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CP3 Crit Care > Critically Ill patients > Flashcards

Critically Ill patients Flashcards

1
Q

EWS RR

A 
3 = <8 or >25
2 = 21-24
1 = 9-11
0 = 12-20
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2
Q

EWS SpO2

A 
3 = <91 
2 = 92-3
1 = 94-5
0 = >96
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3
Q

EWS HR

A 
3 = <40 or >131
2 = 111-130
1 = 41-50 or 91-110 
0 = 51-90
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4
Q

EWS SBP

A 
3 = <90 or >220 
2 = 91-100
1= 101-110
0 = 111-219
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5
Q

EWS AVPU

A 
3 = CVPU 
1 = New agitation or confusion 
0 = alert
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6
Q

EWS - temperature

A 
3 = <35
2 = >39.1
1 = 35.1-35 or 38.1-39 
0 = 36-8
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7
Q

SBARD

A

Situation - what is happening, where, who
Background - what circumstances leading up to situation
Assessment - NEWS, what do you think problem is
Recommendation - plz come + review, what should we d
Decision - are you coming to review + when

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8
Q

What is the Blatchford score for?

A

UGI bleed
0 = likely no admission
>6 = 50% need intervention

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9
Q

What is the triad of shock

A

low BP
Raised lactate
Signs of reduced perfusion

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10
Q

Referral criteria ITU

A 
Threatened airway 
Respiratory/cardiac arrest 
RR >40/<8
sats - <80% on >50% O2
HR - <40 or >140
SBP <90
Suddened decline in GCS by 2 points 
Repeated or prolonged seizures 
Resp acidosis and incr CO2
Any pt w/ clinical cause for concern
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11
Q

Def septic shock

A

Tissue hypoperfusion persisting 1 hr after crystalloid admin

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12
Q

Evidence of septic shock (3)

A

SBP <90
MAP <65
Lactate >4

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13
Q

Mx sepsis 6

A 
3 in: 
IV fl 
ABx
O2
3 out: 
UO 
Blood cultures 
Lactate
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14
Q

How is AKI graded?

A

Rifle criteria

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15
Q

What does the Rifle in the Rifle criteria stand for?

A 
Risk 
Injury 
Failure 
Loss 
ESRD
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16
Q

Mx AKI

A

Mostly supportive
Careful fluid balance
Med review
Tx hyperkalaemia

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17
Q

PS DKA (8)

A 
Abdo pain 
Pear drop breath 
Vomiting 
Kusmal respiration 
Polyuria, polydipsia, dehydration
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18
Q

3 criteria for DKA

A

BM >11
Cap ketones >3
pH <7.35 or bicarb <15

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19
Q

Tx DKA

A

Fl replacement
Insulin
Correct hypoglycaemia
Long acting insulin continued once IV insulin stopped

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20
Q

PS HHS

A

Fatigue, lethargy, N+V
Neuro - change consciousness, headache, weakness, papilloedema
hyperviscosity –> stroke/MI
CV - dehydration, decr BP + incr HR

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21
Q

Diagnosis criteria HHS

A

Hypovolaemia
BG >30 w/ no acidosis
Serum osm >320

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22
Q

Mx HHS

A

Normalise osmolality
Replace fl + electrolytes 0.9% NaCl
Normalise BG

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23
Q

ABG type 1 RF

A

O2 decr

CO2 normal or decr

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24
Q

What is T1RF due to a problem with?

A

Oxygenation

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25
Q

Conditions that cause T1RF (4)

A

Pneumonia/consolidation
Fibrosis
PE
Emphysema

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26
Q

Mx T1RF

A

O2

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27
Q

ABG T2RF

A

O2 low
CO2 high
Hence pH low

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28
Q

What is T2RF due to a problem with?

A

Ventilation

29
Q

Cause T2RF (4)

A

NM eg. MG/DMD/MND
Brainstem - OD/trauma
Obesity

30
Q

Mx T2RF

A

Bipap/NIV

31
Q

Features moderate acute asthma attack (4)

A

PEFR 50-75% predicted
Normal speech
RR <25
HR <110

32
Q

Features severe acute asthma attack (4)

A

PEFR 33-50%
Can’t complete sentances
RR >25
Pulse >110

33
Q

Features life threatening asthma attack (5)

A 
PEFR <33% 
O2 <92%
Silent chest, cyanosed 
Decr HR/BP 
Exhaustion, confusion, coma
34
Q

Mx acute asthma

A

A–>E
MgSO4
IV aminophylline
IV salbutamol

35
Q

Features of acute severe COPD exaccerbation (6)

A 
SOB
Cough
Wheeze 
Incr sputum 
Decr  O2 
Acute confusion
36
Q

Mx acute COPD exaccerbation

A

A–>E
Incr freq bronchodilator therapy –> nebs
Prednisolone 30mg
ABx e.g. amox

37
Q

Mx anaphylaxsis

A

A–>E
Adrenaline 1 in 1,000 - repeat ev 5mins (IM)
Hydrocortisone - 200mg
chlorphenamine - 10mg

38
Q

what blood test can be used after anaphylaxis

A

Serum tryptase

39
Q

Mx pulmonary oedema

A

O2
furosemide
Morphine
BP meds

40
Q

What are the 3 types of post-operative bleeding?

