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Acute Care + Anaesthetics > Intensive Care > Flashcards

Intensive Care Flashcards

1
Q

What is level 0 care?

A

Ward based care

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2
Q

What is level 1 care and which patients require it?

A

Ward based care + critical care advice/support

–> patients at risk of deterioration

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3
Q

What is level 2 care, who requires it and what does it involve?

A

HDU level care

  • patients with a single failing organ system
  • higher nursing care
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4
Q

What is level 3 care, who requires it and what is involved?

A

ICU level care

  • patients with multi-organ failure
  • 1-1 nursing
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5
Q

What are some of the long term effects of being in intensive care?

A 
PTSD, anxiety
Muscle weakness
Fatiguability
Chronic renal replacement therapy need
Long term respiratory support
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6
Q

Which types of vasoactive drugs can be given in ICU to support the CV system?

A

Inotropes + vasopressors

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7
Q

How is the effect of vasoactive drugs monitored?

A

Invasive arterial monitoring (art line)

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8
Q

What is the main physiological effect of vasopressors?

A

Increase SVR

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9
Q

Which types of shock are vasopressors most useful in?

A

Vasodilatory/distributive shock

e.g. sepsis, anaphylaxis

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10
Q

What are some examples of vasopressors?

A

Noradrenaline (norepinephrine)
Metaraminol
Ephedrine
Adrenaline

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11
Q

Which vasoactive drug is most commonly used in ICU and why?

A

Noradrenaline –> because reduced SVR is often a problem in adult sepsis

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12
Q

What is metaraminol usually used for?

A

Drug of choice in theatre to increase SVR + BP as it can be given peripherally

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13
Q

What is the main physiological effect of inotropes?

A

Increase force of cardiac muscle contraction –> increase CO

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14
Q

Which type of clinical situation would require inotropes?

A

Cardiogenic/low flow shock e.g. post MI

Patient is hypotensive having received adequate fluids –> cause of low BP is poor cardiac contractility

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15
Q

Give two examples of inotropes

A

Adrenaline (epinephrine)

Dobutamine

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16
Q

How are inotropes given?

A

Must be given through a central venous catheter

17
Q

What are the options for respiratory support in ICU?

A 
Ventilation (invasive/non-invasive)
Extracorporeal oxygenation (ECMO)
18
Q

When is ECMO used and what does it do?

A

Rescue treatment for severe refractory hypoxaemia

- modified cardiopulmonary bypass circuit providing respiratory + circulatory support for days to weeks

19
Q

Which type of fluids would generally be used first line in the critically ill?

A

Crystalloids –> Hartmann’s better than 0.9% saline as balanced salt solution

20
Q

What is an intra-aortic balloon pump?

A

Inflatable balloon inserted percutaneously via (usually) femoral artery
- improves myocardial oxygen supply and reduces myocardial work

21
Q

When might an intra-aortic balloon pump be used?

A

Refractory cardiogenic shock e.g. post MI

22
Q

How is brainstem death different to cardiovascular death?

A

Two senior doctors must confirm lack of brainstem activity

Heart will continue to beat + organ perfusion continues as patient is ventilated (only really relevant in ICU)

23
Q

What are the indications for insertion of a central venous catheter (CVC)?

A
  • monitoring central venous pressure
  • venous access for haemodialysis
  • venous access for cardiac pacing
  • administration of inotropes, cytotoxic agents + parenteral nutrition
  • (no other route of venous access possible)
24
Q

What are the common sites for insertion of a CVC?

A

Internal jugular vein
Subclavian vein
Femoral vein
Antecubital fossa (PICC line - peripherally inserted central catheter)

25
Q

What are some immediate complications of CVC insertion?

A 
Arterial puncture/haemorrhage
Pneumothorax/haemothorax
Air embolism
Cardiac arrhythmias
Damage to structures e.g. trachea, oesophagus, thoracic duct, nerves
26
Q

What are some of the delayed complications of CVC insertion?

A

Thrombosis
Infection
Endocarditis
Cardiac rupture/valve rupture

Acute Care + Anaesthetics (9 decks)

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