Critically Ill Patient Management Flashcards
equation for BP?
BP = CO x TPR
note - BP = MAP - CVP but CVP is 0 usually
equation for CO?
CO = HR x SV
- CO: ml/min
- HR: beats/min
- SV: ml
what is SV?
stroke volume - volume ejected with each heartbeat
difference between end-diastolic and end-systolic volumes
normal SV?
50 to 100 ml
equation for MAP?
MAP = DP + 1/3(SP - DP)
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
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
when is HTCL avoided?
?c-spine injury
possible sounds that can be heard in airway assessment?
snoring
wheeze
stridor
no sounds
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
what is done before inserting an airway adjunct?
check size
lubricate with gel
when wouldn’t you use a nasopharyngeal airway?
if ?basal skull fracture
how to check size of an oropharyngeal airway vs. nasopharyngeal?
nasopharyngeal: nostril to tragus
oropharyngeal: midpoint of incisors to angle of mandible
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
accessory muscles in respiration?
SCM
scalenes
pec minor
subcostal and intercostal (look like recessions)
what does tracheal deviation suggest?
same side: lung collapse, fibrosis
opposite side: pneumothorax, pleural effusion, haemothorax, masses
normal resp rate?
12-20 breaths per minute
worry if it is 24-25
possible sounds that can be heard on percussion?
stony dull: fluid
dullish: consolidation
resonant: pneumothorax
possible sounds that can be heard on auscultation?
crepitus
crackles (fine/coarse)
stridor
wheeze
rhonchi
rales
what is done as part of breathing treatment?
15L high-flow o2 through non-rebreathe mask
nebuliser if indicated
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%.
