Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACC > ICU > Flashcards

ICU Flashcards

1
Q

Level 0, 1, 2 and 3 based patients

A

Level 0 = ward care, no organ support
Level 1 = ward care, at risk
Level 2 = HDU (single organ support, 1:2 ratio)
Level 3 = ICU (1+ organ support, technical ventilation, 1:1 ratio)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an Apache II score

A

Estimates ICU mortality based on age, health status, bloods etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do different levels of NEWS scores mean?

A

0 = monitor 12 hourly
1-4 = low risk, 4-6 hourly review
>3 / 5-6 = urgent ward based response, review 1 hourly
>7 = emergency response, critical care/airway management involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do different levels of NEWS scores mean?

A

0 = monitor 12 hourly
1-4 = low risk, 4-6 hourly review
>3 / 5-6 = urgent ward based response, review 1 hourly
>7 = emergency response, critical care/airway management involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Indications for sedation

A 
Toleration of distressing procedure 
Optimising mechanical ventilation
Decreasing agitation
Decrease in O2 sats
Decreased ICP
Facilitation of cooling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sedative agents used on ICU

A

Propofol

Thiopentone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Bohr affect?

A

Hb gives up oxygen to tissues more readily at high partial pressures of CO2 (because lowers ph) = right shift of curve = tissues get MORE oxygen more easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of hypoxia

A
  • Hypoxic hypoxia == reduced supply of O2
  • Anaemic hypoxia == reduced Hb - reduced arterial PO2
  • Stagnant hypoxia == reduced cardiac output - reduced delivery to tissues
  • Histotoxic hypoxia == normal delivery to tissues but impaired metabolism
  • Cytotoxic hypoxia == caused by chemicals e.g. cyanide - tissues can’t use oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dead space in context of respiratory failure

A

Normal ventilation of alveolus, but perfusion fails to supply the ventilated area (e.g. PE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Shunt in the context of respiratory failure

A

Normal perfusion, but ventilation fails to supply the perfused area (e.g. obstruction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs of hypercapnia

A 
Headache
Peripheral vasodilation
Tachycardia
Bounding Pulse
Tremor/flap
Confused/drowsy/coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain type 1 respiratory failure and why it occurs

A

Hypoxia with normocapnia

Ventilation perfusion (V/Q) mismatch: air flowing in and out does not match the flow of blood to the lung tissue. PO2 starts to fall, PaCO2 starts to rise so RR increases, which blows of CO2 and corrects it, but PaO2 remains low.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of T1RF

A

Anything causing REDUCED VENTILATION but with NORMAL PERFUSION == pneumonia, oedema, fibrosis, pneumothorax

Reduced perfusion, normal ventilation = PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Explain T2RF

A

Hypoxia + hypercapnia
Occurs due to alveolar HYPOventilation

Muscle fatigue and poor lung mechanics cause increased bronchial constriction and narrowing, and a disordered central ventilatory drive gets used to being hypoxic, so does not recognise high CO2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of T2RF

A 
COPD
Life threatening asthma
CF
Neuromuscular disease
Chest wall deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Explain ARDS

A

Bilateral pulmonary infiltrates and severe hypoxaemia
Caused by a lot of things
Late stage causes fibrosis

16
Q

Explain ARDS

A

Bilateral pulmonary infiltrates and severe hypoxaemia
Caused by a lot of things
Late stage causes fibrosis

17
Q

CPAP explanation and indications

A

Continuous positive air pressure - recruits alveoli and keeps airways expanded so airways do not collapse
Can deliver 100% oxygen
Indications: obstructive sleep apnoea, congestive cardiac failure, acute pulmonary oedema, chest infection
(type 1 rest failure)

18
Q

Explain BiPAP and indications

A

Cycles from high to low pressures - increased pressures help with inspiration.

Indications = T2RF, normally secondary to COPD.
Must be ACIDOTIC and PaCO2 >6

19
Q

Which tests must be carried out before BiPAP is used?

