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Anaesthetics, ED and Plastics > Critical Care > Flashcards

Critical Care Flashcards

1
Q

What are NA requirements

A

1-2 mol / kg / day

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2
Q

What are K, Cl and Na requirements

A

0.5-1 mol / kg / day

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3
Q

What are fluid requirements

A

25-30ml / kg / day

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4
Q

What are glucose requirements

A

50-100g / day

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5
Q

What are levels of care

A 
0 = primary 
1 = ward
2.= HDU (single-organ)
3 = ITU (multi-organ / invasive ventilation)
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6
Q

What suggests a bad airway

A 
Sea-saw breathing
Tracheal tug
Stridor 
Recession
Silent = very worrying
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7
Q

What is a definite airway

A

Gases go in and out of airway without any problem

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8
Q

What is airway maintenance

A

Airway open and unobstructed

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9
Q

What is airway protection

A

Cuffed tube in trachea to protect from contamination
Only air enters lung
e.g. intubation from endotracheal tube or tracheostomy

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10
Q

What is simple airway management

A

Head tilt, chin lift, Jaw thrust

  • Caution if head and neck trauma
  • Caution in AS due to risk of fracture
  • RA / Down - atlanto-axial subluxation
Adjunt
- Nasopharyngeal
- Oropharyneal - Guedeel
- Laryngeal mask 
Maintain airways but DON'T protect
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11
Q

What is a nasopharyngeal airway and when is it used

A

Inserted into nostril if reduced GCS
Measure from tip of nose to triages
Well tolerated in low GCS
Ideal if seizure and can’t insert OPA

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12
Q

When is nasopharyngeal CI

A

Base of skull fracture

Underlying coagulopathy

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13
Q

What is an oropharyngeal airway

A

Used as bridge to more definite as no sedation required but can only tolerate if unconscious
Measure from angle of jaw to teeth
Female = orange
Male = green

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14
Q

What is a laryngeal mask

A

Sits in pharynx above vocal cord
Paralysis not required so can use if just anaesthesia
- If short procedure or low risk

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15
Q

When is laryngeal mask not suitable

A

High pressure ventilation
If not fasted as risk of aspiration as no protection against reflux
Morbid obesity

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16
Q

What is used for airway protection

A 
Endotracheal tube (intubation) 
Tracheostomy
- Performed by ENT surgeon 
Cricothyroiectomy 
- Used in emergency
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17
Q

What is endotracheal tube good for

A

Protecting airway
Cuffed tube seals of trachea
Allow high pressure gas into lungs and not other places
Long and short term ventilation

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18
Q

What does it require

A

Anaesthetic to be put in and for duration of care

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19
Q

What if GI obstruction

A

High risk of aspiration so do rapid induction with pressure to occlude oesophagus then insert

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20
Q

What are risks

A

Traumatic tube insertion

Risk of trachea-oesophageal formation = pneumonia

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21
Q

What is tracheostomy good for

A

Weaning of ventilator
Awake as hole in neck so gag reflex not hit
Can suction to stop infection so useful if weak and can’t cough
Reduces work of breathing

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22
Q

Why do you intubate

A

Protect airway from gastric content
If need tight control of blood gas
If shared airway with risk of blood contamination (surgery in same place)
If restricted acess

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23
Q

What does intubation require

A

Muscle relaxant as gag reflex

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24
Q

What are complications of airway management

A

Failure to wean of ventilator
Obstruction
Aspiration if lose reflex

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25
Q

What can cause failure to wean

A

If suxamethonium apnoea due to cholinesterase deficiency / myasthenia
So take longer to break down relaxant

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26
Q

What causes obstruction

A

Ineffective triple manoeuvre
Airway device malposition
Laynrgospasm if light plains of anaesthesia

