Intensive Care Flashcards
What is level 0 care?
Ward based care
What is level 1 care and which patients require it?
Ward based care + critical care advice/support
–> patients at risk of deterioration
What is level 2 care, who requires it and what does it involve?
HDU level care
- patients with a single failing organ system
- higher nursing care
What is level 3 care, who requires it and what is involved?
ICU level care
- patients with multi-organ failure
- 1-1 nursing
What are some of the long term effects of being in intensive care?
PTSD, anxiety Muscle weakness Fatiguability Chronic renal replacement therapy need Long term respiratory support
Which types of vasoactive drugs can be given in ICU to support the CV system?
Inotropes + vasopressors
How is the effect of vasoactive drugs monitored?
Invasive arterial monitoring (art line)
What is the main physiological effect of vasopressors?
Increase SVR
Which types of shock are vasopressors most useful in?
Vasodilatory/distributive shock
e.g. sepsis, anaphylaxis
What are some examples of vasopressors?
Noradrenaline (norepinephrine)
Metaraminol
Ephedrine
Adrenaline
Which vasoactive drug is most commonly used in ICU and why?
Noradrenaline –> because reduced SVR is often a problem in adult sepsis
What is metaraminol usually used for?
Drug of choice in theatre to increase SVR + BP as it can be given peripherally
What is the main physiological effect of inotropes?
Increase force of cardiac muscle contraction –> increase CO
Which type of clinical situation would require inotropes?
Cardiogenic/low flow shock e.g. post MI
Patient is hypotensive having received adequate fluids –> cause of low BP is poor cardiac contractility
Give two examples of inotropes
Adrenaline (epinephrine)
Dobutamine
How are inotropes given?
Must be given through a central venous catheter
What are the options for respiratory support in ICU?
Ventilation (invasive/non-invasive) Extracorporeal oxygenation (ECMO)
When is ECMO used and what does it do?
Rescue treatment for severe refractory hypoxaemia
- modified cardiopulmonary bypass circuit providing respiratory + circulatory support for days to weeks
Which type of fluids would generally be used first line in the critically ill?
Crystalloids –> Hartmann’s better than 0.9% saline as balanced salt solution
What is an intra-aortic balloon pump?
Inflatable balloon inserted percutaneously via (usually) femoral artery
- improves myocardial oxygen supply and reduces myocardial work
When might an intra-aortic balloon pump be used?
Refractory cardiogenic shock e.g. post MI
How is brainstem death different to cardiovascular death?
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)
What are the indications for insertion of a central venous catheter (CVC)?
- 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)
What are the common sites for insertion of a CVC?
Internal jugular vein
Subclavian vein
Femoral vein
Antecubital fossa (PICC line - peripherally inserted central catheter)
