ICU & Respiratory Care Flashcards
Learn about ICU in general
Type 1 respiratory failure/hypoxaemic respiratory failure
It is due to failure of oxygenation only.
There is gas exchange malfunction at the alveolar-capillary level seen with PaO2 less than 60mmHg while the PaCO2 is normal.
Acute failure includes pneumonia, exacerbated asthma, lung collapse and pulmonary oedema.
Chronic failure includes exacerbated COPD (Pink puffers)
Type 2 respiratory failure/ hypercapnic / ventilatory respiratory failure
It is due to failure of ventilation.
There is malfunction of respiratory pump which is seen by PaO2 less than 60mmHg and PaCO2 greater than 50mmHg.
Acute failure includes sever onset of acute asthma, chest wall injuries, lung parenchyma injury, drug overdose, postoperative hypoxaemic and neuromuscular disease.
Chronic failure includes advanced COPD and advanced restrictive pulmonary disease.
Causes of respiratory failure
CNS control failure due to drug overdose.
Chest bellows failure due to Guillian-Barre, cervical spine injury, myasthenia gravis, ICU acquired weakness, abdominal distension and thoracic cage disorder like rib& sternal fracture.
Airway component failure due to asthma status and acute decompensation of COPD.
Alveolar component failure which is due to pulmonary oedema, extensive pneumonia and diffuse pulmonary haemorrhage syndrome.
Short notes on ICU - Acquired weakness
Refers to a neuromusculoskeletal system response to severe sepsis or illness.
These patients receive large doses of steroids and neuromuscular blockers prior to onset of symptoms of weakness this increase risk of ICU acquired weakness.
Clinical features includes weakness that develop after onset of critical illness, weakness is generalized, symmetrical and flaccid, cranial nerves are intact, cause of weakness is not related to underlying critical illness, MRC-SUM score of less than 48 on more than 2 occasions separated by 24 hours and the patient depends on mechanical ventilator.
Aims of physiotherapy in ICU
Minimise inactivity. Prevent adverse effects of bedrest. Clearance of excessive secretions. Restore lung capacity and volumes. Restore lung compliance Improve oxygenation. Treat pulmonary complications.
Procedure to prevent ventilator acquired pneumonia
Hand wash prior to treatment.
Clean stethoscope.
Switch nasogastric tube feed off prior to treatment
Suction patient’s oropharynx with Yankauer prior to placing patient in supine.
After treatment place patient in semi-fowler’s position and switch the nasogastric tube feed on.
Turning a patient in ICU
Have sufficient slack in lines and tubing.
Clear any water from ventilator tubing prior.
Inform patient of procedures and encourage to assist.
Have enough staff support.
Sufficient hand grip under patient.
Support tracheal tube during turning.
Coordinate turn.
Ensure patient comfort after turning.
Turning a paralyzed/unconscious patient perform same procedure but also look at:
Protect patient’s eyes
Support their head
Limbs in neutral position especially shoulders
No objects under patient
Types of shock
Cardiogenic shock: a compromised cardiac performance resulting in decreased stroke volume & CO; Low BP and inadequate tissue perfusion.
Hypovolemia shock: a decrease in circulating blood volume due to organ or tissue injury.
Neurogenic shock: loss of sympathetic control of blood vessels resulting in dilation of arterioles and venules
Septic shock: severe sepsis in presence of persistent hypotension, microvascular injury to blood vessels occur due to inflammation that leads to tissue ischemia, Frank hypotension.
Clinical features of ICU ACQUIRED WEAKNESS
Weakness develop after onset of critical illness.
Weakness is generalized, symmetrical and flaccid
Cranial nerve are intact.
Cause of weakness is not related to underlying critical illness.
MRC-SUM score of less than 48 or more than 2 occasions separated by 24 hours.
Patient depends on MV
