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Anaesthetics > Critical Care > Flashcards

Critical Care Flashcards

1
Q

SEPSIS

What are the 4 clinical signs of SEPSIS?

(hint: use an ABC approach or think of the OBS)

A
  1. O2 saturations appear low at the outset (1)
  2. A raised respiratory rate manifests itself early in the course of the deterioration (2)
  3. Tachycardia is normally seen prior to hypotension (3)
  4. Hypotension is the latest of the signs (4)
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2
Q

ABCDE

How much fluid should you give to patient in shock initially?

A

Established shock an initial 20 ml/kg is suggested

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3
Q

SEPSIS

Define Sepsis

A

Source of infection + SIRS

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4
Q

Systemic Inflammatory Response Syndrome

How would you know a patient was having a systemic inflammatory response? Give a structured answer

A

General OBS

  • Temp abnormal
  • RR above 20
  • Tachycardia

Bloods

  • CO2 less than 4.3
  • Low WCC 4 12
  • High immature neutrophil count 10%
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5
Q

How is severe sepsis different to regular sepsis?

A

Severe Sepsis associated with organ dysfunction.

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6
Q

Define Septic Shock

A

Sepsis + Hypotension

despite adequate fluid resuscitation.

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7
Q

Differentials in Critical Care

What are the three classifications for clinical signs accompanying a coma?

A
  • Coma with focal neurological signs
  • Coma without focal neurology or meningism
  • Coma with meningism
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8
Q

Differentials in Critical Care

What might cause a coma with focal neurological signs?

A

Infection

  • meningitis
  • abscess,
  • encephalitis

cancer
-tumour

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9
Q

ABCDE

in an unconscious patient what do you need to check first

A

Airways

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10
Q

ABCDE Assessment
AVPU / GCS

How do you distinguish between flexion and localising to pain

A

localising to painful stimuli = raise hands above the level of the clavicle

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11
Q

Intensive Care Unit

The Acute Physiology and Chronic Health Evaluation score is used at the beginning of patient admission to ITU in order to calculate?

A

ICU Mortality

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12
Q

Acute Emergencies in ITU

At what point in airway Mgx would you consider using positive airway pressure?

A

If Oxygen delivery through a mask is inadequate for patients in Respiratory Failure

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13
Q

Acid Base Disorders

You are the GP

Maisy a 16 year old girl has asthma. Which acid base balance disorder would you expect in a patient with mild asthma?

A

Respiratory alkalosis

patients hyperventilate in response to hypoxia

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14
Q

Fluids

Average volume of water in a 70kg man

A

42 L

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15
Q

Fluids

Mr Bills is a 63 year old man who has been vomiting. What Assessment would you carry out? and What is the formula to calculate maintenance fluid requirements?

A

ABCDE

4 ml/kg/h for the first 10 kg
2 ml/kg/h for the next 10 kg
1 ml/kg/h for every kg over 20 kg

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16
Q

Fluids

Using the maintenance fluid formula, how much fluid would a 80 kg patient require?

A

40 + 20 + 60 = 120 mL / hr

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17
Q

Respiratory Physiology

What is a shunt?

A

Shunt describes areas with no ventilation but preserved blood flow

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18
Q

Respiratory Physiology

Formula to calculate oxygen delivery

A

Oxygen delivery

Cardiac output x CaO2

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19
Q

Respiratory Physiology

What is the oxygen content of the blood sensed by and where are these sensors located in the body?

A

The oxygen content of blood is sensed by carotid (mainly) and aortic oxygen-sensitive chemoreceptors in carotid and aortic bodies.

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20
Q

Respiratory Physiology

What is hypoxic pulmonary vasoconstriction?

A

Pulmonary capillaries constrict in response to hypoxia

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21
Q

Respiratory Physiology

Explain the Bohr effect

A

A description of the clever way haemoglobin releases oxygen

Represesnted by either a right or left shift in the oxygen dissociation curve

22
Q

Respiratory Physiology

Describe the Haldane effect

A

It is the dependency of carbon dioxide carrying capacity on the oxygenation status of haemoglobin.

Deoxygenation of haemoglobin in the tissues enhances carbon dioxide carriage, by activation of proton binding and carbamino formation sites.

Oxygenation of haemoglobin causes the reverse effect of displacing hydrogen ion and carbon dioxide, thereby facilitating unloading of carbon dioxide in the lungs.

In patients at risk of hypercapnia, administration of excessive oxygen results in CO2 being displaced from haemoglobin contributing to the increase in PaCO2.

