Critically Ill patients Flashcards
EWS RR
3 = <8 or >25 2 = 21-24 1 = 9-11 0 = 12-20
EWS SpO2
3 = <91 2 = 92-3 1 = 94-5 0 = >96
EWS HR
3 = <40 or >131 2 = 111-130 1 = 41-50 or 91-110 0 = 51-90
EWS SBP
3 = <90 or >220 2 = 91-100 1= 101-110 0 = 111-219
EWS AVPU
3 = CVPU 1 = New agitation or confusion 0 = alert
EWS - temperature
3 = <35 2 = >39.1 1 = 35.1-35 or 38.1-39 0 = 36-8
SBARD
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
What is the Blatchford score for?
UGI bleed
0 = likely no admission
>6 = 50% need intervention
What is the triad of shock
low BP
Raised lactate
Signs of reduced perfusion
Referral criteria ITU
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
Def septic shock
Tissue hypoperfusion persisting 1 hr after crystalloid admin
Evidence of septic shock (3)
SBP <90
MAP <65
Lactate >4
Mx sepsis 6
3 in: IV fl ABx O2 3 out: UO Blood cultures Lactate
How is AKI graded?
Rifle criteria
What does the Rifle in the Rifle criteria stand for?
Risk Injury Failure Loss ESRD
Mx AKI
Mostly supportive
Careful fluid balance
Med review
Tx hyperkalaemia
PS DKA (8)
Abdo pain Pear drop breath Vomiting Kusmal respiration Polyuria, polydipsia, dehydration
3 criteria for DKA
BM >11
Cap ketones >3
pH <7.35 or bicarb <15
Tx DKA
Fl replacement
Insulin
Correct hypoglycaemia
Long acting insulin continued once IV insulin stopped
PS HHS
Fatigue, lethargy, N+V
Neuro - change consciousness, headache, weakness, papilloedema
hyperviscosity –> stroke/MI
CV - dehydration, decr BP + incr HR
Diagnosis criteria HHS
Hypovolaemia
BG >30 w/ no acidosis
Serum osm >320
Mx HHS
Normalise osmolality
Replace fl + electrolytes 0.9% NaCl
Normalise BG
ABG type 1 RF
O2 decr
CO2 normal or decr
What is T1RF due to a problem with?
Oxygenation
Conditions that cause T1RF (4)
Pneumonia/consolidation
Fibrosis
PE
Emphysema
Mx T1RF
O2
ABG T2RF
O2 low
CO2 high
Hence pH low
What is T2RF due to a problem with?
Ventilation
Cause T2RF (4)
NM eg. MG/DMD/MND
Brainstem - OD/trauma
Obesity
Mx T2RF
Bipap/NIV
Features moderate acute asthma attack (4)
PEFR 50-75% predicted
Normal speech
RR <25
HR <110
Features severe acute asthma attack (4)
PEFR 33-50%
Can’t complete sentances
RR >25
Pulse >110
Features life threatening asthma attack (5)
PEFR <33% O2 <92% Silent chest, cyanosed Decr HR/BP Exhaustion, confusion, coma
Mx acute asthma
A–>E
MgSO4
IV aminophylline
IV salbutamol
Features of acute severe COPD exaccerbation (6)
SOB Cough Wheeze Incr sputum Decr O2 Acute confusion
Mx acute COPD exaccerbation
A–>E
Incr freq bronchodilator therapy –> nebs
Prednisolone 30mg
ABx e.g. amox
Mx anaphylaxsis
A–>E
Adrenaline 1 in 1,000 - repeat ev 5mins (IM)
Hydrocortisone - 200mg
chlorphenamine - 10mg
what blood test can be used after anaphylaxis
Serum tryptase
Mx pulmonary oedema
O2
furosemide
Morphine
BP meds
What are the 3 types of post-operative bleeding?
Primary
Reactive
Secondary
Primary post operative bleeding
Within the intraoperative period
Reactive post operative bleeding
Within 24hrs
What is reactive post operative bleeding due to?
Cut vessel
Secondary post operative bleeding
7-10 days post-op
What is secondary post operative bleeding due to?
Infection eroding vessels
Signs post-op bleed (7)
Incr HR Incr RR Decr BP (late sign) Dizzy Agitated Visible bleed Decr UO
Mx post-op bleed
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??
PS major GI haemorrhage (4)
Haematemesis
Melaena
Pain
Collapse
Oesophageal causes major GI haemorrhage (4)
Oesophagitis
Cancer
M-W tear
Varices
Gastric causes major GI haemorrhage (3)
Gastric cancer
Gastritis
Ulcer
PS - oesophagitis
Small vol fresh blood streaks vomit
Spontaenous cessation
GORD Sx precede
PS oesophageal cancer
Small vol blood
Dysphagia
Wt loss
PS M-W tear (2)
Small - mod vol bright red blood
Repeated vomiting
PS oesophageal Varices (3)
large vol fresh blood
If swallowed –> melaena
Haemodynamic compromise
PS Gastric Ca (3)
Frank haematemesis or mixed w/ vomit
Dyspepsia
Decr W/night sweats
PS Gastritis (2)
Haemaemesis
Epigastric pain
Assoc w/ NSAID use
Mx UGI haemorrhage
A-->E Calculate Blatchford + Rockall score Bloods + O-ve transfusion Airway control Varices - Terlipressin before endoscopy/banding OGD - 24hrs of admin
Who should have surgery for UGI haemorrhage (4)
> 60
Continued bleed despite endoscopy
Rec bleeding
Known CVD
Sx of bacterial meningitis
headache fever N+V Photophobia Drowsiness Seizures
CSF appearance bacterial meningitis (4)
Cloudy
Decr glucose
Incr protein
10-5000 WBC, polymorphs
Ix bacterial meningitis
FBC CRP Coag Glucose ABG LP
Mx STEMI
MOANA Morphine (5mpg) O2 Antiemetics - 10mg metocloperamide Nitrates Aspirin
PCI = gold standard
Mx NSTEMI / UA
BROMANCE B-blockers Reassure O2 Morphine aspirin Nitrates Clopidogrel Enoxaparin
cardiac arrest - Non-shockable rhythm Mx
Immediately resume CPR
10ml 1:10,000 Adrenaline ev 3-5mins
cardiac arrest - shockable rhythms Mx
1 shock
Immediately resume CPR after
Adrenaline every 3-5mins (10ml 1:10,000)
300mg IV Amiodarone after 3 shocks
Reversible causes of cardiac arrest (4H’s + 4Ts)
Hypoxia Hypovolaemia Hypothermia Hypo/hyperkalaemia Toxins Tamponade Tension pneumothorax Thrombosis
What are the 2 shockable rhythms
VF
VT
What are the 2 non-shockable rhythms
PEA
asystole
What is post arrest syndrome
Brain injury
Myocardial dysfunction
Systemic ischaemic response