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27
Q

What is type 1 and type 2 resp failure

A

Type 1 = low O2

Type 2 = low O2 and high CO2

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28
Q

If patient hyperventilating what do you do

A

Blood gas

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29
Q

How can you give oxygen and at what rate

A

High flow nasal cannula = 2-4l at 20-30% O2

Hudson face mask = 4-10l at 40% O2

Trauma / non-rebreathe = 15l at 80-90%

Venturi - 24-28l

CPAP

Intubation and ventilation

ECMO

30
Q

If high CO2 what is indicated

A

Invasive ventilation

O2 may help slightly

31
Q

What happens if getting tired

A

No matter how much oxygen you give it won’t work

Want to ventilate for as short a time as possible

32
Q

Blood gas

A

YES

33
Q

What makes up CO

A

HR x SV

34
Q

What affects SV

A

Preload
Contractility
Afterload
Very hard to measure

35
Q

How do you measure BP

A

BP cuff
Arterial line = more accurate
Important to measure but doesn’t reflex CO accurately
Can have good pressure and poor CO

36
Q

How do you speed up heart

A

CHronotrope

37
Q

How do you slow down heart

A

BB

38
Q

How do you improve contractility

A

Inotrope - B1 agonist

Requires central line

39
Q

How do you affect afterload

A

Vasopressor = alpha 1 agonist

40
Q

How do you improve preload

A

Fluids

41
Q

What is better than a cannula

A

Central line
Can put stronger drugs through
Stays in for longer 7-10 ays

42
Q

How do you measure result to drugs

What is a good marker of hypo perfusion

A 
BP
UO 
Conscious level
Lactate - marker of hypo-perfusion
>2 = abnormal
>4 = very serious
43
Q

What are crystalloids and when are they useful

A

Small molecules of electrolyte
Saline / plasmaLyte
Maintain osmolality
Used for resus if vasodilated to fill

44
Q

What are colloid and when are they useful

A

Big molecules

Rarely used unless bleeding to death

45
Q

What do recent guidelines for sepsis suggest

A

30ml / kg fluid

Switch to vasopressor if no longer work

46
Q

What is the risk of large quantities of IV saline

A

Hypercholoaemic acidosis as high volume of Na and Cl

47
Q

What is now favoured

A

PlasmaLyte as more balanced

48
Q

What is not recommended post surgery

A

5% dextrose

49
Q

If patient haemodynaimcally stable and euvolaemic what do you do

A

Restart oral

50
Q

When should you review

A

If low Na <20

51
Q

If patient oedematous but hypovolaemic

A

Treat hypovolaemia first
Then follow with -ve balance of Na and H20
Monitor Na excretion levels

52
Q

Look at table with values of electrolyte of fluid

A

OK

53
Q

How can you get IV access

A 
Peripheral venous cannula
Central line 
IO 
Tunnelled lines 
PICC - peripherally inserted central cannula
54
Q

What are cannula unsuitable for

A

Vasoactive drugs e.g. inotrope

TPN

55
Q

What size of cannula

A 
If stable = smaller cannula
The larger the number the smaller the cannula as can fit 22 in etc 
Grey = biggest
Green
Pink
Blue 
Yellow = smallest
56
Q

What should you avoid in DM

A

Feet

57
Q

What is 1st line route for central line

A

Internal jugular

USS guided

58
Q

What has higher risk of infection

A

Femora but easier to site

59
Q

What is most common area for IO

A

Anteromedial aspect of proximal tibial = most common
Distal femur
Humeral head

60
Q

When do you do IO

A

Paediatric

If perisperhal will be difficult as shut down

61
Q

What are Tunneled lines good for

A

Long term use

62
Q

When do you intubate

A

GCS <8

63
Q

When is head tilt, chin lift CI

A

C-spine injury
AS
RA - atlantoaxial subluxation
Disc protrusion

64
Q

If unconscious patient how do you assess

A

DRABCDE

65
Q

If respiratory effort + normal sounds

A

Airway patient

Continue BLS

66
Q

If respiratory effort + abnormal sounds e.g. snoring (tongue blocking) or stridor

A

Suggests partial obstruction

67
Q

If respiratory effort + non ventilation

A

Suggest complete obstruction

May have tracheal tug or sea saw breathing

68
Q

What do you do if obstruction

A

Triple manoeuvre - HT / CL / JT
Insert simple airway - NP / OP
LMA - laryngeal = next
Endotracheal tube

69
Q

What else once airway established

A

Bag / mask and vent

70
Q

If can find radial pulse what does this suggest

A

BP systolic >90

Anaesthetics, ED and Plastics (14 decks)

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