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ACC > Intensive Care Medicine > Flashcards

Intensive Care Medicine Flashcards

1
Q

What is the nurse to px ratio on ICU compared to a normal ward?

A

1: 1
1: 10

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2
Q

How many levels of care are there in hospitals?

A

3 (0-4)

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3
Q

Describe px criteria for:

  1. Level 0
  2. Level 1
  3. Level 2
  4. Level 3
A
  1. 0 = needs can be met through normal ward care e.g. obs every 4 hours.
  2. 1 = risk of deterioration OR discharged from higher level - input advice from critical care outreach support team.
  3. 2 = pre-operative optimisation OR extended post-operative care (e.g. after major surgery) OR stepped down from higher level - receive single organ support.
  4. 3 = required advanced respiratory support OR 2+ organ support.
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4
Q

Typically level 2 and level 3 correlate to which ward in the hospital?

A 
2 = HDU (High dependancy unit)
3 = ICU (Intensive care unit)
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5
Q

What px physiological variables are displayed on a monitor in ICU?

A
  1. ECG
  2. SpO2
  3. RR
  4. MAP (mean arterial pressure)
  5. CVP (central venous pressure)
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6
Q

Which airway devices provide a definitive airway?

A
  1. Endotracheal tube

2. Tracheostomy

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7
Q

Where should an ETT sit - if in the right place?

A

In the trachea above the carina.

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8
Q

Is an intubated px able to speak?

A

No - no airflow over the vocal cords.

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9
Q

What are the early complications of an ETT?

A

Trauma to any section of the airway (on insertion), aspiration of stomach contents, tube malposition, airway obstruction, hypoxia from prolonged attempts.

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10
Q

What are the late complications of an ETT?

A

Infection, mucosal damage to mouth or trachea due to cuff pressure, injury to vocal cords, tracheal stenosis.

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11
Q

What is a tracheostomy tube and for which px’s is it used?

A

A percutaneous airway device used for px requiring prolonged airway or ventilatory support.

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12
Q

Where is a tracheostomy inserted?

A

Through an incision in the anterior neck between the tracheal cartilaginous rings.

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13
Q

What are the early complications of a trachy?

A

Haemorrhage, pneumothorax, tube misplacement, surgical emphysema, blockage with secretions, stomal infection, TOF

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14
Q

What are the late complications of a trachy?

A

Late haemorrhage due to erosion into an artery, tracheal granulomata, tracheal stenosis, scarring, tracheal necrosis.

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15
Q

What is oxygenation?

A

The provision of oxygen to the tissues.

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16
Q

What is ventilation?

A

The delivery of oxygen to the lungs and the removal of carbon dioxide.

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17
Q

What is the benefit of o2 therapy?

A

Increased inspired o2 concentration allows better o2 delivery to the tissues.

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18
Q

What is the risk of o2 therapy?

A

High conc. inspired o2 for a long period of time (>60% for >48 hours) = pulmonary injury.

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19
Q

What are the two common techniques of oxygen therapy?

A
  1. Continuous positive airway pressure (CPAP)

2. Non-invasive ventilation (NIV)

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20
Q

When is CPAP used?

A

In px in acute hypoxic respiratory failure OR when weaning from invasive ventilation.

21
Q

How does NIV work?

A

Provides a constant pressure during inspiration and expiration = incorporates CPAP + increased pressure triggered by px breathing.

This assists px’s own breathing, reducing the amount they have to ‘work’ and helping px to ‘blow off’ co2.

22
Q

What type of px can NIV be used on and what is their criteria?

A

Alert and co-operative px. Must be able to cough, make own respiratory effort and protect airway.

23
Q

Describe what happens during normal breathing - with regards to muscle contraction and expiration.

A

Inspiratory muscles contract = increasing thoracic volume. This creates negative pressure within the thorax= causing inflow of air. Expiration is passive.

24
Q

What is IPPV and how does it work?

A

Intermittent positive pressure ventilation = creates positive pressure within endotracheal tube - driving air into the lungs.

25
Q

What is the main advantage of IPPV?

A

Oxygenation and ventilation can be achieved without the patient making any respiratory effort.

26
Q

What are the complications of IPPV?

A

Ventilator associated pneumonia (VAP) = common, ventilatory associated lung injury, pneumothorax, haemodynamic instability

27
Q

What pathologies may contribute to hypotension?

A

Sepsis, hypovolaemia, cardiac dysfunction, anaphylaxis.

28
Q

What can be given to px on ICU to support circulation?

A

Fluids

29
Q

What must be ensured before a px is started on vasoactive drugs?

A

That the px is adequately fluid resuscitated.

30
Q

What are the 3 types of vasoactive drugs and what do they do?

A
  1. Inotropes = increase force of contraction which increases stroke volume.
  2. Chronotropes = increase the heart rate.
  3. Vasopressors = cause vasoconstriction this increasing systemic vascular resistance.
31
Q

How should vasoactive drugs be administered?

A

Through a central vein, via a continuous infusion.

32
Q

Why should vasoactive drugs not be given through a peripheral vein?

A

Because of the risk of tissue ischaemia secondary to extravasation.

33
Q

What receptors are affected by Adrenaline and what type of vasoactive drug is it?

A
  1. Alpha-1, beta-1 and beta-2

2. Inotrope, chronotrope and vasopressor.

34
Q

What receptors are affected by Dobutamine and what type of vasoactive drug is it?

A
  1. Beta-1 and beta-2

2. Inotrope and chronotope

35
Q

What receptors are affected by Noradrenaline and what type of vasoactive drug is it?

A
  1. Alpha-1 and beta-1

2. Inotrope and vasopressor

36
Q

What receptors are affected by Phenylephrine and what type of vasoactive drug is it?

A
  1. Alpha-1

2. Vasopressor

37
Q

Which drug does not increase vascular tone?

A

Dobutamine - not a vasopressor.

38
Q

What is commonly a secondary effect of shock or sepsis?

A

AKI

39
Q

How is AKI defined?

A

Falling urine output to less than 0.5ml/kg/hour OR acute deterioration of GFR (manifested by rising serum creatinine and urea).

40
Q

What complications can untreated AKI cause?

A

Hyperkalaemia, acidosis, fluid overload and uraemia.

41
Q

Is intermittent haemodialysis or continuous renal replacement therapy preferred on ICU and why?

A

Continuous renal replacement thereapy = px on ICU are less able to tolerate the large fluid changes associated with intermitted dialysis. In continuous - fluid and electrolyte changes occur continuously at a slow rate.

42
Q

What is the most commonly used technique used to treat px with AKI in ICU?

A

Continuous veno-venous haemofiltration - large double lumen catheter inserted into central vein.

43
Q

What percentage of normal px requiring renal replacement therapy for AKI will require long-term renal replacement therapy?

A

5-10%

44
Q

Why is sedation given on ICU?

A

To aid tolerance of ETT, reduce px pain and anxiety, facilitate ventilation.

45
Q

Typically what sedative is given on ICU?

A

An infusion of synthetic OPIOID (alfentanil or remifentanil) and SEDATIVE (propofol).

46
Q

What are the consequences of insufficient sedation?

A

Chest infection, neuropathies, VTE

47
Q

What is a “sedation hold”?

A

Should occur at least once a day - all sedation is stopped to prevent accumulation of sedative drugs, allowing assessment of neurological function and reducing risk of complications.

48
Q

Why is sedation sometimes stopped after a tracheostomy?

A

To allow physiotherapy, interaction with clinical staff and visitors - resume ADL.

ACC (10 decks)

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