Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anaesthetics > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What are the normal Na+ requirements?

A

1-2mmol/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the normal K+ requirements?

A

0.5-1mmol/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the normal fluid requirements?

A

25-30ml/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the normal glucose requirements?

A

50-100g/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the main things managed in critical care?

A 
Airway
Breathing 
Blood gases
Circulation
Disability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is respiratory rate a good marker in critical care?

A

Respiratory rate is the most sensitive marker of an unwell patient, while it won’t tell you what is wrong with the patient it is a good indicator of decline as it is likely to be one of the first things to decline when a patient is unwell/worsening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much oxygen can critical care doctors provide, compared with a normal ward?

A

Most wards can give 15 L/min maximum

Critical care can give up to 70 L/min, can use non-invasive ventilation and invasive ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why might breathing machinery be useful in critical care?

A

Extremely unwell patients may be too weak to sustain breathing themselves, machinery can take over the work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can be done for patients with inadequate ability to sustain gas exchange or perfusion?

A

ECMO - Extra-Corporeal Membrane Oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are blood gases used regularly on critical care wards?

A

All patients will have an arterial line in so it is easy to obtain blood gas readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main blood gas readings done in critical care?

A

pH
CO2
PO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is there a limited amount of improvement you can make for a patient by increasing their heart rate?

A

Drugs can be given to increase heart rate but at a certain point the increase will no longer have any beneficial effect on cardiac output (CO = HR x SV) and may even worsen CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is stroke volume determined?

A

SV is hard to determine
Subdivided into preload, contractility and afterload
Preload, contractility and afterload cannot be directly measured by markers of them can be measures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should fluid challenge be used as?

A

Intervention, not therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does fluid challenge work?

A

A volume of fluid is given as quickly as possible to a patient with hypotension and tachycardia, BP and heart rate are monitored
If BP goes up and HR goes down then this tells you that the patient is hypovolaemic (decreased volume of blood plasma) and so requires more fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

According to sepsis 6, when should you stop giving fluid and try a new approach? Why is this?

A

When fluid reaches 30ml/kg and there is no improvement

Run the risk of fluid overloading the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What pressure do organ systems require to work?

A

Perfusing pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What MAP value will sustain pressure autoregulation?

A

50-150mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does MAP reflect?

A

Average pressure across the cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What MAP value is aimed for in intensive care?

A

65mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the difference between crystalloid and colloid fluids?

A

Fluids are broken down by the size of molecules in them
If small molecules - crystalloid
If large molecules - colloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the crystalloid fluids used in critical care?

A

0.9% saline
5% dextrose
Hartmann solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What crystalloid fluid should not be used as a resuscitation fluid?

A

5% dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the colloid fluids used in critical care?

