Critical Care

Question 1

What is meant by the term critical care/illness?

Answer 1

• Levels of care are ranked from 0-3
• Level 0 = Primary care
• Level 1 = Ward-based care

Critical care:

• Level 2 = HDU
• Level 3 = ITU
• The levels of care can also be thought of as relating to organ support
• Level 2 (HDU) = Single-organ support
• Level 3 (ITU) = Multi-organ support

Question 2

In what cases might a patient with single-organ support requirements be admitted to ITU?

Answer 2

If the patient required Invasive ventilation

Question 3

What is one of the most common reasons anaesthetists are involved in critical care?

Answer 3

Protection of Airways

Question 4

What are some of the procedures that can be used to protect an airway?

Answer 4

1 - Head tilt, chin lift, jaw thrust

2 - Oropharyngeal airway

3 - Tracheal intubation

4 - Surgery

Question 5

What is type I and type II respiratory failure?

Answer 5

Type I - Low level of O2 in the blood (<60mmHg)

Type II - Low level of O2 (<60mmHg) and high levels of CO2 (>50mmHg) in the blood

Question 6

On a NEWS chart, why is respiratory rate at the top?

Answer 6

It is the most sensitive marker of a deteriorating patient

Question 7

What other information is useful when evaluating a patient who is hyperventilating?

Answer 7

Blood Gas Analysis:

• Are they hypoxic?
• What’s their CO2 level?
• Acid base balance (bicarb vs. CO2)

Question 8

What options are there to provide a patient with oxygen if the their main problem is properly oxygenating?

Answer 8

1 - High-flow nasal cannula

2 - CPAP

3 - Intubation and invasive ventilation

4 - ECMO

Question 9

In which order are blood gases analysed?

Answer 9

1 - What’s the pH?

2 - What’s the CO2 and Bicarb?

3 - What’s the pO2?

Question 10

What calculations are most important when reviewing a patients circulation?

Answer 10

CO = HR x SV

SV = EDV-ESV

Question 11

Why are the cardiac output and stroke volume equations important to remember?

Answer 11

Because they can be manipulated by drugs

Question 12

Which medications can be given to a patient to change their cardiac output?

Answer 12

Beta-blockers - slow down HR

Chronotropes - increase HR

Question 13

Which medications can be given to a patient to change their strove volume?

Answer 13

Inotropes - Alter the strength of the hearts contractions

Vasopressors - Contract blood vessels, increase blood pressure and therefore increase afterload.

Fluids - can increase preload

Question 14

What device is used in ITU to constantly monitor a patients BP?

Answer 14

Arterial line

Question 15

What are the most important fluid types given to critically ill patients?

Answer 15

Crystalloids - Normal saline

Colloids - Albumin

Question 16

When drugs such as beta-blockers, inotropes and vasopressors have been administered to improve cardiac output and stroke volume, how are the results measured?

Answer 16

1 - Improved BP

2 - Measure urine output

3 - Conscious level

4 - Measure lactate (high levels indicate hypoperfusion, >2 = abnormal, >4 = very bad)

Question 17

What other organs are commonly affected in critically ill patients and what can anaesthetists do about it?

Answer 17

GI Failure - Unblock blockages & TPN

Kidney Failure - Dialysis

Liver Failure - Nothing can be done

Brain Failure - Often comas are induced in order to let patients tolerate airway maintenance

Question 18

A GCS of what usually indicates intubation is required?

Answer 18

< 8

Question 19

What is meant by a ‘fluid challenge’?

Answer 19

A fluid challenge is designed to identify whether the patient will be responsive to fluid administration, i.e. will the patient respond positively to giving continued fluids?

Question 20

In which patients are fluid challenges indicated?

Answer 20

1 - Hypotensive patients

2 - Patients with oliguria