INTENSIVE CARE

Question 1

what are the steps in airway maintenance?

Answer 1

• check for foreign body/anything easy to remove. these can be removed with magill forceps or suction
• next consider airway manoeuvres such as head tilt chin lift (do not do this if there is a possibility of c-spine injury) or jaw thrust
• next consider an airway adjunct such as a guedel or nasopharyngeal airway (do not use NPA if there is suspicion of skull base fracture)
• next consider LMA (An i-gel is similar to an LMA, but the cuff does not require inflation)
• finally intubation guarantees a secure airway

Question 2

what anatomical landmarks should be used when sizing a guedel?

Answer 2

angle of incisor to angle of mandible

Question 3

what anatomical landmarks should be used when sizing an NPA

Answer 3

incisor to tragus

Question 4

What 6 features should warrant consideration for assessment for LTOT?

Answer 4

Assess patients if any of the following:

1. very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be ‘considered’ for patients with severe airflow obstruction (FEV1 30-49% predicted)
2. cyanosis
3. polycythaemia
4. peripheral oedema
5. raised jugular venous pressure
6. oxygen saturations less than or equal to 92% on room air

Question 5

How should the assessment for LTOT be done?

Answer 5

Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.

Question 6

What is the criteria for offering LTOT?

Answer 6

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

• secondary polycythaemia
• peripheral oedema
• pulmonary hypertension

Question 7

Give two indications for an arterial line

Answer 7

1. Continuous beat-to-beat blood pressure measurement
2. Frequent ABG analysis

Question 8

What are the 4 main types of cvad?

Answer 8

1. Direct access central catheters are for short term use as they have a high infection risk
2. PICC lines are for longer term use, and are inserted via an arm vein
3. Hickman lines are for longer term used, and are inserted surgically
4. Implanted ports are for long term use, and are inserted surgically

Question 9

Do catecholamines have a long or short half life?

Answer 9

very short, so short they usually have to be given via a central line

Question 10

Name 4 commonly used vasopressors, which is commonly preferred in ICU?

Answer 10

Adrenaline

Noradrenaline

Dobutamine

Dopamine

Question 11

Hw many classes of anti-arrhythmics are there? What is the mechanism of action of each class? Give an example for each class

Answer 11

1. Class I- lidocaine, voltage gated sodium channel blocker
2. Class II- propranolol, B blockers block beta adrenergic responses of the heart
3. Class III- amiodarone, exact mechanism is unknown but believed to block potassium channels therefore slowing repolarisation
4. Class IV- verapamil, block calcium channels

Question 12

What are the 3 options for enteral route feeding?

Answer 12

• nasogastric (NG)
• percutaneous endoscopic gastrostomy (PEG)
• nasojejunal tube (NJT)

Question 13

What option should be considered if enteral feeding fails?

Answer 13

Total parenteral nutrition

Question 14

What are the scoring criteria for GCS?

Answer 14

Eye

Ex: severe trauma to the eyes

1. Does not open eyes
2. Opens eyes in response to pain
3. Opens eyes in response to voice
4. Opens eyes spontaneously

Verbal

Ex: Intubation

1. Makes no sounds
2. Makes sounds
3. Words
4. Confused, disoriented
5. Oriented, converses normally

Motor

Ex: Paralysis

1. Makes no movements
2. Extension to painful stimuli
3. Abnormal flexion to painful stimuli
4. Flexion / Withdrawal to painful stimuli
5. Localizes to painful stimuli
6. Obeys commands