ICU

Question 1

How can the causes of shock be classified?

Answer 1

1. Reduced cardiac output
   - Hypovolemic
   - Obstructive e.g., tension pneumothorax, cardiac tamponade, PE
   - Cardiogenic
2. Distributive e.g., sepsis, anaphylaxis, neurogenic

Question 2

What is the APACHE score?

Answer 2

Acute Physiological Assessment and Chronic Health Evaluation

Risk assessment/mortality predictor tool for patients admitted to ICU

Question 3

What is the FAST HUG mneumonic?

Answer 3

Feeding/fluids

Analgesia

Sedation

Thromboprophylaxis

Head up position

Ulcer prophylaxis

Glycemic control

Key issues to consider in the critically ill patient

Question 4

How is cerebral perfusion pressure calculated?

Answer 4

MAP - ICP

Normal: 60 - 80 mmHg

Question 5

What are the potential complications of NIPPV?

Answer 5

Barotrauma → rupture of alveoli → pulmonary emphysema, pneumomediastinum, pneumoperitoneum, pneumothorax and/or tension pneumothorax (associated with high peak inflation pressures > 40 cm H₂O)

Decreased cardiac output → hypotension → end organ ischaemia

Pressure sores

Question 6

What are some of the contraindications to NIPPV?

Answer 6

Facial surgery, trauma or burns

Confusion/agitation

Cognitive impairment

pH < 7.15

Cardiac or respiratory arrest

Organ failure

Upper airway obstruction

Upper GI surgery or trauma

High risk of aspiration including vomiting, excess secretions