A

Blood most common
Albumin

(colloid starches and jelly products taken off market due to renal failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the benefit of using albumin?
Doesn't need any cross-matching/immuno-compatibility
26
How do vasopressors work?
Almost all are alpha-1 agonists | Cause vasoconstriction which improves preload and afterload
27
What vasopressors are used in critical care?
Metaraminol | Noradrenaline
28
How are vasopressors given in critical care?
As a continuous infusion Should not be given through a peripheral cannula due to risk of peripheral vasoconstriction (unless emergency)
29
How do inotropes work?
Increase contractility of heart | Tend to be beta-1 agonists
30
What are the benefits of arterial lines?
Allow a constant measure of BP without needing repetitive cuff measurements More accurate BP readings in patients who have 'shut down'
31
What are the benefits of cannulas?
Last longer than arterial lines as they are inserted using an aseptic technique so can be used for a longer time without/with less of an infection risk Last 7-10 days compared to 3 days with arterial lines Can be used in 'peripherally shut down' patients - those with no peripheral veins that can be used will normally still have a jugular, subclavian or femoral vein that can be used More options for veins used - jugular, subclavian, femoral Less leakage Quicker dilution
32
What are the disadvantages of cannulas?
If they become infected the infection is more serious and carries higher consequences, and removing it has more risk of complications Insertion can hit major structures such as thyroid, lungs, trachea Not ideal for large volumes in short time
33
What are the complications of vasopressors?
May constrict circulation that you do not want to constrict; Pulmonary arterial circulation constriction Arteries to gut -> ischaemic gut Necrosis from peripheral vasoconstriction
34
What can be done for a vasovagal patient, before administering fluid or drugs?
Lie the patient flat and hold their legs in the air, and re-check BP to see if it improves
35
Features of the circulation that can be measured in critical care are markers of what?
End organ perfusion
36
What are the main markers of end organ perfusion that can be measured in critical care?
Cerebral perfusion - patient becomes more aware, able to talk etc. with improvement Kidney - urine production occurs with perfusion, aim for early urine output of 0.5ml/kg/hour Blood lactate levels - marker of anaerobic metabolism indicating that cells aren't getting sufficient oxygen, if lactate starts to fall with treatment then you are on the right track
37
What are airway issues in critical care usually due to?
Neurological impairment e.g. sepsis, intracranial haemorrhage, rather than a physical problem e.g. tumour, foreign body
38
When is intubation usually indicated in relation to a patient's GCS score?
When GCS is 8 or lower, however this is a guideline, not a set rule
39
What can be done in critical care for the head/brain to prevent additional disability?
Sedation - slow metabolic rate Cool people - affect blood flow and therefore pressures Anti-epileptics Induced thio-coma
40
What can be done in critical care for the gut to prevent additional disability?
Pro-kinetics NG tube or feeding through central line Referral to surgeon if removal is necessary
41
What can be done in critical care for the kidneys to prevent additional disability?
Dialysis - different from that given to a CKD patient, dialysis is constant
42
What can be done in critical care for the liver to prevent additional disability?
No effective extra-corporeal treatments Supported generally by feeding and supporting circulation If liver fails, transplantation is the only treatment option, if eligible
43
What patients are encompassed by level 0 of comprehensive critical care?
Patients whose needs can be met through a normal ward
44
What patients are encompassed by level 1 of comprehensive critical care?
Patients at risk of their condition deteriorating or higher levels of care whose needs can be met on advice and support from critical care team (no organs failing)
45
What patients are encompassed by level 2 of comprehensive critical care?
Patients requiring more detailed observation or intervention Those with single failing organ system or post-operative care, and higher levels of care (e.g. septic shock or single organ failure)
46
What patients are encompassed by level 3 of comprehensive critical care?
Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems This includes all complex patients requiring support for multi-organ failure
47
What levels of comprehensive critical care do high dependency and intensive care usually refer to?
High dependency refers to level 1 or 2 Intensive care usually means level 2 or 3 (i.e. single organ - HDU, multi-organ intensive care)
48
What is the cost per day of a patient staying in critical care?
£1500
49
What respiratory support is given in critical care?
Non-invasive ventilation Invasive ventilation Advanced respiratory support
50
What non-invasive ventilation options can be given in critical care?
CPAP | Assisted spontaneous ventilation - improves minute volume and increases CO2 clearance
51
What invasive ventilation options can be given in critical care?
Endotracheal tubes
52
What are the benefits of endotracheal tubes?
Allow use of higher pressures without leakage Airway protection Full ventilation overriding or not dependent on intrinsic effort
53
When is advanced respiratory support given? How is this given?
When conventional ventilation fails, addition of inhaled NO Given via HFOV or ECMO
54
In what conditions might ventilatory support be indicated in critical care?
``` Severe pneumonia - hospital/community acquired Pulmonary embolism Congestive cardiac failure Life-threatening bronchospasm SIRS ```
55
When might airway protection be indicated in critical care?
Decreased conscious level Actual or impending acute airway compromise Sedation to allow treatment of a delirious patient's underlying disorder
56
What cardiovascular support might be given in critical care?
Invasive monitoring with appropriate fluid resuscitation Inotropic or vasoactive support Intra-aortic balloon counter pulsation Extracorporeal support e.g. ECMO, VAD
57
What renal support might be given in critical care?
Dialysis (rarely) Continuous veno-venous haemofiltration (CVVHDF) Slow continuous ultrafiltration (SCUF) Sustained low-efficiency dialysis (SLED)
58
When might renal support be indicated in critical care?
Acute renal failure secondary to sepsis or other shock states
59
When might neurological support be indicated in critical care?
Trauma Spontaneous intracranial haemorrhage Status epilepticus Meningitis
60
What neurological support can be given in critical care?
Monitoring of ICP Treatment of raised ICP Management of physiological parameters - PCO2, PO2, MAP, glucose, temperature Osmotherapy, mannitol, hypertonic saline Therapeutic hypothermia Burst suppression of cerebral activity
61
When should patients go to ICU?
When: There is reversible organ dysfunction or failure Supportive treatment to allow definitive treatment to work Patients who are beyond capabilities of other levels of care
62
When should patients not go to ICU?
Progressive decline in chronic irreversible condition 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 the patient
63
What is involved in identification and early treatment in critical care?
``` Systematic management of ABC Appreciation of clinical urgency Seeking advice appropriately Proper use of monitoring Good organisational skills Adequate supervision by senior staff Background knowledge and understanding ```

Anaesthetics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions