Critical Care

Question 1

What is the purpose of an arterial line?

Answer 1

Continual monitoring of arterial blood pressure and access to blood for arterial blood gas measurements. *Most commonly inserted in radial artery, but can also be inserted into femoral or carotid

Question 2

What measurements does an arterial line provide?

Answer 2

Systolic, diastolic, and mean arterial pressure (MAP)

Question 3

What are the PT implications for an arterial line?

Answer 3

AVOID removal of line due to increased risk of profuse bleeding.
Mobility may be LIMITED if line is inserted in groin (FEMORAL artery). Mobility should be normal for radial or carotid insertions.

Question 4

What is MAP? What is the normal range ?

Answer 4

Reflection of tissue perfusion based on the average pressure pushing blood through circulatory system.
NORMAL: 70-110 mmHg
Inadequate Organ Perfusion < 60 mmHg

Question 5

What is the purpose of a central line?

Answer 5

Allows IV access for MEDICATION administration directly into proximal SUPERIOR VENA CAVA. Also continuously monitors central venous pressure (CVP) and right arterial pressures (RAP) - Cardiac fxn.
*Inserted in SUBCLAVIAN or JUGULAR VEIN, sometimes femoral

Question 6

What is used in patients requiring prolonged, placement of a central line?

Answer 6

PICC Line - Peripheral line inserted into cephalic or brachial vein and advanced towards the superior vena cava

Question 7

Precautions for PICC line

Answer 7

Do NOT take blood pressure on ipsilateral arm
Do NOT get line wet
Caution with lifting

Question 8

What is the purpose of a Pulmonary Artery Catheter? (Swan-Ganz)

Answer 8

Allows for direct measurements of RAP, PAP, PCWP, LAP, O2, CO, PVR and pacing of heart
*Inserted centrally into subclavian or jugular vein & advanced to PULMONARY ARTERY

Question 9

What is important about the Swan-Ganz placement?

Answer 9

Very precise placement in the pulmonary artery. Caution with movement of line because it may block artery

Question 10

Immediate risks associated with central venous access

Answer 10

Pneumothorax, bleeding, arrhythmias, & arterial entry

Question 11

Delayed risks associated with central venous access

Answer 11

Infection, catheter fracture/dislodgement/occlusion, or air in the catheter

Question 12

What is pulmonary capillary wedge pressure?

Answer 12

Associated with LAP & LVEDP - Both measure pressure within pulmonary circulation and peripheral resistance after diastole. Indicator of left ventricle performance
PAEDP = LVEDP
NORMAL: <12 mmHg

Question 13

Why measure PCWP?

Answer 13

Assess severity of L ventricular function, mitral/aortic valve dysfunction, pulmonary edema, pulmonary HTN, and treat hypovolemic states

Question 14

What is normal ICP - Intracranial Pressure

Answer 14

0-10 mmHg (adults)
0-5 mmHg (children <5 years old)

Question 15

What is ICP highly correlated with?

Answer 15

Cerebral perfusion pressure. When ICP is high, perfusion pressure is low.
*Inverse relationship

Question 16

Effect of CO2 on cerebral vessels

Answer 16

Hypercapnia (increased CO2) – Dilation
Hypocapnia (decreased CO2) – Constriction

Question 17

Purpose of intraaortic balloon pump?

Answer 17

Assists in circulation throughout body and improving myocardial oxygen consumption in hemodynamically unstable patients

Question 18

How does an intraaortic balloon pump work?

Answer 18

Balloon is inflated during diastole when aortic valve closes, creating an increased pressure that pushes blood into the aortic arch and stimulates a retrograde flow into coronary arteries to improve perfusion of myocardium

Question 19

Precautions with intraaortic balloon pump

Answer 19

NO hip flexion on ipsilateral leg
BED REST until catheter is removed!

Question 20

What is ECMO?

Answer 20

Life support machine that replaces the function of the heart & lungs for a few hours/days while they are waiting for a transplant.
Blood is pumped from the body to an artificial lung for oxygenation and CO2 removal, then it returns to the body.

Question 21

What is a Berlin Heart?

Answer 21

Artificial heart pump that maintains blood flow in babies with serious heart failure. Pumps blood to aorta from left ventricle.

Only device that is like ECMO for babies - Very similar to LVAD for adults as well.

Question 22

What condition do 80% of mechanically ventilated patients present with that can lead to negative outcomes like increased ICU stay, decreased survival and increased cognitive dysfunction?

Answer 22

Delirium

Question 23

What are the three subtypes of delirium?

Answer 23

Hyperactive (ICU psychosis), Hypoactive (quiet delirium), or Mixed

Question 24

What is called when patients present with remaining health problems after critical illness?

Answer 24

PICS - Post-Intensive Care Syndrome

Question 25

Warning Signs of PICS

Answer 25

ICU-Acquired weakness, balance difficulties, thinking/memory issues, severe anxiety, depression, & nightmares

Question 26

Three main rehab interventions

Answer 26

Cognitive stimulation, in-bed cycling & early mobility

Question 27

When would you stop early mobility in the ICU?

Answer 27

If a patient has a symptomatic drop in MAP
Patient distress, arrhythmias, concern for MI, fall
Heart rate <50/>130, RR <5/>40, and/or systolic BP >180 for 5 minutes

Question 28

Johns Hopkins Activity & Mobility Promotion scale has how many stages?

Answer 28

8