Critical care

Question 1

What is level 1 critical care

Answer 1

Ward based care

Question 2

What is level 2 critical care

Answer 2

HDU: single organ support, slightly more advanced resp/some CVS support with the use of visual active medicines

Question 3

What is level 3 critical care

Answer 3

Intensive care. Patients with multple organs needing support

Question 4

What is type 1 respiratory failure & main method of managment

Answer 4

Oxygen failure

> supplementary O2
High flow nasal cannula

Question 5

What is type 2 respiratory failure & describe method of managment

Answer 5

Oxygen and ventilation failure (increased CO2, aswell as reduced O2)

Non invasive veintilation

Question 6

What is the function of nasal cannulae

Answer 6

Warms & humidifies air
Up to 70L O2 per minute
High pressure & flow rate
Type 1 resp failure

Question 7

What is the function of non-invasive ventilation

Answer 7

Applies pressure to airway
Used in type 2 resp failure

Question 8

How do we manage severe respiratory failure

Answer 8

Veintator

Question 9

How does a ventilator work?

Answer 9

Tube in trachea with cuff that forms a seal
1. Significant pressure- severe resp failure
2. protects the airway (physical barrier to stuff getting into lungs)

Once on a ventilator we can control i.e. exact % of O2 due to the fact it’s a closed system so nothing can get between lungs & ventilator

Fullness of time either…
Infection
Resp system gets better

Question 10

What is shock?

Answer 10

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

Inability of body to get O2 from outside into blood stream & into tissues

Question 11

Describe relationship between CO, HR and SV

Answer 11

Cardiac output = Heart rate X stroke volume

Question 12

List 3 things that impac stroke volume

Answer 12

Preload, contractibility and afterload

Question 13

What can an arterial and central line be useful for treating

Answer 13

Cardiovascular failure

Question 14

List some beneifts of using arterial line vs central line

Answer 14

Get a beat by beat reading of BP (useful if they have arrythmia/unstable & BP changing)
Allows us to do repeated blood sampling (gassess etc) without need to do further needles in patient

Question 15

What are the benefits of a central line?

Answer 15

Can give number of potent drugs directly into circulation which would be damaging if injected peripherally
i.e. when injecting adrenaline
Also, typically comes with a number of lumen ilnes: huge variety & different amounts of drugs thorugh the one port
Can stay in for 7-10 days

Acess to central venous site
Can aspirate for blood samples
Measure central venous pressure

Question 16

WHat are the negatives of using a central line

Answer 16

These are long & relatively thin, rapid delivery of fluid if hypovolemic for example, maybe want to use a cannula instead.

Question 17

Name 2 drugs which can be helpful in cardiovascular failure?

Answer 17

Vasopressors and inotropes

Question 18

Name 2 examples of vssopressor

Answer 18

Metaraminol and adrenaline

Question 19

What are the function of vasopressors

Answer 19

Cause beta constrictions
> improves preload (reduces venous volume)
> Increases afterload: causes arterial contraction, increasing pressure

Question 20

Describe the function of inotropes

Answer 20

Mainly used in pump dysfunction
- alters the force or energy of muscular contraction

Question 21

name two examples of ionotropes

Answer 21

Adrenaline
(alpha and beta, in patients who are really struggling)
Dobutamine (beta agonist, only used in patients with increased HR and contractibility
supportive for those with HF as bridge to recovery)

Question 22

What are colloids?

Answer 22

Fluids with large, osmotically active molecules i.e. starches or gelatin

Question 23

What are crystalloids

Answer 23

Fluids with small molecules in them

Question 24

What is the most appropraite crystaloid fluid used

Answer 24

Plamsa lyte 148

Question 25

What is fluid challenge?

Answer 25

Checkingthat fluids have worked, check urine output

Question 26

What is fluid limit

Answer 26

SEPSIS: 30mnl/kg limit
> how much fluid we give before thinking about critical care

septic shock= fluid unresponsivness