Critical Care and Pharmogenetics

Question 1

what is high care

Answer 1

potential recovery who can benefit from detailed observation, 1-2% of beds and 1:1 patient to nurse ratio

Question 2

who should be admitted into ICU?

Answer 2

• those most likely to benefit
• those who need advanced respiratory support
• support of 2+ organ systems
• co-morbidities with acute reversible failure

Question 3

Care bundle interventions that shows improved outcomes in the critically ill

Answer 3

F - feeding
A - analgesia
S - sedation
T - thromboprophylaxis
H - head up
U - ulcer prophylaxis
G - glucose control

Question 4

name 4 pharmacogenetic disorders of anaesthesia

Answer 4

1. Malignant hyperthermia
2. Scoline apnea
3. Porphyria
4. Halothane hepatitis

Question 5

what is MH?

Answer 5

inherited disorder of calcium receptor on sarcoplasmic reticulum, hence volatiles trigger a hyper metabolic state = runaway cellular metabolism so there is a lot of CO2

Question 6

MH triggers

Answer 6

• volatiles
• sux most potent

Question 7

MH presentation

Answer 7

Early
- hypercapnia
- O2 extraction
- tachypnea

Late
- cyanosis
- muscle rigidity
- hyperthermia

Question 8

what are the consequences of MH?

Answer 8

• renal and hepatic failure
• coagulopathy
• cerebral oedema
• death

Can be treated if early recognition

Question 9

Management of MH

Answer 9

1. Stop trigger
2. Call for help
3. Hyperventilate at 100% O2
4. Give antidote = Dantrolene 2.5mg/kg initial bolus
5. Cool down pt and give supportive management with ice cold fluids
6. ICU admission

Question 10

What is scoline apnea ?

Answer 10

Prolonged sux effect after one dose
- abnormal or absent pseudocholinesterase enzyme

• doesn’t reverse after 5 minutes and no twitches even with nerve stimulator

Question 11

Scoline apnea Mx

Answer 11

1. ventilate
2. sedate
3. FFP
4. medic alert bracelet

Question 12

what is porphyria?

Answer 12

• accumulation of porphyrin in Afrikaans

Question 13

Porphyria precipitants

Answer 13

• Thiopentone
• Pain
• Infection
• Starvation
• Dehydration

Question 14

Clinical porphyria

Answer 14

• abdominal pain and vomiting
• motor and sensory neuropathy
• ANS dysfunction
• seizures, death and coma

Question 15

safe drugs with porphyria

Answer 15

Propofol for induction

Nitrous oxide
Isoflurane
Most volatiles probably safe

Suxamethonium
Atracurium

Morphine
Fentayl probably safe

Question 16

Type II hypersensitivity reaction

Answer 16

halothane hepatitis