Critical Care Flashcards
Na+ requirements for patients
1 - 2 mmol/kg/day
K+ requirements for patients
0.5 - 1mmol/kg/day
Fluid requirements for patients
25 - 30 ml/kg/day
Glucose requirements for patients
50 - 100 g/day
Care levels
0 = primary care 1 = ward based 2 = HDU 3 = ITU
What is involved in HDU?
Single organ support
What is involved in ITU?
Multi organ support
What levels of the care levels are classed as “critical care”?
Levels 2 and 3
- HDU
- ITU
What is the other factor, as well as organ support, which would mean you would need to come to the ITU?
Invasive ventilation
What does a definitive airway mean?
Gases go in and out without any problems / fancy instruments
What signs would indicate a bad airway?
See-saw breathing
Tracheal tug
Silent patient
Stridor
Which type of tubes do you need anaesthesia for?
Endotracheal tube = need anaesthetic
Tracheostomy tube = do not need sedation as does not hit the gag reflex
Airway manoeuvres
Head tilt, chin lift and jaw thrust most simple insert an airway - endotracheal tube - tracheostomy tube Intubation
Two types of respiratory failure
Type 1
Type 2
Type 1 respiratory failure
One problem = low O2
Type 2 respiratory failure
Two problems = low O2 and high CO2
What is the most common type of respiratory failure?
Type 1
What is the most sensitive marker of a deteriorating patient? (although not very specific)
Respiratory rate
Treatment if the patient has an issue with oxygenation
High flow nasal cannula - 2-4L at 20-30% Face mask (Hudson mask) - 4-10L at 40% O2 Trauma mask - 15L on ward at 80-90% CPAP Intubation and invasive ventilation ECMO
Treatment if the patient has an issue with CO2 removal
Some oxygenation might help
Invasive ventilation more indicated
What do CO = ?
CO = HR x SV
What does stroke volume involve?
Preload / contractility / afterload
What do beta blockers do to your HR?
Slow it down
What do chronotropes do to your HR?
Speed it up
What do inotropes do to your HR/CVS?
Drive contractility
What do vasopressors do to your HR/CVS?
Drive the afterload
What do fluids do to your HR/CVS?
Improve preload
Types of fluids
Crystalloids
Colloids
What is crystalloids?
Fluid that contains small molecules/electrolytes suspended in fluid
What are crystalloids used for?
To maintain the osmolarity
What are colloids?
Fluids that contain big molecules e.g. blood, starch. If given these, the big molecules are least likely to leak across the capillary bed and therefore stay in the vasculature longer.
What should never be used as a resuscitation fluid?
Dextrose
Cannulas vs central lines
Cannulas - can stay in for 72 hours - more flimsy Central lines - 7- 10 days
What do vasopressors do?
They are alpha-1-agonists which constrict blood vessels, predominately veins (“capacitance vessels”)
What do inotropes do?
Beta-1-agonists which improve contractility
How are inotropes usually given?
Via central lines
How to measure the results of drugs….
Look at end organ perfusion BP urine output Conscious level Capillary refill Lactate
What does looking at the urine output indicate?
If the kidney is perfused
What does looking at the conscious level indicate?
If the brain is perfused
What does looking at the capillary refill indicate?
If the skin is perfused
What is lactate a marker of?
Tissue hypoperfusion
Above what level of lactate is abnormal and what level is very bad?
abnormal = > 2
very bad > 4
What GCS score requires intubation?
8
Failure of which organs can occur in Disability?
Raised ICP = brain failure GI failure Pancreatic failure Kidney failure liver failure
How to treat raised ICP
Sedation to reduce BP to the brain
Neurosurgery
How to treat GI failure
Unblock / surgery
Feeding (NG tube)
How to treat pancreatic failure
Support diabetic function
How to treat kidney failure
Dialysis
CVVF in ITU
How to treat liver failure
not much you can do apart from liver transplant
