Critical Care Flashcards
What is critical care?
- Initial assessment - ABCDE
- Organ system support
- Single vs multiple
What are the different levels of critical care?
- Level 1 care
- Ward based care
- Level 2 care
- Used to be called high dependency unit (HDU)
- Single organ support
- Level 3 care
- Intensive care
- Multiple organ support
What are the different classifications of respiratory failure?
- Type 1
- Oxygenation failure
- Type 2
- Oxygenation and ventilation
Describe the management of type 1 respiratory failure?
- Give oxygen
- On ward can give 0-15L/min
- Nasal canuli (2-4L/min, 25-30% oxygen)
- Hudson mask (4-10L/min, 40% oxygen)
- Trolley mask (15L/min, 90% oxygen)
- In critical care
- High flow nasal canuli (humidifies air so can give more oxygen than normal ward, 70L/min, 100% oxygen)
- On ward can give 0-15L/min
How much oxygen can be given in a ward?
0-15L
- Nasal canuli (2-4L/min, 25-30% oxygen)
- Hudson mask (4-10L/min, 40% oxygen)
- Trolley mask (15L/min, 90% oxygen)
How much oxygen can be given in critical care?
- High flow nasal canuli (humidifies air so can give more oxygen than normal ward, 70L/min, 100% oxygen)
Describe the management of type 2 respiratory failure?
- Non-invasive ventilator – applies pressure to airways to keep them open and reduce work of breathing
- Invasive ventilator – stops air from escaping, protects the airway from secretions
- Need NG tube for feeding, cannot talk
- Tracheostomy – for long term, allows patient to swallow
What is shock?
Shock = acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia
What are the different classifications of shock?
- Distributive (septic)
- Blood going to wrong places
- Hypovolemic
- Aetiology – blood loss, trauma, surgery
- Anaphylactic
- Blood vessels abnormally dilated so blood going to wrong places, but also pump failure (unlike distributive)
- Neurogenic
- Disruption of sympathetic nervous system causes abnormal vasodilation – blood in wrong places
- Cardiogenic
- ‘Heart failure’ – heart cannot pump blood around the body
What is distributive shock also called?
Septic shock
What is septic shock?
- Blood going to wrong places
What is the cause of hypovolaemic shock?
- Aetiology – blood loss, trauma, surgery
What is anaphylactic shock?
- Blood vessels abnormally dilated so blood going to wrong places, but also pump failure (unlike distributive)
What is neurogenic shock?
- Disruption of sympathetic nervous system causes abnormal vasodilation – blood in wrong places
What is cardiogenic shock?
- ‘Heart failure’ – heart cannot pump blood around the body
What is cardiogenic shock also called?
Heart failure
What formula relates CO, HR and SV?
- CO = HR x SV
What are markers of potential stroke volume?
- SV = Preload/contractility/afterload (markers)
Describe the management of CV failure?
- AV line or central line
- Gives absolute measurement of BP, allows repeated blood sampling for gases
- Vasopressors
- Effect – cause vasoconstriction, increasing preload
- Indication – septic shock (distributive issues)
- Drugs
- Metraminol
- Noradrenaline
- Inotropes
- Effect – increases heart rate and contractility, also causes vasoconstriction
- Indication - cardiogenic
- Drugs
- Adrenaline
- Dobutamine – only increases HR and contractility, not vasoconstrictor (B agonist)
- Fluids
- Colloids (fluid with large osmotically active particles) or crystalloids (fluids with small molecules, such as saline or dextrose)
- Maintenance or resuscitation
- 30mg/kg is the limit
What does an AV or central line allow?
- Gives absolute measurement of BP, allows repeated blood sampling for gases
What are the effectos of vasopressors?
- Effect – cause vasoconstriction, increasing preload
What is a consequence of vasocontriction on CVS physiology?
Increases preload
What are indications for vasopressors?
- Indication – septic shock (distributive issues)
What drug is used for septic shock (distributive issues)?
Vasopressors
What are examples of vasopressors?
- Metraminol
- Noradrenaline
What are the effects of inotropes?
- Effect – increases heart rate and contractility, also causes vasoconstriction
What is an indication for inotropes?
- Indication - cardiogenic shock
What are examples of inotropes?
- Adrenaline
- Dobutamine – only increases HR and contractility, not vasoconstrictor (B agonist)
What drug is used for cardiogenic shock?
Inotropes
What are the different categories of fluids?
- Colloids (fluid with large osmotically active particles) or crystalloids (fluids with small molecules, such as saline or dextrose)
What are colloids and crystalloids?
Colloids - fluid with large osmotically active particles
Crystalloids - fluids with small molecules, such as saline or dextrose
What is the maximum amount of fluid that can be given?
30mg/kg
What are the different classifications of neurological failure?
- Metabolic
- Other problem has caused reduced conscious level, such as severe sepsis, renal failure, electrolyte failure or inflammation
- Trauma
- Infection
- Meningitis and encephalitis
- Stroke
Describe the management of neurological failure?
- Optimise patients ventilation
- Fluid management to get blood into head
What are complications of neurological failure?
- Problems breathing, protecting airway
