Cross spec Flashcards
What mask do you use to deliver oxygen in a cardiac arrest?
Bag Valve Mask (BVM):
A bag valve mask, also known as Ambu bag or manual resuscitator, is a handheld device used to provide positive pressure ventilation to patients who are not breathing or who have inadequate breathing, such as during cardiac arrest.
It consists of a self-inflating bag attached to a mask and a one-way valve system.
The rescuer squeezes the bag manually to deliver a tidal volume of oxygen-enriched air into the patient’s lungs.
BVM ventilation is crucial during cardiac arrest or other situations where the patient is not breathing adequately or at all.
BVM ventilation can be performed by healthcare professionals or trained individuals as part of cardiopulmonary resuscitation (CPR) efforts to support oxygenation and ventilation until advanced airway management or definitive treatment can be provided.
What patients are at risk of type 2 respiratory failure?
Moderate-to-severe chronic obstructive pulmonary disease (COPD): may be undiagnosed
Cystic fibrosis
Severe obesity (i.e. obesity hypoventilation syndrome)
Neuromuscular disease (e.g. Motor neurone disease)
Severe chest wall deformity (e.g. kyphoscoliosis)
Previous episode of T2RF
Explain the pathophysiology of oxygen induced hypercapnia
In patients with type 2 respiratory failure, excessive oxygen administration can suppress the body’s natural drive to breathe, leading to hypoventilation. This reduced breathing effort can cause a mismatch between ventilation and perfusion, particularly in areas with increased dead space, where air is present but not effectively participating in gas exchange. As a result, carbon dioxide accumulates in the bloodstream, leading to oxygen-induced hypercapnia.
What are some indications for ECMO?
Indications for ECMO:
Severe acute respiratory distress syndrome (ARDS)
Hypoxemia refractory to conventional ventilation
Profound cardiogenic shock
Cardiac arrest with refractory ventricular arrhythmias
Post-cardiotomy cardiogenic shock
Pulmonary embolism with circulatory collapse
Severe trauma or acute lung injury with refractory hypoxemia
ECMO provides temporary support for:
Respiratory failure
Cardiac failure
Aimed at:
Allowing time for recovery
Bridging to definitive therapies (e.g., transplantation)
Multidisciplinary team assesses patient suitability.
Potential complications require careful patient selection.
For a patient presenting with acute respiratory distress syndrome (ARDS) and requiring mechanical ventilation, what specific clinical indicators would prompt admission to the Intensive Therapy Unit (ITU) rather than High Dependency Unit (HDU)?
- PaO2/FiO2 ratio less than 100 mmHg despite high levels of positive end-expiratory pressure (PEEP) and other lung protective ventilation strategies.
- Systolic blood pressure less than 90 mmHg despite fluid resuscitation
- Vasopressor support to maintain adequate perfusion pressure
- Possible consideration of extracorporeal membrane oxygenation therapy
In the context of sepsis management, what criteria differentiate patients suitable for High Dependency Unit (HDU) care from those necessitating escalation to Intensive Therapy Unit (ITU) admission?
- Patients with sepsis requiring HDU care typically have stable hemodynamics with a mean arterial pressure (MAP) above 65 mmHg and respond adequately to fluid resuscitation and antibiotic therapy
- ITU admission exhibit signs of septic shock with persistent hypotension despite fluid resuscitation (MAP < 65 mmHg) or require vasopressor support to maintain perfusion pressure
- patients with sepsis-induced acute kidney injury requiring renal replacement therapy or severe metabolic acidosis despite aggressive resuscitation would warrant ITU admission for closer monitoring and advanced organ support.
When managing patients with acute pancreatitis, what factors guide the decision between High Dependency Unit (HDU) versus Intensive Therapy Unit (ITU) admission, considering the risk of complications such as organ failure or necrotizing pancreatitis?
- Acute pancreatitis and no evidence of organ failure- HDU
- Severe acute pancreatitis
- They will need invasive mechanical ventilation, vasopressor therapy and possible surgical intervention
How do you define severe acute pancreatitis
- Persistent organ failure
- PaO2/FiO2 <300mmHg
- Creatinine >171 umol/L
- Systemic complications, sepsis, DIC
- Pancreatic necrosis on CT with contrast
For patients post-major abdominal surgery, what specific postoperative complications or clinical parameters would warrant transfer to the Intensive Therapy Unit (ITU) rather than ongoing management in the High Dependency Unit (HDU)?
- Those with hypotension despite fluid resuscitation or ongoing blood loss requiring massive transfusion protocols
- Those with ARDS
- Those on PEEP
- AKI
In the setting of acute heart failure exacerbation, what clinical criteria or hemodynamic parameters dictate the need for escalation to Intensive Therapy Unit (ITU) care versus initial management in the High Dependency Unit (HDU), particularly regarding the need for invasive monitoring or inotropic support?
- Patients for ITU- cardiogenic shock, need for vasopressor support
- Altered mental status, serum lactate >2, oligouria
- May need intra-aortic balloon pump or mechanical circulatory support.
- Patients on HDU have less severe symptoms- on low-dose inotropic support, dobutamine
List of specific criteria that warrant transfer to the ITU for hemodynamic instability
Systolic blood pressure < 90 mmHg despite adequate fluid resuscitation.
Requirement for vasopressor support to maintain adequate perfusion pressure (e.g., norepinephrine, dopamine).
List of specific criteria that warrant transfer to the ITU for respiratory failure
Acute respiratory distress syndrome (ARDS) with severe hypoxemia (PaO2/FiO2 < 200 mmHg) despite maximal oxygen therapy.
Hypercapnic respiratory failure with pH < 7.25 and PaCO2 > 50 mmHg despite non-invasive ventilation or high-flow oxygen therapy.
List of specific criteria that warrant transfer to the ITU for neurological compromise
Severe traumatic brain injury (Glasgow Coma Scale < 8) requiring invasive intracranial pressure monitoring and possible neurosurgical intervention.
Status epilepticus refractory to initial treatment and requiring continuous sedation and antiepileptic therapy.
List of specific criteria that warrant transfer to the ITU for cardiogenic shock
Acute myocardial infarction complicated by cardiogenic shock with evidence of end-organ hypoperfusion (e.g., altered mental status, oliguria).
Severe heart failure exacerbation with persistent hypotension despite optimal medical therapy and requiring mechanical circulatory support (e.g., intra-aortic balloon pump, ventricular assist device).
List of specific criteria that warrant transfer to the ITU for severe sepsis
Sepsis-induced hypotension requiring vasopressor support to maintain mean arterial pressure (MAP) > 65 mmHg despite fluid resuscitation.
Evidence of end-organ dysfunction (e.g., acute kidney injury, liver dysfunction) or metabolic derangements (e.g., lactic acidosis) indicative of severe sepsis or septic shock.
