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MRCS Critical care > Definition > Flashcards

Definition Flashcards

1
Q

Henderson Hasselback equation

A

H20 + CO2 = H2CO3 = H+ + HCO3-

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2
Q

Chloride shift

A

exchange of bicarbonate and chloride across RBC membrane

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3
Q

Buffer

A

Limit the change of pH by binding or releasing H+

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4
Q

Categories of Acute limb ischaemia

A

1 - Not immediately threatened
2a - Salvageable, partial sensory deficit
2b - salvageable, partial motor deficit
3 - amputation

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5
Q

reperfusion injury

A

revascularisation leads to increase venous return from ischaemic tissue containing toxic metabolites
This leads to SIRS - hypotension, MODS, arrythmia

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6
Q

Acute tubular necrosis

A

Damage to renal tubular cells 2ry to ischaemic insult or nephrotoxin
Causes - hypoperfusion, aminoglycosides, contrast, Mb, myeloma

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7
Q

Acute respiratory distress syndrome

A

Acute respiratory failure and non cardiogenic pulmonary oedema
Hypoxaemia and reduced lung compliance, which is refractory to Oxygen therapy
Normal pulmonary artery wedge pressure - <18mmHg
PaO2/FiO2 ratio reduces

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8
Q

Pain

A

unpleasant sensory and emotional experience associated with actual or potential tissue damage
Carried by A delta and C fibres - dorsal horn of spinal cord - thalamus - somatosensory cortex

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9
Q

Allodynia

A

Increased sensation of pain from normally non painful stimuli
Caused by cross talk of sympathetic or A beta and nociceptive fibres

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10
Q

Neuropathic pain

A

Results of damage to the pain signalling pathway

present as numbness or burning

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11
Q

Apnoea test

A

1) increase FiO2 to 1.0 check Sats >95% then lower resp rate
2) Once ETCO2 >6.0, and check PaCO2 >6.0
3) disconnect ventilator and give O2 5L/min via endotrachial catheter for 5mins, if PaCO2 raises by 0.5kPa - loss of respiratory drive

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12
Q

second degree burn

A

burns that have penetrated into the deep dermal layer of the skin
pink, painful, branches, blisters

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13
Q

Burn’s unit referral

A 
Size - 5% in child, 10% in adults
Age - <5, >60
Chemical
Electrical
Face, Hands, Feet, perineum, flexures, circumferential 
Inhalation injury
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14
Q

Frank-Starling law

A

Stroke volume of the heart increases in response to an increase in the volume of blood in the left ventricle

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15
Q

Myoglobin

A

Oxygen binding protein found in the muscle

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16
Q

Charcot’s triad

A

RUQ pain, jaundice, pyrexia

Ascending cholangitis

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17
Q

Disseminated intravascular coagulation

A

pathological consumptive coagulopathy
generation and deposition of fibrin - microvascular thrombi in various organ
Consumption of coagulation factors, platelets and activation of fibrinolysis leads to bleeding
Low Hb, PLt, fibrinogen and high PT/APTT/DDimer

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18
Q

Massive blood transfusion

A

> 50% of replacement of blood volume in 12 hours

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19
Q

Hypothermia

A

core body temperature <35
May lead to
metabolic acidosis, hypocalcaemia, cardiac arrythmia, enzyme dysfunction, shift in haemoglobin dissociation curve, platelet dysfunction

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20
Q

Signs of hypovolemia

A 
pale
anxious
sinus tachy
hypotension
oliguria
cool/clammy 
slow CRT
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21
Q

Fat embolism

A

Clinical diagnosis
Circulating fat globules in the circulation and pulmonary parenchyma
Trauma - pelvis, femur, tibia; IM nailing; major burns
Non trumatic - BM transplant, pancreatitis
petechial rash over axilla, neck, sternum
low sats
confusion

22
Q

Areas of portosystemic shunt

A 
lower oesophagus
umbilical
retroperitoneal
bare area of liver
patent ductus venosus
upper anal canal
23
Q

oesophageal varices

A

bulging veins secondary to back pressure due to portal hypertension at the portosystemic anastomosis
rule of 2/3
2/3 of cirrhosis leads to portal HTN
2/3 of portal HTN leads to oesophageal varices
2/3 of oesophageal varices presents with bleed

