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Anaesthetics > Critically Ill Patient Management > Flashcards

Critically Ill Patient Management Flashcards

1
Q

equation for BP?

A

BP = CO x TPR

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

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2
Q

equation for CO?

A

CO = HR x SV

  • CO: ml/min
  • HR: beats/min
  • SV: ml
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3
Q

what is SV?

A

stroke volume - volume ejected with each heartbeat

difference between end-diastolic and end-systolic volumes

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4
Q

normal SV?

A

50 to 100 ml

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5
Q

equation for MAP?

A

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

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6
Q

what is done as part of airway assessment?

A
  • look: secretions, obstructions, pt speaking?
  • feel: trachea central, breath on cheek
  • listen: added sounds
  • measure: resp rate, o2 sat
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7
Q

what is done as part of airway treatment?

A
  • 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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8
Q

when is HTCL avoided?

A

?c-spine injury

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9
Q

possible sounds that can be heard in airway assessment?

A

snoring
wheeze
stridor
no sounds

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10
Q

airway adjuncts that can be used?

A

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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11
Q

what is done before inserting an airway adjunct?

A

check size
lubricate with gel

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12
Q

when wouldn’t you use a nasopharyngeal airway?

A

if ?basal skull fracture

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13
Q

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

A

nasopharyngeal: nostril to tragus

oropharyngeal: midpoint of incisors to angle of mandible

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14
Q

what is done as part of breathing assessment?

A

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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15
Q

accessory muscles in respiration?

A

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

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16
Q

what does tracheal deviation suggest?

A

same side: lung collapse, fibrosis

opposite side: pneumothorax, pleural effusion, haemothorax, masses

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17
Q

normal resp rate?

A

12-20 breaths per minute

worry if it is 24-25

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18
Q

possible sounds that can be heard on percussion?

A

stony dull: fluid
dullish: consolidation
resonant: pneumothorax

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19
Q

possible sounds that can be heard on auscultation?

A

crepitus
crackles (fine/coarse)
stridor
wheeze
rhonchi
rales

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20
Q

what is done as part of breathing treatment?

A

15L high-flow o2 through non-rebreathe mask

nebuliser if indicated

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21
Q

what is done as part of circulation assessment?

A

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

22
Q

what should be measured when checking pulse?

A

volume
rate
regularity
character

23
Q

what is measured in an abg/vbg?

A

pH
pao2
paco2
hco3-

24
Q

what are normal pH levels?

A

7.35-7.45

25
Q

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

A

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

26
Q

what is done as part of circulationt reatment?

A

2 large bore cannulae into the antecubital fossae

if hypotensive then iv fluid bolus -> blood transfusion

catheter to measure UO

27
Q

what is done as part of disability assessment?

A

consciousness levels: AVPU or GCS
PEARL
neck stiffness

measure: BM, ABG/VBG for lactate

treatment: glucose if hypoglycaemic

28
Q

what does AVPU stand for?

A

alert
voice
pain
unresponsive

29
Q

GCS components?

A

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)

30
Q

what forms part of exposure assessment?

A

top to toe (gross assessment)
- rashes
- bleeding
- abdomen SNT?
- calves SNT?

relevant system exam
other ix (swabs, cultures)

31
Q

what is done after exposure assessment?

A

take full history
document in notes
SBAR handover

32
Q

indications for intubation?

A

work of breathing too high
poor oxygenation
poor co2 clearance

may be due to impaired airway patency

33
Q

what signs may suggest a pt needs to be intubated?

A

gcs < 8
crt > 2s

34
Q

what are the types of shock?

A
  • hypovolaemic
  • distributive
  • mechanical
  • cytotoxic
35
Q

what is hypovolaemic shock?

A

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

36
Q

what are causes of hypovolaemic shock?

A

bleeding
diarrhoea
vomiting
serious burns

37
Q

what is distributive shock?

A

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

38
Q

subtypes of distributive shock?

A

septic
neurogenic
anaphylactic
psychogenic

39
Q

what is mechanical shock?

A

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

40
Q

subtypes of mechanical shock?

A

obstructive
cardiogenic

41
Q

what is cytotoxic shock?

A

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

42
Q

causes of cytotoxic shock?

A

CO poisoning
CN- poisoning
nitrate poisoning
anaemia
asphyxia

43
Q

what is cardiogenic shock?

A

subtype of mechanical shock caused by irregular or absent functioning of heart

prevents normal, effective circulation

44
Q

causes of cardiogenic shock?

A

MI
electrocution
poisoning/overdose

45
Q

what is obstructive shock? causes?

A

subtype of mechanical shock caused by physical obstruction within heart/vessels

e.g. cardiac tamponade
tension pneumothorax
PE

46
Q

what is psychogenic shock? causes?

A

temporary loss of circulating blood to braine

causes: fear, emotional trauma, anxiety

47
Q

what is septic shock? causes?

A

subtype of distributive shock caused by blood being unable to carry o2 due to buildup/introduction of poisons

e.g. poisoning, sepsis from infection

48
Q

what is anaphylactic shock?

A

subtype of distributive shock caued by release of histamines and redistribution of blood from core to surface

e.g. allergic rxn

49
Q

steps of escalation for oxygen therapy in pt with asthma?

A

give oxygen - max 4L

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

50
Q

how do nasal cannulas work?

A

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

51
Q

benefit of O2 face mask over nasal cannulae?

A

provide humidified oxygen

52
Q

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

A

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

Anaesthetics (5 decks)

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