

what can cause cardiogenic shock

A

MI
arrhythmias
cardiomyopathy
valve disease

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15
Q

what is obstructive shock

A

obstruction (in larger vessels or around heart) preventing complete cardiac filling

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16
Q

causes of obstructive shock

A

PE
tension pneumothorax
pericardial effusion
tamponade

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17
Q

what is neurogenic shock

A

disruption to autonomic pathways following spinal injury

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18
Q

what type of shock is neurogenic

A

distributive

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19
Q

signs of neurogenic shock

A

low BP
vasodilatation so warm peripheries
LOW HR !! (inappropriate as it should be high)
autonomic lability of temperature

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20
Q

is neurogenic shock the same as spinal shock

A

NO - spinal shock involves spinal cord stunning so LMN signs and paralysis, but no autonomic issues

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21
Q

list HR, JVP and tissue perfusion for hypovolaemic shock

A

HR high
JVP down
tissue perfusion - cool

22
Q

Mx of hypovolaemic shock

A

treat the underlying cause !!
fluid replacement - blood, crystalloids, colloids (rare)

23
Q

when would you give blood replacement vs crystalloids in hypovolaemic shock

A

give blood if blood was lost (trauma / haemorrhage)
give crystalloids if dehydrated etc

24
Q

list HR, JVP and tissue perfusion for distributive shock

A

HR high
JVP down
tissue perfusion - warm peripheries

25
Q

Mx of distributive shock

A

treat the cause !!!
- sepsis = ABx
- anaphylaxis = remove allergen, adrenaline
fluid replacement
vasopressors

26
Q

what are vasopressors

A

vasoconstrictors

27
Q

types of vasopressors

A

noradrenaline
vasopresin
dopamine
meteraminol

28
Q

list HR, JVP and tissue perfusion for cardiogenic shock

A

HR can be high/low/normal
JVP up
tissue perfusion - cool peripheries

29
Q

Mx for cardiogenic shock

A

treat the cause
- PCI
- arrhythmia Tx
- repair valve
inotropes
GTN - reduce afterload

30
Q

what do inotropes do

A

cause increase in cardiac conrtility and CO

31
Q

examples of inotropes

A

adrenaline
dobutamine

32
Q

list HR, JVP and tissue perfusion for obstructive shock

A

HR up
JVP up - great vessels are blocked so blood backs up
tissue perfusion - cool

33
Q

Mx of obstructive shock

A

treat the cause
- thrombolysis
- needle decompression (T pneumo) in 2nd ICS MCL
- drain effusion
inotropes / vasopressors

34
Q

list HR, JVP and tissue perfusion for neurogenic shock

A

HR can be up or down
JVP down
tissue perfusion - warm

35
Q

Mx of neurogenic shock

A

vasopressors
get them to a neuro centre asap

36
Q

70M cough and SOB.
COPD and HF. Smoker.
cyanosed, dyspnoea. crackles
hr 100, bp 105/78, rr 30, o2 sats 84%. CO2 high.
given salbutamol nebs, what is next Mx?

A

non invasive ventilation

37
Q

70M cough and SOB.
COPD and HF. Smoker.
cyanosed, dyspnoea. crackles
hr 100, bp 105/78, rr 30, o2 sats 84%. CO2 high.
why not increase the o2 via non rebreathe?

A

can reduce the capnic drive to breathe if o2 is too high in COPD pt

38
Q

26M found unconcious in street.
gcs 3/15, hr 60, bp 100/60, rr 5. pin point pupils. Dx?

A

opioid overdose

39
Q

26M found unconscious in street.
gcs 3/15, hr 60, bp 100/60, rr 5. pin point pupils. Dx?

A

opioid overdose

40
Q

44F increasingly hypotensive in ICU.
admitted with ?pylonephritis.
temp 38, hr 110, bp 91/60, o2 sats 95% on 60% o2. jvp high.
normal K/Na, but AKI. UO 400ml total, 10-20ml/hr for 4hrs. given 3L 0.9% NaCl since admission.
best immediate Mx?

A

IV noradrenaline infusion

41
Q

purpose of IV norad

A

vasopressor so constricts blood vessels peripherally to protect organs

42
Q

71M on ICU after cardiac arrest.
intubated and ventillated.
high co2, low o2, slightly high bicarb, low ph.
what is happening?

A

respiratory acidosis with partial metabolic acidosis

43
Q

71M on ICU after cardiac arrest.
intubated and ventillated.
high co2, low o2, slightly high bicarb, low ph.
Mx?

A

increase ventillation

44
Q

69M central chest pain radiating to shoulder.
hr 88, bp 138/85, temp 37, o2 sats 95% RA.
ecg sinus rhythm with ST depression V2-V6.
Dx?

A

NSTEMI

45
Q

69M central chest pain radiating to shoulder.
hr 88, bp 138/85, temp 37, o2 sats 95% RA.
ecg sinus rhythm with ST depression V2-V6.
what is the best O2 therapy?

A

no supplemental o2 - his sats are fine for now

46
Q

27F has cardiac arrest with PEA.
she had attended with L chest pain, pleuritic, sudden onset.
before arrest: hr 126, bp 88/40, rr 32, o2 sats 94% on 15L.
ecg sinus tachy, cxr normal.
cause of arrest?

A

PE

47
Q

37M trapped in burning house.
facial erythema, beard singed, oral burns
inspiratory stridor, hoarse voice, accessory muscle use.
what has been damaged to cause resp sx?

A

larynx

48
Q

50F acute exacerbation of asthma.
had salbutamol, ipratropium, IV hydrocortisone.
rr 38, hypercapnic resp failure, sats 88 on 15L.
mx?

A

intubate and ventilate

49
Q

is aminophylline used for asthma mx routinely?

A

not any more - only if controlled monitoring is done in extreme circumstances

50
Q

24M purpuric rash, fever, neck stiffness
hr 130, bp 88/50
what mediator causes hypotension?

A

nitric oxide

51
Q

35M weighs 80kg
needs norad infusion at 0.1 micrograms/kg/min
infusion is made up of 4mg/50ml dextrose saline.
what is the most appropriate rate of administration?

A

6ml/hour

working out:
80 x 0.1 micr/kg/min = 8micr/kg/min = 480mcr/kg/hr
400mcr

A&E, T&O & ICU (3 decks)

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