A

Primary
Reactive
Secondary

41
Q

Primary post operative bleeding

A

Within the intraoperative period

42
Q

Reactive post operative bleeding

A

Within 24hrs

43
Q

What is reactive post operative bleeding due to?

A

Cut vessel

44
Q

Secondary post operative bleeding

A

7-10 days post-op

45
Q

What is secondary post operative bleeding due to?

A

Infection eroding vessels

46
Q

Signs post-op bleed (7)

A 
Incr HR 
Incr RR
Decr BP (late sign) 
Dizzy 
Agitated 
Visible bleed 
Decr UO
47
Q

Mx post-op bleed

A 
A-->E
IV access 
Fl resus 
Read operation notes 
Direct P to visible bleed
Urgent sr review 
Blood transfusion/major haemorrhage protocol 
Return to threatre??
48
Q

PS major GI haemorrhage (4)

A

Haematemesis
Melaena
Pain
Collapse

49
Q

Oesophageal causes major GI haemorrhage (4)

A

Oesophagitis
Cancer
M-W tear
Varices

50
Q

Gastric causes major GI haemorrhage (3)

A

Gastric cancer
Gastritis
Ulcer

51
Q

PS - oesophagitis

A

Small vol fresh blood streaks vomit
Spontaenous cessation
GORD Sx precede

52
Q

PS oesophageal cancer

A

Small vol blood
Dysphagia
Wt loss

53
Q

PS M-W tear (2)

A

Small - mod vol bright red blood

Repeated vomiting

54
Q

PS oesophageal Varices (3)

A

large vol fresh blood
If swallowed –> melaena
Haemodynamic compromise

55
Q

PS Gastric Ca (3)

A

Frank haematemesis or mixed w/ vomit
Dyspepsia
Decr W/night sweats

56
Q

PS Gastritis (2)

A

Haemaemesis
Epigastric pain
Assoc w/ NSAID use

57
Q

Mx UGI haemorrhage

A 
A-->E 
Calculate Blatchford + Rockall score 
Bloods + O-ve transfusion 
Airway control 
Varices - Terlipressin before endoscopy/banding 
OGD - 24hrs of admin
58
Q

Who should have surgery for UGI haemorrhage (4)

A

> 60
Continued bleed despite endoscopy
Rec bleeding
Known CVD

59
Q

Sx of bacterial meningitis

A 
headache 
fever 
N+V
Photophobia 
Drowsiness 
Seizures
60
Q

CSF appearance bacterial meningitis (4)

A

Cloudy
Decr glucose
Incr protein
10-5000 WBC, polymorphs

61
Q

Ix bacterial meningitis

A 
FBC
CRP
Coag
Glucose 
ABG
LP
62
Q

Mx STEMI

A 
MOANA 
Morphine (5mpg) 
O2
Antiemetics - 10mg metocloperamide 
Nitrates 
Aspirin

PCI = gold standard

63
Q

Mx NSTEMI / UA

A 
BROMANCE 
B-blockers
Reassure 
O2 
Morphine 
aspirin 
Nitrates 
Clopidogrel
Enoxaparin
64
Q

cardiac arrest - Non-shockable rhythm Mx

A

Immediately resume CPR

10ml 1:10,000 Adrenaline ev 3-5mins

65
Q

cardiac arrest - shockable rhythms Mx

A

1 shock
Immediately resume CPR after
Adrenaline every 3-5mins (10ml 1:10,000)
300mg IV Amiodarone after 3 shocks

66
Q

Reversible causes of cardiac arrest (4H’s + 4Ts)

A 
Hypoxia 
Hypovolaemia 
Hypothermia 
Hypo/hyperkalaemia 
Toxins 
Tamponade 
Tension pneumothorax 
Thrombosis
67
Q

What are the 2 shockable rhythms

A

VF

VT

68
Q

What are the 2 non-shockable rhythms

A

PEA

asystole

69
Q

What is post arrest syndrome

A

Brain injury
Myocardial dysfunction
Systemic ischaemic response

CP3 Crit Care (9 decks)

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