CO = HR x SV - CO: ml/min - HR: beats/min - SV: ml

Critically Ill Patient Management Flashcards by Mina Patel

equation for BP?

BP = CO x TPR

note - BP = MAP - CVP but CVP is 0 usually

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equation for CO?

CO = HR x SV

CO: ml/min
HR: beats/min
SV: ml

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what is SV?

stroke volume - volume ejected with each heartbeat

difference between end-diastolic and end-systolic volumes

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normal SV?

50 to 100 ml

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equation for MAP?

MAP = DP + 1/3(SP - DP)

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what is done as part of airway assessment?

look: secretions, obstructions, pt speaking?
feel: trachea central, breath on cheek
listen: added sounds
measure: resp rate, o2 sat

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what is done as part of airway treatment?

maneuvres: HTCL, jaw thrust
O2: 15L high flow oxygen through non-rebreathe mask
-magill forceps: remove solid obs
-yankauer sucker: remove liquid secretions
airway adjuncts

if airway still not patent, escalate + intubation

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when is HTCL avoided?

?c-spine injury

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possible sounds that can be heard in airway assessment?

snoring
wheeze
stridor
no sounds

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airway adjuncts that can be used?

nasopharyngeal airway - less irritating, used if higher gcs

oropharyngeal airway - used if obtunded airway, very irritating so if pt can tolerate then suggests LOC/low GCS

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what is done before inserting an airway adjunct?

check size
lubricate with gel

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when wouldn’t you use a nasopharyngeal airway?

if ?basal skull fracture

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how to check size of an oropharyngeal airway vs. nasopharyngeal?

nasopharyngeal: nostril to tragus

oropharyngeal: midpoint of incisors to angle of mandible

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what is done as part of breathing assessment?

look: excessive muscle use, cyanosis, abnormal chest expansion, tripoding, respiratory distress

feel: normal/symmetrical chest expansion, percuss lung fields

listen: breath sounds (front and back chest )

measure: resp rate, o2 sat, ?abg, ?cxr request

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accessory muscles in respiration?

SCM
scalenes
pec minor
subcostal and intercostal (look like recessions)

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what does tracheal deviation suggest?

same side: lung collapse, fibrosis

opposite side: pneumothorax, pleural effusion, haemothorax, masses

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normal resp rate?

12-20 breaths per minute

worry if it is 24-25

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possible sounds that can be heard on percussion?

stony dull: fluid
dullish: consolidation
resonant: pneumothorax

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possible sounds that can be heard on auscultation?

crepitus
crackles (fine/coarse)
stridor
wheeze
rhonchi
rales

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what is done as part of breathing treatment?

15L high-flow o2 through non-rebreathe mask

nebuliser if indicated

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what is done as part of circulation assessment?

look: pallor, sweating, raised JVP

feel: peripheries for temp/clamminess, pulse (periph, central), ankle/sacral oedema

listen: heart sounds, lung bases

measure: hr, bp, CRT, UO, temp, bloods

what should be measured when checking pulse?

volume
rate
regularity
character

what is measured in an abg/vbg?

pH
pao2
paco2
hco3-

what are normal pH levels?

7.35-7.45

when is the target o2 sat around 94-97%?

if pt has impaired resp system - e.g. copd, hyperventilation syndrome, obesity

what is done as part of circulationt reatment?

2 large bore cannulae into the antecubital fossae if hypotensive then iv fluid bolus -> blood transfusion catheter to measure UO

what is done as part of disability assessment?

consciousness levels: AVPU or GCS PEARL neck stiffness measure: BM, ABG/VBG for lactate treatment: glucose if hypoglycaemic

what does AVPU stand for?

alert voice pain unresponsive

GCS components?

eye opening: spont (4), to speech (3), to pain (2), none (1) best verbal r: oriented (5), confused (4), inappropriate words (3), incomprehensible sounds (2), none (1) best motor r: obeys commands (6), moves to localise to pain (5), flexion withdrawal from pain (4), abnormal flexion (3), abnormal extension (2), none (1)

what forms part of exposure assessment?

top to toe (gross assessment) - rashes - bleeding - abdomen SNT? - calves SNT? relevant system exam other ix (swabs, cultures)

what is done after exposure assessment?

take full history document in notes SBAR handover

indications for intubation?

work of breathing too high poor oxygenation poor co2 clearance may be due to impaired airway patency

what signs may suggest a pt needs to be intubated?

gcs < 8 crt > 2s

what are the types of shock?

- hypovolaemic - distributive - mechanical - cytotoxic

what is hypovolaemic shock?

state of shock caused by loss of circulating volume -> reduced cardiac preload -> reduced cardiac output

what are causes of hypovolaemic shock?

bleeding diarrhoea vomiting serious burns

what is distributive shock?

state of shock caused by reduced SVR so decreased ability of blood to carry O2 to tissues therefore, despite increased CO, tissue is still not perfused

subtypes of distributive shock?

septic neurogenic anaphylactic psychogenic

what is mechanical shock?

state of shock caused by physical obstruction to heart filling -> reduced cardiac preload -> reduced CO

subtypes of mechanical shock?

obstructive cardiogenic

what is cytotoxic shock?

state of shock caused by uncoupling of tissue O2 delivery and mitochondrial O2 uptake

causes of cytotoxic shock?

CO poisoning CN- poisoning nitrate poisoning anaemia asphyxia

what is cardiogenic shock?

subtype of mechanical shock caused by irregular or absent functioning of heart prevents normal, effective circulation

causes of cardiogenic shock?

MI electrocution poisoning/overdose

what is obstructive shock? causes?

subtype of mechanical shock caused by physical obstruction within heart/vessels e.g. cardiac tamponade tension pneumothorax PE

what is psychogenic shock? causes?

temporary loss of circulating blood to braine causes: fear, emotional trauma, anxiety

what is septic shock? causes?

subtype of distributive shock caused by blood being unable to carry o2 due to buildup/introduction of poisons e.g. poisoning, sepsis from infection

what is anaphylactic shock?

subtype of distributive shock caued by release of histamines and redistribution of blood from core to surface e.g. allergic rxn

steps of escalation for oxygen therapy in pt with asthma?

give oxygen - max 4L nasal cannula o2 face mask high flow nasal oxygen (up to 60L/min, 100% o2) NIV intubation + ventilator

how do nasal cannulas work?

connected to gas cylinder or to wall source BUT they have dry air - not humidified due to high flow rate, causing airway to dry out and epithelial damage

benefit of O2 face mask over nasal cannulae?

provide humidified oxygen

how much oxygen in 1L? 2L? 3L? 4L?

1L - 24%, 2L - 28%, 3L - 32%, 4L - 36%.