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MRCS-Critical care > Deck 3 > Flashcards

Deck 3 Flashcards

1
Q

Fat embolism definition

A

Circulating fat globules in circulation and pulmonary parencgyma

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2
Q

Triad of fat embolism syndrome

A

Respiratory insufficiency: Increased RR, SOB, cyanosis
Cerebral features: drowsiness, rigidity
Petechial rash: sternum, axilla, mouth

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3
Q

Causes of fat embolism

A

Traumatic:

  • fractures
  • Hip/knee arthroplasty

Non-traumatic:

  • pancreatitis
  • liposuction
  • bone marrow transplant
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4
Q

Mechanical theory of fat embolism pathophysiology

A

Fracture leads to damage to vasculature at that site
Fat globules enter circulation and taken to pulmonary circulation causing damage
They gain access to systemic circulation via arterio-venous shunts and cause ischaemia by obstructing various vessels

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5
Q

Biochemical theory of fat embolism pathophysiology

A

Stress hormones such as steroids and catecholamines release activated lipase

Free fatty acids increase vascular permeability and induce pulmonary damage

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6
Q

Different forms of fat embolism

A

Subclinical: minor haematological change, decreased PaO2, no resp distress

Non fulminant (subacute): triad, resolves after 72hrs

Fulminant: resp failure, altered mental state, death

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7
Q

CXR appearance of fat embolous

A

Snow storm appearance

bilat fluffy infiltrates

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8
Q

Which brain imaging to use for fat embolism

A

T2 weighted MRI shows high intensity areas within white matter

CT has limited use, may display minimal cerebral oedema

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8
Q

Which brain imaging to use for fat embolism

A

T2 weighted MRI shows high intensity areas within white matter

CT has limited use, may display minimal cerebral oedema

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9
Q

Causes of enterocutaneous fistula

A

Abdo surgery 75%

Inflammation: Crohns or infection

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10
Q

Classification of fistulas by output

A

Low output<200ml/day
Moderate 200-500
High output >500ml//day

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11
Q

Fistula mx

A

SNAP
Sepsis: abx + drainage
Nutrition: Decompression + TPN to allow healing (In high output fistulas)
Adequate fluid and electrolyte
Plan and protect: conservative vs surgical, protect skin

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12
Q

Which fistulas could be treated conservatively

A
  • no obstruction or sepsis

- not complicated with IBD

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13
Q

Imaging for fistulas

A

CT with oral contrast or contrast injected through the fistula

MRI used for complex anal fistulation

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14
Q

Complications of TPN

A

Metabolic:

  • K, Mg, phosphate
  • glucose (most common)

Line related:
- as per Central line

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15
Q

Rule of 2/3 for portal HTN

A

2/3 cirrhosis gets portal HTN
2/3 of protal HTN develop oesophageal varices
2/3 oesophageal varics present with acute bleeding

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15
Q

Rule of 2/3 for portal HTN

A

2/3 cirrhosis gets portal HTN
2/3 of protal HTN develop oesophageal varices
2/3 oesophageal varics present with acute bleeding

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16
Q

Sites of porto-sysyemic anastomosis

A 
Umbilical 
Upper anal
Varices
Bare area of liver
Retroperitoneal
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17
Q

TIPS procedure

A

Transjugular intrahepatic portosystemic shunt
Hepatic vein cannulated via IJV
Stent inserted between hepatic vein and branch of portal vein to reduce portal pressure

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18
Q

Complication of TIPS

A

Encephalopathy as portal blood diverted from liver

Occlusion

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19
Q

False localising sign

A

Weakness on lateral gaze

Due to brain herniation and its impact on CN6 (long intra-cranial path)

20
Q

Classical presentation of extra dural haemorrhage

A

Concussion
Lucid period (conscious): haematoma expanding
Loss of consciousness: ICP increases as per Monro-Kellie

doctorine

21
Q

Secondary brain injury definition

A

Any injury that occurs hours or days after primary injury

Due to cellular damage

22
Q

Prevention of secondary brain injury

A
  1. Rapid sequence intubation to keep sedation and control ventilation (hyperventilate pt)
  2. nurse at 45 degrees (reduces oedema)
  3. Central line to monitor ICP -> hypertonic saline, mannitol, dex
23
Q

