Intensive Care Flashcards
What are the levels of care?
- Pt needs met on normal ward, jobs >4hrly
- Pt at risk of deterioration, advice & support from CCT
- Pt requiring more detailed jobs/interventions, single failing organ, post-op care, basic response support, burns, neuro, renal support
- Pt requiring advanced resp support alone, support for 2 organ systems, multi-organ failure
Who can go to ICU?
- Potentially reversible clinical condition
- Underlying level of long-term health allowing pt to survive & benefit from critical care
- Some pre-planned following major surgery
What interventions can be given on ICU?
- Physiological control: constant monitoring, invasive intravascular monitoring, sedation & analgesia, glucose control
- Specific therapy: stopping iatrogenic issues
- VTE & ulcer prophylaxis
- Fluids
- Nutritional support
- Infusion of vasoactive drugs: Inotropes & vasopressors
- Mechanical organ support: Renal replacement therapy, ventilation, extracorporeal oxygenation
When would the critical care outreach team be called to review a patient?
NEWS >7
NEWS of >3 in any one parameter
What do NEWS scores correlate to in regards to monitoring?
0: Minimum 12hourly obs
1-4: LOW, minimum 4hourly obs
5/ 3in one parameter: MEDIUM, minimum 2hourly obs
7: HIGH, minimum, 1hourly obs
In ICU, which patients are candidates for organ donation?
DBD: Donation after brainstem death
e.g RTA w/serious head injury
DCD: Donation after circulatory death
e.g out of hospital cardiac arrest= widespread ischaemia
What is the mnemonic for what to check when monitoring/assessing a patient on ICU?
F- Feeding A- Analgesia S- Sedation T- Thromboembolic prophylaxis H- Head up U- Ulcer prophylaxis G- Glucose
What pathology can put someone in a coma?
A- Addison's/Alcohol/Arrhythmia E- Epilepsy/electrolytes/encephalopathy I- Infection O- Overdose/opiates U- Uraemia T-Trauma (head)/thyroid I- Insulin (sugars) P- Psych S- SDH, Stroke
What is the range for blood sugars in a query stroke?
3-22
When is sedation used?
- Allows patients to tolerate painful/distressing procedures (e.g. endotracheal intubation, invasive lines)
- Optimise mechanical ventilation (e.g. tolerate permissive hypercapnea)
- Used to decrease O2 consumption (e.g. sepsis)
- Decrease ICP in neurosurgical patients (results in immobility so limits metabolic requirements)
- Facilitate cooling (e.g. therapeutic hypothermia)
- Control agitation
Are there any side effects or complications of sedating someone?
hypotension respiratory depression arrhythmias drug specific effects sleep disturbance withdrawal delirium
What are the dose dependant effects of sedation?
Anxiolysis – Relief of apprehension or agitation with minimal alteration of sensorium
Amnesia – memory loss for a period of time
Analgesia – relief of pain without an altered sensorium
Anaesthesia – loss of sensation
What are the depths of sedation?
- Minimal sedation: anxiolysis only
- Moderate sedation: responsive to verbal/tactile stimuli, airway reflexes, spont ventilation, CV function maintained
- Deep sedation: responsive purposefully to repeated or painful stimuli; airway reflexes or spont ventilation may not be maintained, but CV function preserved.
- GA: state of unconsciousness & unresponsiveness such that the autonomic nervous system is unable to respond to surgical or procedural stimuli.
- Dissociation: cause a disconnection between the thalamoneocortical system and the limbic systems, preventing higher centers from receiving sensory stimuli. Airway reflexes, spontaneous ventilation, and cardiovascular function are all maintained.
How is death diagnosed?
- Respond to verbal stimuli
- Respond to painful stimui
- Fixed and dilated pupils (corneal reflex test)
- Feel for carotid pulse
- Auscultate for heart sounds for 2mins
- Auscultate for respiratory sounds for 3mins
What is the Monro-Kellie doctrine
- If other masses in the brain cavity
- Brain will push out CSF first then blood then the brain
- Dec blood: Cerebral ischaemia
- Dec brain: Coning