24
Q

Sengstaken Blakemore tube

A

NG tube with two balloon (one above and below GOJ)
Inflated under radiological guidance
Used for 24 hrs
Can cause ischaemia, perforation, aspiration pneumonia

25
Q

TIPSS

A

Tansjugular intrahepatic porto systemic shunt
Hepatic vein is cannulated from IJV using needle under fluoroscopy
Stent is inserted between hepatic and portal vein
Can lead to encephalopathy

26
Q

False localising sign

A

6th nerve palsy due to raised ICP/herniation

Compression of the nerve not damage to nucleus

27
Q

Secondary brain injury

A

injury insulted secondary to the primary injury
prevented by
Intubation, Sedation, PaCO2 <5.0, nurse at 45 degrees, CVP, Arterial line, ICP monitor, Mannitol

28
Q

Cerebral perfusion pressure

A

MAP - ICP
pressure gradient that drives oxygen delivery to the brain
>65mmHg (MAP 90, ICP25)

29
Q

Cerebral blood flow

A

autoregulated between 50-150mmHg

regulated by myogenic reflex and C02 and O2

30
Q

Monroe Kellie doctrine

A

States that skull contains a certain amount of brain, blood and CSF
Any SOL leads to displace the others

31
Q

Difference between CSF and plasma

A 
PCO2 is higher
Lower pH
low protein
low glucose
high chloride
low cholesterol
32
Q

CSF circulation

A 
Choroid plexus
Lateral Ventricles 
Foramen Monroe
Third ventricle
Cerebral Aquaduct
Fourth ventricle
Foramen of Luschka &amp; Magendie
Subarachnoid space
Arachnoid granulation
33
Q

Respiration

A

Transportation of Oxygen to tissue and carbon dioxide outside the tissue

34
Q

Minute ventilation

A

RR x tidal volume

Amount of air inspired per minute

35
Q

Ischaemia

A

Abnormal reduction in the blood supply or drainage of a tissue/organ

36
Q

Infarct

A

consequence of an ischaemic insult resulting in tissue death

37
Q

Respiratory quotient

A

ratio of CO2 excretion to O2 consumption which determines which food is being metabolised during cellular respiration
RQ= CO2/O2

38
Q

Ranson criteria

A 
For non-gallstone pancreatitis
Age >55
WCC >16
Glucose >11.2
LDH >350
AST>250
48hrs
Hct drop by >10%
Urea increase by 1.79
Ca <2.00
PaO2 60mmHg
Base deficit 4
Fluid required >6L
39
Q

Pancreatic pseudocyst

A

encapsulated fluid collection encased by fibrous capsule caused by leakage of enzyme-rich fluid, usually around 4 weeks
Can form anywhere along the pancreas
Seen in lesser sac obstructing gastroepiploic foramen

40
Q

shock

A

inadequate tissue perfusion for metabolic requirement

41
Q

coronary perfusion pressure

A

systemic diastolic arterial pressure - left ventricular end diastolic pressure

42
Q

sedation

A

alteration in consciousness/analgesia/anxiety
used for diagnostic/therapeutic procedure of short duration
contraindicated - unstable patient, long lasting, no observation
Need to have reversal meds as well

43
Q

light sedation

A

maintain airway with intact reflex
respond to stimuli
anxiolytic effect

44
Q

deep sedation

A

airway is not necessary patent, may need support

repeated and painful stimuli needed for response

45
Q

General anaesthesia

A

airway is not protected

patient not rousable

46
Q

sepsis

A

life threatening organ dysfunction due to a dysregulated host response to infection

47
Q

Septic shock

A

persistent hypotension requiring vasopressor to maintain a MAP of 65mmHg or having a serum lactate >2 despite adequate volume resuscitation

48
Q

Steroid

A

organic compound that contains a characteristic arrangement of 4 cycloalkane rings that are joined together

49
Q

ASA

A 
American society of anaesthesiologist
1 - healthy
2- mild systemic disease
3 - severe systemic disease
4 - severe systemic disease with constant threats to life
5 - morbidund
6 - brainstem dead
50
Q

LEMON assessment

A

Look - facial trauma, small mandible, short neck
Evaluate - 3 fingers between incisors, 3 fingers hyoid to chin, 2 fingers thyroid notch to floor of mouth
Mallanpati score
Obstruction
Neck mobility

MRCS Critical care (1 decks)

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