Intensive care

Question 1

What are the levels of intensive care

Answer 1

0- ward based, no organ support, may ned oxygen support
1- at risk of deterioration, 24 hour outreach team, 4 hourly obs
2- monitoring or support of single system, staffed one nurse to 2 patients
3- 1:1 nursing, need mechanical ventilation, support of 2 or more organ systems.

Question 2

Purpose of ICU

Answer 2

Provide intensive support intensive treatment and intensive monitoring.

Question 3

Types of ICU

Answer 3

Adult, paediatric, neonatal (new-born) and special care baby

Question 4

Equipment

Answer 4

Ventilator
Oxygen
Fluids
Dialysis- keep fluids in balance when kidneys stop working.
Nasogastric tube- tube from nose to stomach short-term feeding.
Gastrostomy- tube from skin to stomach, long term feeding.
Jejunostomy- tube from skin to small intestine, long term feeding.
Total parenteral nutrition- short or long-term when gastrointestinal tract is not working.

Question 5

Drugs

Answer 5

Diuretics to remove water
Anti-coagulants to thin blood
Inotropes to boost Q
Noradrenaline to increase cardiac contraction
Sedatives

Question 6

Role of physio in ICU

Answer 6

maintain lung volume
improve oxygenation and ventilation
optimize secretion clearance
maximise musculoskeletal function
facilitate return of independence.

Question 7

Indications for mechanical ventilation

Answer 7

support gas exchange
improve alveolar ventilation
achieve acceptable ABGs
increase lung volumes
reduce work of breathing
V/Q mismatch

Question 8

Benefits of mechanical ventilation

Answer 8

Reduce WOB
Improve lung volumes 
Adequate gas exchange
Humidification
Control of gas exchange

Question 9

Complications of mechanical ventilation

Answer 9

Difficulty weaning off
Disruption of coughing mechanism
Effects of sedation and paralysis (loss of memory, drowsiness, heaviness)
Psychological effects (PTSD, anxiety, delirium)
Oxygen toxicity (too much oxygen)
Complications due to intubation ( speech, atelectasis, infection)

Question 10

Volume cycled MV

Answer 10

Delivers set tidal volume at a constant flow rate

Not fixed airway pressure

Question 11

Pressure cycled MV

Answer 11

Set inspiratory pressure per breath
Varied tidal volume
Minimum RR set and maintained
Doesn’t allow for patient initiated breaths

Question 12

Assist control MV

Answer 12

Maintains minimum RR regardless of spontaneous breathing.

Question 13

What is a mandatory breath

Answer 13

Triggered and cycled by ventilator

Question 14

What is a assisted breath

Answer 14

Triggered by patient and cycled by ventilator

Question 15

What is a spontaneous breath

Answer 15

Triggered and cycled by patient

Question 16

Controlled mandatory ventilation

Answer 16

Fully controlled
Used for patients who are unable to breathe
Spontaneous breathing inhibited
Requires heavy sedation

Question 17

Pressure support ventilation

Answer 17

Minimum RR not set
Breaths triggered by patient
Provides pressure boost to each inspiratory effort
Commonly used for weaning.

Question 18

CPAP (+/- PS)

Answer 18

Used for weaning
CPAP supports expiration, PS supports inspiration
Spontaneous breathing

Question 19

High frequency jet ventilation

Answer 19

Delivers small tidal volume
Passive expiration
Patient needs to be heavily sedated to avoid spontaneous breathing.

Question 20

Extracorporeal membrane oxygenation

Answer 20

Blood continuously pumped from patient to ventilator to mimic gas exchange
Allows heart and lungs time to recover
May be used when other modes of ventilation have failed.

Question 21

Nitric oxide

Answer 21

Pulmonary vasodilator

Reduce pulmonary artery pressure

Question 22

Broad problems in ICU

Answer 22

Decreased lung volumes
Decreased gas exchange
Reduced mucociliary clearance
Increased WOB
Respiratory muscle weakness.

Question 23

Decreased lung volumes due to…

Answer 23

V/Q mismatch
Which is due to cephalad displacement f diaphragm, lack of spontaneous respiration and alveoli developing different levels of resistance.

Question 24

Decreased mucociliary clearance due to…

Answer 24

Impaired cough, high inspiratory pressures, high levels of inspired oxygen, history of smoking, denudation of ciliary by tubing, history of chronic respiratory disease.

Question 25

Mechanical ventilation for 48 hours + causes…

Answer 25

Reduced diaphragm strength and respiratory muscle endurance.

Question 26

Increased WOB due to…

Answer 26

Asynchrony between patient and ventilator

Meaning ability of ventilator to respond to patient’s demand for flow during inspiration.