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Finals > CC > Flashcards

CC Flashcards

1
Q

4 reasons for admission to CCU

A

resp support
invasive monitoring eg BP, cardiac function
renal support
dec conscious lvl

… must be reversible ! eg pneumonia, cardiac failure…

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2
Q

list some aims of itu

A

maintain perfusion
remove and treat problems
allow body to recover

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3
Q

2 ways that airways may be opened for patients

A

endotracheal tube and tracheostomy

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4
Q

endotracheal tube is given via mouth or nose down trachea into lung, why do patients lose the ability to communicate

A

goes through voicebox

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5
Q

what is the significance of the blue line on endotracheal tubes

A

allows for x ray imaging to see placement

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6
Q

why are endotracheal tubes placed where the bronchi split

A

to inflate both lungs

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7
Q

why is the biggest tube that is suitable for the size of a patients neck used

A

easier to breathe

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8
Q

disadvantages of endotracheal tube

A

dry mouth, oral hygiene hard, moisture lesions due to tape, not for long term

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9
Q

tracheostomy uses a tube that as a similar diameter to endotracheal tubes but is shorter, what might be some other benefits of tracheostomy

A

makes breathing easier
mouth can shut so no longer dry
reduces need for sedation
temporary

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10
Q

what machine is used to support the pressure in the lungs

A

ventilator

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11
Q

true or false it is better for ventilated patients if lungs are not overinflated and alveoli are kept only semi inflated

A

true

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12
Q

what is the tidal volume that is used for ventilation and what is it based on

A

6ml/kg of predicted body weight

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13
Q

true or false, systemic vascular resistance dictates arterial blood pressure

A

true

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14
Q

cardiac function is measured indirectly using blood pressure from which 2 areas

A

central venous and arterial

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15
Q

what different techniques exist to measure cardiac function from the left side of the heart ()

A

lidco
picco
oesophageal doppler
swan ganz

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16
Q

2 sites for central line

A

internal jugular, subclavian

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17
Q

give one adverse effect that may occur if central lines are placed too close to the lungs

A

pneumothorax

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18
Q

give some different reasons for circulatory failure

A

inadequate preload
maldistribution
anaphylaxis
septic shock
myocardial failure

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19
Q

give some causes for inadequate preload

A

dehydration
circulatory loss through trauma

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20
Q

how can inadequate preload be measured

A

cvp and straight leg raise: tilt patient on bed and reassure, bp will raise in 2-3 mins

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21
Q

how does straight leg raise detect inadequate preload

A

if bp rises when legs are lifted not enough circulating volume

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22
Q

treatment for inadequate preload

A

fluid with crystalloid balanced salt solution
may need to give albumin too if low

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23
Q

fluid with crystalloid balanced salt solution

A

maldistribution

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24
Q

treatment for low afterload

A

vasoconstrictor (vasopressor)

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25
Q

which heart receptors are inotropic and involved in muscle contractility

A

b1

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26
Q

which receptors in the heart work on vasoconstriction of blood vessels

A

a1 and a2

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27
Q

which receptor of the heart works on vasodilatation of blood vessels and bronchodilatation

A

b2

28
Q

NAd increases svr so can be used for low afterload give its AEs

A

angina and ischaemia due to increased oxygen consumption, hr

29
Q

giving industrial doses of NAd can cause vasoconstriction of fingers and digits that can lead to

A

necrosis

30
Q

why does the gut stop working on high doses of NAd

A

doesnt have enough blood to absorb anything

31
Q

dopamine can be used as a vasoconstrictor but why is it not used as much anymore

A

increased morbidity compared to adrenaline

32
Q

low dose dopamine works on which receptors in vascular tissue to cause vasodilatation

A

D1

33
Q

high dose dopamine works on which receptors of the heart

A

B1

34
Q

adverse effects of dopamine

A

tachycardia
arrythmias
myocardial ischaemia

35
Q

vasopressin or the synthetic version argipressin causes profound vasoconstriction and acts on which receptors

A

V1

36
Q

how can myocardial failure be measured

A

low CO

37
Q

treatment for what condition would be appropriate with an inotrope

A

myocardial failure

38
Q

example of an inotrope that can be used that is also a racemic mixture

A

dobutamine

39
Q

what does dobutamine do to the heart

A

increases contractility by agonising a and b receptors

40
Q

dobutamine AEs

A

tachycardia
arrythmias
can lead to increased myocardial oxygen consumption
ischaemia
tolerance

41
Q

adrenaline increases contractility and hr and is an agonist for which receptors in the heart

A

a1, b1, b2

42
Q

adrenaline AEs

A

tachycardia
myocardial ischaemia
arrythmias
sudden death

43
Q

vasodilators aim to decrease afterload by enabling the heart to beat more efficiently and is usually something nitrate donating, eg

A

gtn, isosorbide dinitrate

44
Q

sedation and analgesia aims to keep patients patients comfortable and rousable however may require sedation holidays, what are these and why are they a good thing

A

stopping drug every morning, prevents accumulation, gets off ventilator quicker and avoids associated pneumonia

45
Q

opioid infusions may be used as analgesia, morphine may be used but name other more renal/ hepatic dysfunction friendly options

A

fentanyl and alfentanil

46
Q

give a non opioid analgesic that may be used for itu patients

A

paracetamol

47
Q

list 2 agents that may be used for sedation

A

propofol and benzodiazepine

48
Q

3 different antipsychotic drugs that may be used for delirium

A

haloperidol
olanzapine
quetiapine

49
Q

alpha 2 adrenergic agonists activate central inhibitory x receptors to exhibit a depressive effect on cns function in order to work an antipsychotics

A

a2

50
Q

instead of alpha 2 adrenergic agonists what drug may be useful in withdrawal states

A

clonidine
dexmedetomidine

51
Q

non depolarising agents are used as paralysing agents however patients must have adequate analgesia and sedation on board, why are paralysing agents limited in use

A

difficulty in ventilation and neuroinjury

52
Q

renal support for patients is continuous instead of intermittent, what can be used to achieve this

A

filtration, dialysis or mixture of both

53
Q

when to consider sepsis

A

RR 22, altered mental state, systolic less than 100

54
Q

give 2 complications of uti in elderly patients

A

sepsis and severe confusion

55
Q

septic shock means vasopressor therapy is needed to maintain MAP (mean arterial pressure) equal or above x hg

A

65

56
Q

septic shock is associated with a lactate above x mmol/l despite adequate fluid resus

A

2

57
Q

can phosphate and magnesium be administered through the same line

A

no - will precipitate

58
Q

if there is acidosis, how would you rule out a respiratory cause?

A

if CO2 is also low and bicarbonate is low

59
Q

why is CO2 low in metabolic acidosis

A

respiratory system compensates by breathing

60
Q

what elec if given too fast will kill

A

potassium!
strong sols given peripherally –> extravasation, tissue necrossi

61
Q

is cockroft-gault creatnine valid for septic patients

A

no px needs to be stable

62
Q

what to consider for renal impairment

A

does drug accumulate, does drug worsen impairment, does metabolite accumulate

63
Q

what affect does benzylpenicillin have on the CNS

A

irritation of brain meninges

64
Q

what is needed after critical care

A

rehabilitation, support groups

65
Q

what to give instead of oral antidiabetics in reduced consciousness

A

continuous infusion

66
Q

causes of ST depression

A

digoxin, hypokalaemia, NSTEMI

67
Q

why may hydrocortisone be given with NAd

A

reduces the amount of NAd needed

Finals (29 decks)

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