Critical Care

Question 1

What is level 0 care?

Answer 1

Patients whose needs can be met through normal ward

Question 2

What is level 1 care?

Answer 2

Patients at risk of their condition deteriorating, or higher levels of care whose needs can be met on advice and support from the critical care team

Question 3

What is level 2 care?

Answer 3

Patients requiring more detailed observation or intervention, single failing organ system or postoperative care, and higher levels of care

Question 4

What is level 3 care?

Answer 4

Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems

Question 5

What non invasive ventilation is available with critical care?

Answer 5

CPAP- continuous positive airway pressure

Assisted spontaneous ventilation

Question 6

What is the purpose of assisted spontaneous ventilation?

Answer 6

Augmentation of intrinsic respiratory effort
Improves minute volume and increases CO2 clearance
Prevents downward spiral of acidosis and worsening muscle Fx

Question 7

What invasive ventilation is available with critical care?

Answer 7

Endotracheal tube

Question 8

What is the purpose of endotracheal tubing?

Answer 8

Allow use of higher pressures without leakage
Airway protection
Full ventilation overriding or not dependent on intrinsic effort

Question 9

When is ventilatory support indicated?

Answer 9

Severe pneumonia CAP/HAP
PE 
CCF 
Life threatening bronchospasm 
SIRS 
Decreased conscious level 
Actual or impending acute airway compromise (traumatic, infective) 
Sedation to allow treatment or delirious patient's underlying disorder

Question 10

What methods are available for cardiovascular support in available in critical care

Answer 10

Invasive monitoring with appropriate fluid resuscitation
Inotropic or vasoactive support
Intra-aortic balloon counter pulsation
Extracorporeal support (AV ECMO, VAD

Question 11

In what circumstances might cardiovascular support be required?

Answer 11

Shock 
Hypovalaemia 
Disruptive (sepsis, neurogenic)
Obstructive (Tamponade, tension PTX) 
Cardiogenic

Question 12

What methods of renal support are available in critical care?

Answer 12

Dialysis
Continuous vino-venous haemofiltration
CVVHDF, SCUF, SCLED

Question 13

In what circumstances might renal support be required?

Answer 13

Usually secondary rather than primary

Acute renal failure secondary to sepsis or other shock states

Question 14

What is the hepatic support available in critical care?

Answer 14

MARS- molecular adsorbents recirculating system

Question 15

What methods of neurological support are available in critical care?

Answer 15

Airway protection
Monitoring of ICP
Treatment of ICP

Question 16

What are the treatment options for ICP?

Answer 16

Management of physiological parameters (PCO2, PO2, MAP, Glc, Temp)
Osmotherapy, mannitol, hypertonic saline
Therapeutic hypothermia
Burst suppression of cerebral activity

Question 17

In what circumstances might neurological support be required?

Answer 17

Trauma
Spontaneous intracranial haemorrhage
Status epilepticus
Meningitis

Question 18

Who should go to ICU?

Answer 18

Reversible organ dysfunction or failure
Supportive treatment to allow definitive treatment to work
Patients who are beyond capabilities of other levels of care

Question 19

Who shouldn’t go to ICU?

Answer 19

Progressive decline in chronic irreversible conditions
Those who will not survive
Those who will not become free from support available within the ICU
Likely outcome represents quality of life that would be unacceptable to patients