Critical care assessment

Question 1

Patient is snoring and you suspect airway partially patent. How should you assess and correct?
If continues not to respond?

Answer 1

Listen/feel air flow
Head tilt/chin lift
Jaw thrust
If you suspect C spine injury - no head tilt/chin lift but can still jaw thrust
Can then use Guedel airway (If v unconscious GCS <8)
Gentle oral suction/nasal suction w/ the pt on the LEFT LATERAL position

Question 2

What can you use instead of guedel airway?

Answer 2

Nasophangeal airway - tolerated much better than guedel - usually size 7

If too conscious: other airway management techniques: recovery position, nasal airway, intubation, gentle suction.

Question 3

Asseessment of breathing?

Answer 3

Resp rate - fast (tachypnoea), difficult (dyspnoea)
Saturation (>94% OA)
Cyanosis
Examination: Symmetry of chest expansion
Percussion
Auscultation - breath sounds

Question 4

Treatment of breathing issue & if not breathing

Answer 4

High flow oxygen -
Reservoir mask + 15L/min O2
100% O2 non re-breath mask

If not breathing: bag and mask ventillation

Question 5

Assessment of circulation?

Answer 5

Perfusion - CRT, sats, cyanosis
Bleeding
Organ perfusion: reduced level of consciousness (brain), kidneys (urine output inadequate)
Heart sounds
Pulses - peripheral + central, rate, vol, rhythm
BP

Question 6

what timeframe post op is common to flip into AF?

Answer 6

72 hrs

Question 7

Treatment of circulation issue?

Answer 7

Fluid challenge - insert large bore IV access and take appropriate bloods (abc, U&E, coat, cultures, glucose)
Give 2x 250ml (one over 2 mins) fluid challenge (Hartmann’s) - assess response (lower HR, ^BP, perfusion etc) ,
(give up to 2000mls). Check for signs of overload.
Haemorrhage protocol
Blood gas

Question 8

Assesment of disability?

Answer 8

Level of consciousness (AVPU)/GCS
Pupils - signs of stroke
Glucose

Question 9

Assessment for exposure?

Answer 9

Focussed clinical examination
Abdomen - peritonitis, wound and stoma healthy, bleeding
Temperature
Life/limb threatening injuries

Question 10

Further management after ABCDE?

Answer 10

Ongoing observation - review charts, notes
Fluids
Abx
Further ivestiagtions - CXR/CT

Question 11

What is the lethal triad in trauma?

Answer 11

Coagulopathy, acidosis and hypothermia. 
Injury
 -> haemorrhage  -> coagulopathy
-> haemorrhage -> hypo perfusion -> acidosis
-> exposure -> hypothermia

Question 12

Give 3 life threatening chest injuries

Answer 12

tension pneumothorax
haemopneumothorax
flail chest
open pneumothorax
cardiac tamponade

Question 13

If bleeding what do you give? + dose

Answer 13

IV tranexamic acid -> 1g over 10 minutes, further 1g over 8hrs

Question 14

Signs of fluid overload?

Answer 14

^resp distress, bulging neck veins, crackles in chest