Critical Care Flashcards
4 levels of comprehensive critical care
- Level 0, Patients whose needs can be met on a normal ward
- Level 1, Patients at risk of deteriorating, or needing higher levels of care whose needs can be met on advice + support from the critical care team (CCT)
- Level 2, Patients requiring more detailed observation/intervention, single failing organ system or post-op care, and higher levels of care
- Level 3, Patients requiring adv. resp. support alone or basic resp. support + support of 2/> organ systems (or multi-organ failure)
What levels do high dependency and intensive care refer to
- High dependency = 1 or 2
- Intensive care =2 or 3
What can you get in a ICU/ITU
- Resp. support
- Cardiovascular support
- Renal support
- Hepatic support
- Neurological support
Types of resp. support available
- Sophisticated NIV
- Invasive ventilatory support
- Adv. resp. support
Describe NIV
- CPAP (Continuous +ve Airway Pressure)
- Improves oxygenation both via CPAP + closed system
- Assisted spontaneous ventilation = Augmentation of intrinsic resp. effort, improves volume + increases CO2 clearance. Prevents downgrades and spiral of acidosis + worsening muscle fatigue
Describe invasive ventilation
- Endotracheal tubes
- Allows use of higher pressures without leakage
- Airway protection
- Full ventilation overriding or not dependant on intrinsic effort
Describe adv. resp. support
- When conventional ventilation fails
- Addition of inhaled NO
- HFOV (High Frequency Oscillatory Ventilation)
- ECMO (Extracorporeal Membrane Oxygenation)
When to give ventilatory support
- Severe pneumonia (CAP/HAP)
- P.E.
- CCF (?Congestive Cardiac Failure?)
- Life threatening bronchospasm
- SIRS (Systemic @Inflammatory Response Syndrome)
When to give airway protection
- GCS < 8
- Actual or impending acute airway compromise (e.g. traumatic/infective)
- Sedation to allow treatment of delirious patient’s underlying disorder
Describe cardiovascular support in terms of tanks
- Shock = tank pumping fluid to a tap
- Hypovolaemia = empty tank
- Distributive (sepsis/neurogenic) = leaky pipe
- Obstructive (tamponade, tension PTX)= blocked pipe
- Cardiogenic = pump failure
What is offered during cardiovascular support
- Invasive monitoring with appropriate fluid resuscitation
- Ionotropic vs vasoactive support
- Intra-aortic balloon counter pulsation
- Extracorporeal support (AV ECMO, VAD (Ventricular Assist Device) )
What is offered during renal support
-Dialysis rarely undertaken due traumatic physiological changes in context of limited reserve
-Renal Replacement Therapies (RRTs)
CVVHDF( Continuous Venovenous Haemodiafiltration)
SCUF( Slow Continuous Ultrafiltration)
SLED (Sustained Low Efficiency Dialysis)
What’s offered in hepatic support
- MARS (Molecular Adsorbents Recirculating System)
- Long term transplant only option
- Supportive management of acute decompensation of chronic failure
What’s offered in neurological support
- Airway protection
- ICP monitoring (bolts, continuous EEG)
- Treatment of ICP
Describe the treatment of ICP
-Management of physiological factors PCO2 + PO2 MAP Temp. Glucose
- Osmotherapy (hypertonic saline/mannitol)
- Therapeutic hypothermia
- Burst suppression of cerebral activity
