ICU, Anaesthetics and Emergency Medicine Flashcards
Thrombolysis for ischaemic stroke can be considered up to how many hours after onset of symptoms?
4.5hours
If exact Sx onset not known, go back to when patient was last known to be well
What are the criteria included in the Canadian CTHead Rules
1) GCS <15 2hrs post-injury
2) AGE >65yo
3) Vomiting 2+
4) Amnesia ≥30mins
5) Suspected open/ depressed/ basal skull #
6) Dangerous mechanism
A stroke in the ACA territory will cause_______
Contralateral leg weakness, personality changes (if frontal lobe injury)
What components make up the ABCD^2 rule for TIA risk stratification?
Age >60yo - 1pt
BP >140 (systolic) - 1pt
Clinical features: unilateral weakness (2pt), speech impairment (1pt)
Duration >60mins (2pts), 10-59mins (1pt)
Diabetes (1pt)
What are the 3 grades of TBI (as defined by GCS)?
Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS <9
Blood (aka haemorrhage) is white on a CT head scan for ____ week/s
One (1) week
Hypocapnia causes cerebral vaso(dilation/constriction)
Vasoconstriction
What is the qSOFA score components?
Need 2+ of the following
- Altered mental status
- RR >22 / min
- SBP <100mmHg
How long can CVL and PICC lines be left in
1 week and 6 weeks, respectively
What is the target ICPafter TBI?
<20mmHg
Which of the following vasopressors does NOT have any inotropic effect? Dopamine, metaraminol, noradrenaline, adrenaline
Metaraminol
What are the 5 elements in the ‘chain of survival’ with regards to resuscitation
1) Early recognition of arrest & activation of emergency services
2) BLS
3) Early defib
4) ALS
5) Post-arrest cares
What 3 measures have been shown to have survival benefit in resuscitation?
1) competent BLS
2) Early defib for VT/VF
3) Post-arrest cooling
Failure of circulation for ____ mins can lead to irreversible brain damage
3-4 mins
List 3 risk factors for aspiration under anaesthesia
1) GORD
2) Delayed gastric emptying
3) Unfasted patient
In anaesthetics, how is pre-oxygenation achieved?
100% O2 is delivered for 2-6minutes until end-tidal CO2 is >80
Which inhalational agent can be used for induction of anaesthesia? Which cannot?
Can - sevoflurane
Cannot - desflurane, isoflurane
What does TIVA stand for in anaesthetics?
Total intravenous anaesthesia
What is the normal level of ETCO2?
35-45mmHg
The waveform of ETCO2 reflects the amount of a) time or b) volume of CO2 the monitor is exposed to
a) time
List 4 factors causing hypothermia during anaesthesia
1) Vasodilatory effects of anaesthetic agents
2) Anaesthetic effects on hypothalamus
3) Exposure of viscera to environment
4) Reduced heat production
List 5 complications of hypothermia related to anaesthesia
1) Impaired coagulation
2) Increased risk post-op infection
3) Prolonged drug action -> slow waking
4) Confusion
5) post-op shivering & increased O2 demand
What is the max safe dose for lignocaine? Lignocaine + adrenaline?
Lignocaine alone: 3mg/kg
Lignocaine + adrenaline: 7mg/kg
What are the initial CNS and CVS effects of local anaesthetic toxicity?
CNS - circumoral tingling, dizziness, tinnitus, restlessness
CVS - tachycardia, HTN
What analgesic medications can be delivered via a PCA?
Morphine, fentanyl, oxycodone, tramadol ± ketamine
With a laryngoscope the posterior aspects of the glottis can be seen, but not the anterior commissure. What grade view is this?
Grade II
(grade I = full glottis i.e. ant + post commissures
grade II = post glottis but not ant commissure
grade III = epiglottis only
grade IV = hard palate only (glottis/ epiglottis not seen)
What are the aims of pre-oxygenation?
To create a high concentration oxygen reservoir in the functional residual capacity and delay desaturation during apnoeas during airway manipulation
What are the 4 types of hypoxia?
1) Hypoxic hypoxia
2) Anaemic hypoxia
3) Ischaemic hypoxia
4) Histotoxic hypoxia
A Swan-Ganz catheter is also known as _____
Pulmonary artery catheter
Hypothermia intra-operatively leads to (increased/ decreased) O2 consumption and increases the risk for ____ and ____?
Increased O2 consumption
Infection and post-op bleeding
ETCO2 is generally ____ mmHg (lower/ higher) than arterial CO2
2-3mmHg LOWER
What are the causes of hypocarbia (low ETCO2)?
Hyperventilation Hypothermia Deep anaesthesia Decreased CO2 production: poor perfusion Leak from system
PEEP should not exceed __cm H2O. Higher settings increase the risk of ___, ____ and ____
20cm H20
Severe lung damage, subcutaneous emphysema and pneumothorax
What are the daily requirements for a) water b) sodium c) potassium d) glucose?
a) 25-30mL/kg/day H2O
b) 1-2mmol/kg/day Na+
c) 1mmol/kg/day K+
d) 50-100g/day glucose
What is the Apfel score?
Assessing risk of post-op nausea & vomiting (PONV). It gives 1 point for each of
- Female
- Non-smoker
- Hx of motion sickness or PONV
- Use of post-op opioids
A score of 4 = 79% risk of PONV within 24hrs
What are the 6 life-threatening injuries considered with trauma?
ATOM-FC Airway obstruction Tension PTX Open PTX Massive haemothorax Flail chest Cardiac tamponade
What is Beck’s triad? What is it a sign of?
Distended neck veins + Muffled heart sounds + hypoTN
It’s a sign of cardiac tamponade
Opioids should be dosed by (age / weight)
Age
What is the alveolar gas equation?
P(A)O2 = (FiO2x(PB-PH20)) - (PaCO2/0.8)
Where PB = barometric pressure (760mmHg)
PH2) = water vapour pressure (47mmHg)
i.e. P(A)O2 = (FiO2 x 713) + (PaCO2/0.8)
What is the formula for minute ventilation?
Tidal volume x resp rate
Normal = ~450mL/breath x 10 breaths/ min = 4500mL/min
What are the causes for high anion gap metabolic acidosis (HAGMA)?
'L TKR' Lactic acidosis Toxins (methanol, ethylene glycol, salicylates) Ketoacidosis (diabetic, starvation) Renal failure
Distinguish type 1 and type 2 respiratory failure
Type 1 = hypoxaemic resp failure i.e. low PaO2 (but normal PaCO2). Due to problems with O2 getting into blood e.g. low FiO2, shunt, VQ mismatch, impaired diffusion
Type2 = hypercapnic resp failure i.e. low PaO2 AND low PaCO2. Due to impaired ventilation, e.g. reduced resp drive, neuromuscular weakness, structural deformity (kyphoscoliosis), increased dead space
How much volume and FiO2 can be delivered via Hudson mask? High-flow nasal cannulae?
Hudson mask = 6-10L/min, FiO2 40-60%
HFNC = up to 70L/min, FiO2 30-90%
A patient presents with an acute asthma attack. They are speaking in few words, their RR is 26, HR 90 and O2 sats 93%. What is the severity of their attack?
Severe (only need 1 of the features)
- in favour: speaking in words, RR>25, O2 90-94%
- HR of 90 fits under mild/ moderate, however if any of above features are present, the attack automatically becomes severe
What are the components of the PSI (pneumonia severity index)?
Low-risk if ALL of the following <50yo No malignancy, CCF, cerebrovascular, renal or hepatic impairment Normal mental state Normal vitals
What does SMART-COP stand for?
Assessment of pneumonia severity & likelihood of needing ICU support SBP <90 Multilobar involvement on CXR Albumin <35g/L RR >25 Tachycardia >125 Confusion O2 <93% or PaO2 <70 pH <7.35 (i.e. acidaemic)