23
Q

Respiratory Physiology

Hypoxia effects on the heart and kidney

A

Heart

  • Coronary vasodilatation
  • Decreased systemic vascular resistance
  • Tachycardia

Renal effects:

  • Activation of the renin-angiotensin system
  • Increased erythropoietin production
24
Q

Respiratory Physiology

Hypoxia effects on the blood vessels carrying oxygen to the brain

A

cerebral vasodilatation

25
Q

Respiratory Physiology

What level of brain hypoxia will cause confusion and decreased mental function

A

Confusion and decreased mental functioning occurs if the PaO2 falls to 6 kPa ( ~ SaO2 80 %)

26
Q

Respiratory Physiology

What level of brain hypoxia will cause a loss of consciousness

A

Consciousness is lost at 4 kPa ( ~ SaO2 56 %)

27
Q

ABCDE

The BTS guidelines recommend the use of high flow oxygen delivered by a ________ in all critically ill patients

Complete the sentence

A

Hudson non rebreathe reservoir mask at 15 L min in all critically ill patients

28
Q

ABCDE

The BTS guidelines recommend the use of a ______
for cardiac and respiratory arrest in order to ventilate a patient

Complete the sentence

A

bag-valve mask with oxygen reservoir should be used

29
Q

ABCDE

ABG Indications

A
  • During the initial assessment of a critically ill patient
  • Patients with un-explained hypoxaemia (SpO2 <94 %)
  • Worsening of long standing hypoxaemia
  • Any previously stable patient who deteriorates and requires a significantly increased FiO2 to maintain a constant oxygen saturation
  • Any patient with risk factors for hypercapnic respiratory failure who develops acute breathlessness, deteriorating oxygen saturation, drowsiness or other symptoms of carbon dioxide retention
  • Breathless patients who are thought to be at risk of metabolic conditions such as diabetic ketoacidosis or metabolic acidosis due to renal failure [Grade D]
  • Acutely breathless or critically ill patients with poor peripheral circulation in whom a reliable oximetry signal cannot be obtained
30
Q

ABCDE OXYGEN

You are the a and e doctor.
The patient has COPD with low sats of 82. You put them on Oxygen via a venturi mask. What blood test do you need to do to make sure patient is accumulating CO2?

A

ABG

For patients with a target saturation of 88-92 %, blood gas analysis done within 30-60 min of starting oxygen therapy helps to detect carbon dioxide accumulation.

31
Q

ABCDE OXYGEN

What is the lowest dose of oxygen for most stable convalescent patients and what do you administer with

A

2 L/min of oxygen with nasal cannulae or 24 % venturi mask for patients at risk of hypercapnia.

32
Q

ABCDE OXYGEN

For spontaneously breathing patients, oxygen therapy devices fall into two categories:

A

Fixed performance devices
(HAFOE)

Variable performance devices

33
Q

ABCDE OXYGEN

Variable performance devices

A

Nasal cannulae and catheters

Medium oxygen concentration providing face masks

High oxygen concentration providing face masks with reservoir bag

34
Q

ABCDE OXYGEN

What group of patients might need controlled oxygen therapy?

A

COPD
CF
Obese > 40BMI
Chest Wall Deformity

35
Q

ABCDE OXYGEN

Correct oxygen therapy for
Post op patient

A

Medium concentration oxygen delivery through nasal cannula facemask

36
Q

ABCDE OXYGEN

Correct oxygen therapy for
critically ill patient

A

15L Oxygen from a non rebreathe Hudson mask with resevoir bag

37
Q

ABCDE OXYGEN

Correct oxygen therapy for
patient at risk of hypercapnic respiratory failure

A

Controlled oxygen therapy with venturi mask

38
Q

ACID BASE

alveolar hypoventilation will cause what type of acid base disturbance

A

Respiratory acidosis

39
Q

ACID BASE

alveolar hyperventilation will cause what type of acid base disturbance

A

Respiratory alkalosis

40
Q

ACID BASE

What does the deficit refer to

A

the amount of acid in mmol/L that must be added or subtracted from the same blood sample with an Hb set at 5.5 g/dL to regain a normal pH at a PCO2 of 40 mmHg

The more negative the SBE, the more acidotic the blood sample

41
Q

TRUE or FALSE

The pulmonary excretion of CO2: will raise the serum H+ concentration

A

False

42
Q

TRUE or FALSE

The pulmonary excretion of CO2:will raises the serum pH

A

True

43
Q

TRUE or FALSE

The pulmonary excretion of CO2: Decreases the renal excretion of bicarbonate

A

False

44
Q

TRUE or FALSE

The pulmonary excretion of CO2: Raises the serum concentration of bicarbonate

A

True

45
Q

If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: The cerebral blood flow decrease

A

True

46
Q

If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: The standard bicarbonate decreases

A

False

47
Q

If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: The Hb-oxygen dissociation curve shifts to the left

A

True

48
Q

If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: The ionised calcium concentration decreases

A

True

49
Q

If a normal person hyperventilates for 2 hours to an arterial PCO2 of 4 kPa: The plasma bicarbonate increases

A

False

50
Q

Critical Care Patient

A 
Presentation of Condition needing Surgery
CVS Resp Funtional Capacity
Other Systems Review
Drugs
Allergies
Peri Op Modifications
Examination eg airway
Igx Findings
Differentials
Precipitating Factor for critical care referral
Initial ABCDE
Initial Mgx
Goals of critical care
Care Bundles

Future Mgx

Anaesthetics (6 decks)

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