Why want to hyperventilate a pt to prevent secondary brain injury

A

High O2 and low CO2 leads to decrease cerebral perfusion -> cerebral oedema

24
Q

Normal levels of
CPP
MAP
ICP

A

CPP >65mmHg
MAP> 90mmHg
ICP < 25mmHg

25
Q

How is cerebral flow autoregulated

A

Autoregulated between SBP 50-150

Myogenic: stretch in artery causes vasoconstriction

Chemical: low o2 and high co2 causes vasodilation

26
Q

Causes of increased CSF

A

Increased production: choroid carcinoma
Decreased circulation: Aqueduct stenosis, haemorrhage
Decreased reabsorption (sinus thrombosis, haemorrhage)

27
Q

Anaphylaxis meds

A

IM adrenaline 1:1000, 500 micrograms
Chlorphenamine 10mg IM or IV
Hydrocortisone: 200mg IM or IV

28
Q

How does pulse oximetry work

A

Infra-red light and red light emitted and reabsorbed
Oxygenated and deoxygenated haem habsorbs different amounts
Ratio is calculated to give the percentage oxy haem

29
Q

Factors interfering with accurate pulse oximetery

A

Nail varnish
Poor peripheral circulation
CO
Jaundice (under estimates)

29
Q

Factors interfering with accurate pulse oximetery

A

Nail varnish
Poor peripheral circulation
CO
Jaundice (under estimates)

30
Q

Risks with colloid solutions

A

Dextran 70 interfers with vWF and platelet adhesion

Anaphylaxis

Interferes with cross matching process

31
Q

Causes of increased CVP

A

Right sided HF

Caridac tamponade

32
Q

Causes of decreased CVP

A

Poor circulatory volume

Vasodilation

33
Q

Levels of care

A

Level 0 = ward
Level 1 = ward + input of critical care
Level 2 = HDU (one organ failure)
Level 3 = ICU (>1 organ failure or advanced support for one organ eg ventilation or bypass)

34
Q

Complications of tracheostomy

A

Early:

  • bleeding : thyroid isthmus, anterior jugular
  • injury : trachea, recurrent laryngeal n
  • blockage: mucous or blood
  • displacement

Intermediate: infection

Late: tracheal stenosis

34
Q

Complications of tracheostomy

A

Early:

  • bleeding : thyroid isthmus, anterior jugular
  • injury : trachea, recurrent laryngeal n
  • blockage: mucous or blood
  • displacement

Intermediate: infection

Late: tracheal stenosis

35
Q

Post op care for tracheostomy pts

A

Humidified O2
Regular suction and cleaning of inner tube
Emergency equipment at bedside

36
Q

Examples of hypovolaemic hyponatraemia

A

Burns
Diarrhoea
Diuretics

37
Q

Causes of hyervolaemic hyponatraemia

A

Heart failure
Polydipsia
IV overload

38
Q

Examples of pseudohyponatraemia

A

High lipids/albumin in blood (eg myeloma)

Dilutes the concentration of Na

38
Q

Examples of pseudohyponatraemia

A

High lipids/albumin in blood (eg myeloma)

Dilutes the concentration of Na

39
Q

Causes of SIADH

A

Drugs: psych meds, opiates

Lung path: PE, tumours

Brain: tumours, meningitis

40
Q

Sx of low Na

A

Headache
Confusion
Weakness
Seizure

41
Q

Consequence of rapid correction of Na level

A

Centra pontine myelinolysis

Demyelination of pons:
- lethargy, locked in syndrome, coma

42
Q

How fast can you correct low Na

A

No faster than 10mmol per 24hrs

43
Q

How fast can you correct low Na

A

No faster than 10mmol per 24hrs

44
Q

Methods of intra op heat loss

A

Radiation (50%)
Conduction (to air and operative table)
Evaporation

45
Q

ECG of hypothermia

A

J waves (upward deflection after QRS)

MRCS-Critical care (10 decks)

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