ICU Flashcards
Where are patients managed based on their level?
- level 1: general acute ward
- level 2: high dependency unit
- level 3: ICU
Common reasons for ICU admittance
- following major surgery e.g. AAA repair
- severe sepsis
- major trauma
- following cardiopulmonary resuscitation
- organ failure
What system support is available in ICU?
- resp support
- cardiovascular support
- renal support
- nutritional support
- neurological support
- dermatological support
- liver support
What are the two main factors that are considered for admission to ICU?
Potential to reverse acute condition
Baseline physiological reserve (baseline)
What scoring systems can help predict mortality at time of admission to ICU?
- APACHE: acute physiological and chronic health evaluation
- SAPS: simplified acute physiology score
- MPM: mortality prediction model
What is enteral nutrition?
Options for this
- nutrition via the GI tract
- mouth
- NG tube
- percutaneous endoscopic gastrostomy
What is total parenteral nutrition?
Meeting the complete nutrition requirements using IV infusion of a solution of carbs, fat, protein, vitamins + minerals
What is a risk of total parental nutrition?
What can be done to help with this?
Thrombophlebitis
Given through ventral line rather than peripheral cannula
Complications of ICU admission + treatment
- ventilator associated lung injury or pneumonia
- catheter related blood infections
- stress- related mucosal disease
- delirium
- VTE
- critical illness myopathy
- critical illness neuropathy
What is ventilator associated lung injury?
- Common complication of mechanical ventilation
- forcefully blowing air into lungs can cause volutrauma, barotrauma + inflammation
What is volutruama?
Damage from over inflating alveoli
What is barotrauma?
Damage from pressure changes
What can ventilator associated lung injury cause?
Short term + long term
- short term: pulmonary oedema + hypoxia
- long term: fibrosis, reduced lung function, recurrent infections, cor pulmonae
What is ventilator associated pneumonia?
- common complication of mechanical ventilation associated lung
- due to bacteria being aspirated into lungs
What position can you put a patient in to reduce the risk of aspirating secretion from the stomach?
Bed at 30°
What can you do to reduce the risk of ventilator associated pneumonia?
- position bed at 30° angle
- good oral care with regular mouth cleaning
What are catheter related bloodstream infections?
Infections introduced by invasive lines e.g. central venous catheters
What can you do to reduce the risk of catheter related blood stream infections?
- antibiotic impregnated or silver impregnated catheters
- keeping them in for shortest time possible
How can you reduce the risk of catheter assocaited UTIs?
Only use when necessary
Keep in for shortest time possible
What is stress related mucosal disease?
- damage to the stomach mucosa due to impaired blood flow
- increases risk of upper GI bleeding
How can you reduce the risk of stress-related mucosal disease?
- PPIs or H2 receptor antagonists e.g. ranitidine
- starting NG feeding early in patients that cannot eat normally
What can be used as a scoring system for delirium?
Confusion assessment method
What can be used to screen for delirium?
4AT test
(+AMT-4 test)
Main preventative measures of VTE + PE
- LMWH e.g. enoxaparin
- Intermittent pneuamatic compression devices
