Critical care

Question 1

When talking about levels of care, what is meant by Level 1, 2 & 3?

Answer 1

Level 1 = Normal ward

Level 2 = HDU - single organ support

Level 3 = ICU/ITU - multi organ support

These levels are not very distinct from eachother though - theres lots of overlap depending on the ward etc

Question 2

What is the difference between type 1 and type 2 respiratory failure?

Answer 2

Type 1 = oxygenation failure

Type 2 = oxygenation failure + ventilation (CO2 clearance) failure

Question 3

On the wards, what methods of oxygen delivery can be used? (in ascending order of L/min)

Answer 3

Nasal cannula:

• 2 - 4 L/min
• 25-30% O2

Hudson mask:

• 4 - 10 L/min
• 40% O2

Trauma mask:

• 15 L/min
• 90% O2

Question 4

In critical care, what types of oxygen delivery can be used for respiratory failure?

Answer 4

High flow nasal cannula:

• type 1 respiratory failure

NIV - non-invasive ventilator:

• type 2 respiratory failure

Intubation (ETTs etc):

• severe respiratory failure
• if prolonged stay - tracheostomy to bypass oropharynx

Question 5

Define shock

Answer 5

Shock is acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia

Question 6

What are the types of shock

Answer 6

Distributive (septic)

Hypovolaemic

Anaphylactic

Cardiogenic

Neurogenic

Question 7

What groups of drugs are given in critical care for CVS failure?

Give examples of each

Answer 7

Vasopressors - eg metaraminol, noradrenaline

Inotropes - eg adrenaline, dobutamine

Question 8

What are vasopressors?

Answer 8

Alpha 1 agonists

These cause vasoconstriction - mainly of veins

The effect of this is to increase preload and afterload

Question 9

What are the similarities & differences between the vasopressors Metaraminol and Noradrenaline?

Answer 9

Metaraminol:

• A1 agonist + little bit of Beta activity
  
  • effect = vasoconstriction + small increase in contractility
• can be given peripherally or through central line

Noradrenaline:

• A1 agonist + lil bit Beta activity
  
  • same effect as ^
• only via central line

Question 10

What are inotropes?

Answer 10

Beta agonists

These act to increase heart contractility - so are useful for patients who just aint pumping right

Their effect is to increase HR & contractility

Question 11

What are the similarities and differences between the inotropes Adrenaline and dobutamine?

Answer 11

Adrenaline:

• Alpha and beta agonist so causes vasoconstriction (alpha effect) and an increase in HR and contractility (beta)
  
  • useful in patients with both problems

Dobutamine:

• Beta agonist only - so only increased HR, contractility
  
  • useful in heart failure

Question 12

What is the difference between colloid and chrystaline fluids?

Answer 12

Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules - includes saline and plasmalite

Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid

Question 13

What is the fluid limit before you should refer to critical care? (ie fluids arent working)

Answer 13

30 ml/kg is the limit

so if someone is 100 kg - then 3 litres is the max amount of fluid before youre like nah

Question 14

What are the different groups of causes of neurological failure?

Answer 14

Metabolic

Trauma

Infection

Stroke