ICU (general info)

Question 1

Level 1-3 patients

Answer 1

Level 1: patients who can be managed on general acute ward

Level 2: patients that can be managed on a high dependency unit (HDU)

Level 3: patients that can be managed on the ICU (highest level of support).

Question 2

Common reasons patients are admitted to ICU

Answer 2

Following major surgery (e.g., aortic aneurysm repair)
Severe sepsis
Major trauma
Following cardiopulmonary resuscitation
Organ failure (acute respiratory, renal or liver failure)

Question 3

What support can be offered in ICU?

Answer 3

Respiratory support
Cardiovascular support
Renal support
Nutritional support
Neurological support
Dermatological support
Liver support

Question 4

Two main factors to consider if a patient should be admitted to ICU

Answer 4

the potential to reverse the acute condition

the baseline physiological health reserve of the patient

Question 5

mortality rate prediction scoring system

Answer 5

APACHE: (Acute Physiology and Chronic Health Evaluation)

SAPS (Simplified Acute Physiology Score)

MPM (Mortality Prediction Model)

Question 6

Main complications associated with admission and treatment on ICU

Answer 6

Ventilator-associated lung injury
Ventilator-associated pneumonia

Catheter-related bloodstream infections (e.g., from central venous catheters)
Catheter-associated urinary tract infections

Stress-related mucosal disease (erosion of the upper gastrointestinal tract)

Delirium
Venous thromboembolism
Critical illness myopathy
Critical illness neuropathy

Question 7

Catheter-related bloodstream infections

• causes
• prevention

Answer 7

infections introduced by invasive lines, such as central venous catheters.

common (up to 25%) and carry a high risk of death (up to 25%).

reduce risk: antibiotic-impregnated or silver-impregnated catheters and keeping them in for the shortest time possible.

Question 8

Catheter-associated urinary tract infections

Answer 8

common

risk can be reduced by only using urinary catheters when necessary and keeping them in for the shortest time possible

Question 9

critical illness myopathy

Answer 9

muscle wasting and weakness during critical illness and treatment in the ICU. The weakness mostly affects the limbs and respiratory muscles.

prevention / tx: corticosteroids or muscle relaxants

complications:

critical illness myopathy can cause difficulty weaning the pt of mechanical ventilation (short term)

can result in reduced exercise capacity and quality of life, taking years to recover (long term)

Question 10

critical illness polyneuropathy

Answer 10

degeneration of the sensory and motor nerve axons during critical illness and tx on ICU (often occurs alongside critical illness myopathy)

prevention: optimal glycemic control (to reduce risk of degeneration of nerves)

signs/symptoms: symmetrical weakness, decreased muscle tone, reduced reflexes, difficulty in weaning patients off mechanical ventilation.

Question 11

delerium

Answer 11

an impaired mental state.
common complication

causes: pain, infection, hypoxia, electrolyte disturbances, renal failure, and medications.
identification: CAM (confusion assessment)
treatment: dexmedetomidine (sedate agitated pts)