Critical Care Flashcards
What is critical care?
Management of fluids, respiratory failure cardiovascular failure and neurological failure
Involves the care of organ support whether this is single or multiple organs
What is the one thing to take away from this lecture?
A- Airways B-Breathing C-Cardiovascular D- Disability E- Exposure
What is the difference between Type 1 and Type 2 observations
Type 1 oxygenation failure p02 low, pCO2 fine.
Type 2 Ventilation failure- p02 and pCO2 low. Large amount of lung is compromised or something further up is wrong.
What is the first step of management of the assessment of a critically ill patient
What is important when looking at metabolic data
Get the obs truck in and get obs done.
To know how much oxygen the patient is on
What are the options of management in someone with respiratory problems
What can be induced by too much ventilator
Nasal cannula- 3/4 litres of oxygen
Trauma mask- 15L of oxygen
High fluid nasal cannula- wet warm gas. 70-80L of oxygen per minute. Gives positive pressure
NBI- reserved fro type 2 respiratory failure
ARDS
What are the 5 types of shock?
Hypovolaemic- not enough fluid
distributive- vascular tree abnormally dilated. enough blood but in the wrong bits
Anaphylactic- profound vasodilation, inflammatory markers released
Neurogenic- spinal cord injuries, typically high spinal cord injuries that knock out sympatheitc outflow
Cardiogenic- heart cannot pump enough
How is cardiovascular failure treated
Vasopressors, medications aimed at raising blood pressure. Examples of this include metaraminol, noradrenaline (alpha 1 agonists)
Inotropes, given to increase strength of heart contractions, examples of these include adrenaline (a and B receptor) and dobutamin B1 antagonist, non specific.
arterial tube used to measure each beat of the heart, tubes sit facing away from the heart.
Central lines can be put in, stay in for up to a week. Also allows strong medications to be given.
What is given to increase blood volume.
Why are colloids not used
Crystalloids and colloids are given to increase blood volume
commonly 0.18% saline and 5% dextrose. Can also be potassium chloride
induce anaphylactic shock
How do you decide what drugs to give when doing resucitation
Want big fluids that will stay in vascular tree longer, 5% dextrose sucks so don’t give that. Limit for fluids is 30ml per KG,
dont drown people in fluids.
Observe OBS after fluids are given, dont just walk away
What could cause neurological failure?
What are concerning consequences of neurovascular failure
Metabolic issues, trauma, infection, stroke
GCS<8 cant protect airways, uneven pupils, cushing reflex (increased ICP)
What is the job of critical care for a neurological injury?
Head injury has already been sustained, act as support. Make everything as normal as possible in the head. Avoid hypothermia, avoid high CO2, avoid oxygenation, dont allow glucose to get out of range, dont allow blood pressure to be too high
What is the first line of management for a neurological injury?
ABC! any quick fixes? diabetes, encephalitis, meningitis.
