Critical Care

Question 1

7 parameters in a NEWS chart

Answer 1

Temperature
BP
GCS
O2 sat
Oxygen therapy
HR
Respiratory rate

Question 2

What is the NEWS chart for?

Answer 2

To quickly determine the degree of illness in a patient

Question 3

What is the definition of shock

Answer 3

Failure of circulation causing under-perfusion and cellular hypoxia

Question 4

Failures in what subsystems can cause shock?

Answer 4

Heart - pump
Vessels - pipe
Blood volume - fluid

Question 5

What are the 4 types of shock and e.g causes

Answer 5

Cardiogenic - MI, heart failure
Hypovolaemic - blood loss
Distributive - e.g. anaphylaxis, sepsis
Obstructive - e.g PE

Question 6

Describe stage 1 shock - signs/symptoms and criteria

Answer 6

0-15% blood volume loss
Near full compensation
Normal RR/HR/BP
Normal GCS, CRT and Urine output
Pale skin

Question 7

Describe stage 2 shock - signs/symptoms and criteria

Answer 7

15-30% blood volume loss (0.75-1.5L)
Normal systolic but increased diastolic (narrows pulse pressure)
Raised RR, HR
Pale, cold clammy skin
Anxiety/restlessness
Delayed CRT
Urine output 20-30mls/hour

Question 8

Describe stage 3 shock - signs/symptoms and criteria

Answer 8

Tachycardia >120
tachypnoea >30
Systolic BP <100
Sweatling cool clammy skin
Delayed CRT
Altered GCS
Urine output 20mls/hour

Question 9

Describe stage 4 hypovolaemic shock - signs/symptoms and criteria

Answer 9

Marked tachycardia >140 w/ weak pulse
Tachypnea
Systolic <70
Low GCS
Moribund skin
Absent CRT
Negligible urine output

Question 10

What changes in hypovolaemic shock

Answer 10

Heart rate
Respiratory rate
Systolic/diastolic BP
Skin color, temperature
CRT
Urine output
Consciousness

Question 11

Whats the first compensatory mechanism in hypovolaemic shock and visible sign

Answer 11

Constriction of peripheral arteries presenting as pale skin

Question 12

What is assessed in ABCDE

Answer 12

Airway patency
Breathing rate/rhythm/symmetry/color/o2 sats
Circulatory function; HR, BP, rhythm, CRT, urine output
Dysfunction; GCS/AVPU, BM, pupillary reflex
Examination/everything else

Question 13

6 step approach to interpreting ABG

Answer 13

See if breathing is normal
Look at blood pH to determine acidosis/alkalosis
Look at CO2 to see if respiratory cause
Look at HCO3 to see if metabolic cause
Determine primary cause of pH shift
Determine if any compensation is evident

Question 14

What kind of dysfunction causes respiratory acidosis

Answer 14

anything that causes hypoventilation

Question 15

What kind of dysfunction causes respiratory alkalosis

Answer 15

Anything that increases ventilation

Question 16

What kind of dysfunctions cause metabolic acidosis

Answer 16

Increase in anion gap (added acid)

Decrease in anion gap (loss of bicarb)

Question 17

Types of dysfunction in metabolic alkalosis

Answer 17

Loss of acid or gaining alkali

Question 18

Normal values in ABG

Answer 18

PH 7.35 - 7.45
CO2 - 4.6 - 6.0
O2 - 10-13
HCO3 - 25-35 mmols/l
Base excess - +/- 2
Anion gap 10-18