A

CXR - rule out pneumothorax

ABG - ensure T1RF

20
Q

Indications for mechanical ventilation

A

Respiratory failure due to:

  • Apnoeas
  • Haemodynamic instability/ CV collapse
  • Acute ventilatory failure
  • Impending ventilatory failure (declining ABGs, respiratory distress)
  • Respiratory muscle fatigue (rising PCO2, low tidal volume)
  • Obstruction
21
Q

Adverse effects of ventilation

A

VAP
Barotrauma (alveolar rupture from excessive pressure –> pneumothorax)
Volutrauma (high pressure caused by large volume ventilation)
Haemodynamic compromise (higher inspiration pressures can cause decreased venous return)
Ventilator malfunction

22
Q

What are FiO2 and PEEP

A 
FiO2 = oxygenation
PEEP = peak end expiratory pressure (positive airway pressure during expiration to maintain alveolar recruitment)
23
Q

Explain shock

A

Inadequate tissue perfusion and oxygenation causes ABNORMAL METABOLIC FUNCTION

Intracellular calcium overload = reduced myocardial contractility

H+ excess = decreased myocardial function

Anaerobic respiration = lactic acidosis = further exacerbation of issues

24
Q

How to calculate oxygen delivery to tissues

A

10 x cardiac output x concentration of O2 in blood

25
Q

What are crystalloid and colloid fluids

A

Crystalloid = sodium etc dissolved in water, short lived effect. Either hypotonic or isotonic.

Colloid = high molecular weight particles e.g. gelatine, albumin. Expand the intravascular volume. Risk of anaphylaxis.

26
Q

Explain ionotropes and vasopressors + examples

A

Iontropes = work on beta receptors increase cardiac muscle contractility by increasing calcium availability for myocyte contraction (thus increasing stroke volume). Used when reduced CO.
E.g. Adrenaline, noradrenaline, dobutamine

Vasopressors = work on alpha receptors to increase SVR (thus increasing BP and tissue perfusion). E.g. adrenaline, phenylephrine, vasopressin.

27
Q

Explain obstructive shock

A

Shock caused by cardiac output problem but NOT caused by the heart itself e.g. cardiac tamponade, tension pneumothorax

28
Q

AKI grades

A

GRADE 1 = creatinine rise of 150-200% OR >26.4 –> UO <0.5ml/kg/h for 6 hours

GRADE 2 = creatinine rise of 200-300% –> UO <0.5ml/kg.h for 12 hours

GRADE 3 = creatinine rise of >300% or >354umol.L –> anuria for 12 hours or <0.3ml/kg/h for >24 hours

29
Q

Indications for acute dialysis

A 
Acidosis
Electrolyte abnormalities (treatment resistant hyperkalaemia)
Intoxication 
Oedema (severe/unresponsive)
Uraemia
30
Q

Difference between renal filtration and dialysis

A

Filtration = purely high pressure forces filtrate across a membrane

Dialysis = moves filtrate in opposite direction to blood, creates a concentration gradient

31
Q

Equation for CPP

A

CPP = MAP - ICP

so raised ICP decreases CPP –> physiological response is increased BP –> further hydrocephalus and herniation

32
Q

Explain Munro-Kellie doctrine

A

3 tissues in the brain are in equilibrium (blood, CSF, Brain parenchyma). Increase in one has to be compensated by a decrease in volume of another –> i.e. downward displacement of CSF into spinal canal (can compensate for 100-120ml change in volume).

After this = cushing’s triad –> hypertension, bradycardia, irregular respiration.

Terminal event = cerebral ischaemia.

33
Q

GCS categories of brain injury

A 
13-15 = minor
9-12 = moderate
3-8 = severe
34
Q

At what level should mean arterial pressure be maintained above on ICU

A

> 90 mmHg

35
Q

Signs of coning (cerebral herniation)

A

Reduction in GCS
Bradycardia, tachycardia, hypertension
Irregular breathing
Fixed, dilated pupils

36
Q

Common issues post-ICU

A

Airway problems
Joint mobility problems - contractures
Cognitive issues - memory, problem solving, organisation
Psychological issues - insomnia, PTSD, nightmares
Weakness of muscles

37
Q

Legally, how should decisions on patient care for an incapacitous patient be made if no close relatives are able to give insight?

A

an independent mental capacity advocate (IMCA) should be assigned

38
Q

How do brainstem death and circulatory death differ in terms of organ donation?

A

BRAIN STEM DEATH = diagnose death –> optimise –> mobilise team –> organ retrieval

CIRCULATORY DEATH = mobilise team –> stop support, heart must stop within 5 minutes –> diagnose death –> organ retrieval

ACC (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions