ICU equipment Flashcards
What ICU equipment can you use?
Blood gas NIBP ECG Pulse oximetry capnograph IBP(arterial catheters via transducers) CVP (central line, haemodynamic changes) Multiparameter monitors Glucometer Lactate monitor Microscope Heamotology and bichem centrifuge syringe drivers and infusion pumps
What are the normal blood gas paratmeters for pH, PaO2 PaCO2, HCO3-
BE
Anion gap
ph. 7.35-7.45 PaO2- 80-100mmHg PaCO2; 35-45mmHg HCO3- 21-24 BE +2 or -2 Anion gap Cats 13-27mEq/L Dogs 12-24mEq/l
What is metabolic acidosis?
ph <7.35
What is metabolic alkalosis?
pH >7.45
what compensatory factors are used to impact on metabolic acidosis and alkalosis?
HCO3- low in acidosis high in alkalosis
CO2 high in alkalosis low in acidosis
What can a rise in lactate cause?
Metabolic acidosis
What is respiratory acidosis?
High CO2>45mmHg
what is respiratory alkalosis?
Low CO2 <35mmHg
What can cause metabolic acidosis?
diabetic ketoacidosis Diarrhoea renal failure addisons disease lactic acidosis (sepsis\)
what can cause metabolic alkalosis?
Vomiting
Hypoalbuminaemia
Upper GI obstruction
What is kirbys rule of 20?
A list of parameters that should be checked in critical care patients.
should be done hourly or daily
What critical parameters should be checked daily in a critically ill patient (kirbys rule of 20)?
Fluid balance Glucose Blood pressure TLC Haemoglobin WBCs (Immune status) Pulse quality/arrythmias/murmur Renal function Nutrition Mobilisation Oncotic pull/albumin Electrolytes and acid base oxygenation and ventilation Level of consciousness temperature Coagulation GI motility Drug dose and metabolism Pain wound care
How should fluid balance be monitored?
assess hydration at triage
calculate fluid therapy levels and an appropriate solution
Bolus may be required if hypovolaemic
How should oncotic pull/albumin be monitored?
maintain above 20
TS can be measured using a refractometer
low levels can lead to odema higher risk of mortality
can increase them by administration of blood, plasma and nutrition.
How should glucose be monitored in the critically ill patient?
Hypotensive and septic animals closely monitored. Be aware of the stress response in cats. anorexia=hypoglycemia
starving young animals for procedures = hypoglycemia
How should electrolytes and acid base be monitored in the critically ill patient
Often low potassium in ill patients (renal disease, GI disease, sepsis).
High potassium indicative urinary obstruction or addisons bradycardia may develop.
Sodium low and high levels can lead to CNS signs
Hypophosphataemia can lead to RBC heamolysis
repeat measurements several times a day same with scid base
Metabolic acidosis due to sepsis (lack of perfusion)
Why should oxygenation and ventilation be monitored in a critically ill patient and how?
Assess for hypoxaemia
Hypoventilation
o2 therapy or mechanical ventilation can be used
Observe patients resp effort pattern and rate
SpO2 PaO2 PaCO2
Why should levels of consiousness and mentation be monitored in a critically ill patient?
may be a result of hypotension, hypoglycema, hyperammonaemia
normal, obtunded, stuporous and comatosed
Assess via the glassgow coma sacle
a drop of 2 should be flagged up to the vet
Why should blood pressure be monitored in the critically ill patient and how?
IBP, NIBP always maintain systolic BP above 90mmHg
Fluid therapy may be enough to support BP
give vasopressors via CRI
Why should you assess heart rate and quality in a critically ill patient?
Monitor pulse quality and pulse deficits, listen for heart murmurs ECG for arrythmias
cardiac output is essential to maintain in critically ill patient
Why should temperature be monitored in a critically ill patient?
Measure regularly sepsis and hypothermia main reasons for fluctuations in hypothermia
Why should coagulation and clotting times be monitored in the critically ill patient and how is it done?
ACT, PT, APTT and thrombocytes can be measured
Risk of developing DIC and thrombocytopenia
If septic likely to be hypercoagulable may result in multiple organ dysfunction or pulmonary thromboembolism
Why should you measure Hb in the critically ill patient and how?
frequent sampling can lead to anaemia
most significatn factor responsible for o2 concentration
manual PCV more useful along side TS
O2 therapy can help but blood transfusion may be required
O2 carrying capactiy is compromised
Why should renal function be assessed in the critically ill patient?
Shock, dehydration, hypotension and hypoxia can contribute to renal dysfunction
measure urine output 1-2ml/kg/hr
urinary dipstick
Urinary catheterisation in recumbent animals
Why should the immune status of critically ill patients be assessed?
Neutropenic patients should be barrier nursed
Iv versus oral AB
Treat infectiosn with specific AB to reduce resistance
Why should GI motility be assessed in the critically ill patient?
ileus and gastric ulceration are common may be due to stress or opioid therapy V and D should be medically managed anti-emetics or proton pump inhibitors Bowels can be auscultated for sounds care risk of aspiration pneumonia
Why should drug doses and metabolism be assessed in the critically ill patient and how?
Liver plays key role in metabolism
drug accumulation should be considered
Body weight changes so drugs should be calculated on a daily basis
Why should nutrition be assessed in the critically ill patient?
Cats require arginine and taurine
risk of catabolism an hepatic lipodosis(cats)
RER calculated on daily bases 70(BW)0.75
feeding tube slow refeeding
How should pain be controlled in the critically ill patient?
pain can manifest as restlessness tachycardia or mental depression Assess Glasgow composite pain scale 1-4 hours multimodal analgesia constant rate infusions avoids accumulation
How should patient mobilisation be controlled in the critically ill patient?
minimal restraint check iv lines turn recumbant patients every 4 hours maintain in sternal where possible complete a physio plan appropriate bedding prevent faecal and urine scalding
How should wound care be managed in the critically ill patient?
observe on daily basis
any strike through change in aseptic manner
Why is TLC important in a critically ill patient?
Bath grooming regular owner visits cat boxes to hide in
allow times of quiet and dark so animals can rest and sleep
How should the ventilator patient be nursed?
Eye care Mouth care Airway Humidification Physio and positioning urination and defecation lines, drains and tubes drugs treatment underlying diseases communication record keeping acid base blood gases electrolytes
