Critical Care

Question 1

Define type 1 and type 2 respiratory failure

Answer 1

Type 1: low pO2 only, due to lung tissue damage

Type 2: low pO2 AND high CO2, due to ventilation failure

Question 2

Which observation is the most sensitive marker of an unwell patient?

Answer 2

Respiratory rate

Question 3

Give three indications for airway protection

Answer 3

• Decreased conscious level (GCS ≤ 8, coma)
• Actual or impending acute airway compromise e.g. traumatic, infective
• Sedation to allow treatment of delirious patient’s underlying disorder

Question 4

What information is essential to obtain when looking at a patient’s pO2?

Answer 4

How much oxygen the patient is on

Question 5

Describe the indication for a fluid challenge

Answer 5

Used as a diagnostic intervention for patients with low blood pressure.
If the BP rises (and heart rate slows), patient was hypovolaemic.

Question 6

When should a fluid challenge be discontinued?

Answer 6

After 30ml/kilo has been given

Question 7

Give two classes of drugs which can be used to increase MAP

Answer 7

Vasopressors (alpha-1 agonists)

Inotropes (beta-1 agonists)

Question 8

What intervention is given to critical patients requiring renal support?

Answer 8

Continuous veno-venous haemofiltration

Question 9

Give four possible reasons why a patient may require neurological support

Answer 9

Trauma
Spontaneous intracranial haemorrhage
Status epilepticus
Meningitis

Question 10

Describe the different types of fluid

Answer 10

• 0.9% saline (crystalloid)
• 5% dextrose (crystalloid) – do not use as a resuscitation fluid (RBCs take up dextrose leaving just water which doesn’t stay in the circulation)
• Hartmann’s solution (sodium lactate solution)
• Blood (colloid)
• 5% albumin (colloid, doesn’t require ross-matching)

Question 11

Describe a patient requiring “level 0” care

Answer 11

o Patients whose needs can be met through normal ward

Question 12

Describe a patient requiring “level 1” care

Answer 12

o 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 13

Describe a patient requiring “level 2” care

Answer 13

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

Question 14

Describe a patient requiring “level 3” care

Answer 14

o Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems. This level includes all complex patients requiring support for multi-organ failure.

Question 15

Which patients should not be admitted to ICU (other than those who do not require a high level of care)

Answer 15

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