Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DA > Intensive Care Medicine > Flashcards

Intensive Care Medicine Flashcards

1
Q

What is the mnemonic used to summarise the basic ICU care bundle

A

FASTHUG

F - Feeding 
A - Analgaesia
S - Sedation
T - Thromboprophylaxis
H - Head Up
U - Ulcer Prophylaxis
G - Glucose control
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is feeding the ICU patient vitally important

A

Protein Energy Malnutrition (Negative Nitrogen Balance) —> Impaired immunity + Sepsis and wound break down.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the methods of feeding in the ICU

A

Enteral
- NGT/NJT/Gastrostomy/Jejunostomy

Parenteral
- TPN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is TPN indicated

A

Enteral nutrition is contraindicated

  • Gastric stasis
  • Intractable diarrhoea
  • Malabsorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is TPN administered

A

CVL - with strict asepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the complications of TPN

A

Infection
Septicaemia
Hyperbilirubinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is analgaesia paramount

A

The patient needs to be able to cough and expand the lungs.

Multimodal NB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is sedation required in the ICU and what is used for this?

A

Inadequate pain control and anxiety has physiological sequelae.

Facilitation of mechanical ventilation
Decrease O2 demand
Impose day - night cycles

Prolonged benzos no longer used
Propofol infusions used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the measures used for thromboprophylaxis in the ICU

A
  1. Prophylactic LMWH
  2. Graduated compression stockings
  3. Calf compression devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are ICU patient’s nursed head up and how many degrees head up is required for these benefits?

A

15 degrees head-up

  • Reduces aspiration of feeds (d/t passive regurgitation)
  • Decreases incidence of ventilator associated pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the options for ulcer prophylaxis in the ICU

A

Sucralfate - 1 g 6hrly NGT

H2RA / PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the benefit of maintaining euglycaemia (4 -8 mmol/L)

A

Decreases septic complications
Decreases cardiac complications
Improves wound healing

Measure Hgt 2 hourly

insulin infusion commonly required due to hyperglycaemia related to the stress response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the indications for mechanical ventilation

A
  1. Ventilation failure: PaCO2 increased with pH < 7.2
  2. Oxygenation failure: PaO2 < 11 kPa FiO2 > 0.4
  3. RICP and cerebral ischaemia (O2 demand : supply)
  4. Reduce work of breathing

RR > 30
pH < 7 .2 (with Increased PaCO2)
PaO2 < 8 kPa or < 11 kPA with FiO2 > 0.4

Exhaustion
Confusion
Severe shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is IPPV divided

A

Volume Control and Pressure Control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is IMV vs SIMV

A

IMV - Intermittent Mandatory Ventilation
- Fixed number of fixed volume breaths are administered

SIMV - Synchronised Intermittent Mandatory Ventilation
- Mandatory ventilator breaths are synchronised with the patient’s own breaths to prevent stacking and hyper-inflating the lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the benefits of PEEP

A
  1. Increases FRC
  2. Improves pulmonary compliance
  3. Improves V:Q matching
  4. Improves oxygenation
17
Q

What is CPAP

A

This is continuous positive pressure applied during SPONTANEOUS VENTILATION to the expiratory side of the breathing circuit - requires tight fitting mask and an alert an co-operative patient.

Airway reflexes must be intact to prevent aspiration

18
Q

How does CPAP improve oxygenation and why is it beneficial

A

Baseline pressure in the upper airways is set above zero —> prevent alveolar collapse and atelectasis and recruit collapsed alveoli.

It will improve lung compliance and reduce the work of breathing by repositioning the lung on a more advantageous part of the lung compliance (Pressure - Volume) curve.

Its benefit is that it can be used in the ward so a patient does not need an ICU bed.

19
Q

What pressure is used for CPAP:

A

5 - 10 cmH20

20
Q

When can a patient be weaned off the ventilator

A

Ease of weaning is inversely related to duration on the ventilator

  1. Disease prompted IPPV is reversed or under control
  2. Effective cough or VC > 1000 ml (±15ml/kg)
21
Q

What are the principles of cardiovascular supportive care in the ICU

A
  1. Optimise preload and afterload
  2. Reverse myocardial depressants
    - hypoxia
    - hypercapnoea
    - acidosis
    - hypovolaemia
    - hypocalcaemia
  3. Inotrope
22
Q

How does adrenalin effect its different receptors at high and low doses

A

Low doses - predominant beta effect - inotropy

High doses - predominant alpha effect - VC

23
Q

Which receptors does noradrenalin predominantly act

A

alpha receptors –> vasoconstriction

24
Q

Which receptors does dobutamine predominantly effect and what other important effect does it have

A

Beta mediated increase in CO

Decreases SVR

25
Q

What is the mechanism of action of milrinone

A

Phosphodiesterase 3 inhibitor

–> Dilates pulmonary vasculature and useful in pulmonary hypertension.

26
Q

Why is dopamine no longer used as an inotrope

A

Traditionally it was used for renal protection.

This has since been disproved and dopamine is no longer used.

27
Q

What agents can be used to reduce afterload and reduce myocardial O2 demand.

When are these agents used clinically

A

Direct acting vasodilators

  1. Hydralazine
  2. Sodium Nitroprusside (SNP)
  3. Nitroglycerine (GTN) - most frequently used

Alpha blockers

  1. Phenoxybenzamine
  2. Phentolamine

Heart failure
Control of angina and reduce ischaemia

28
Q

What are the indications for renal replacement therapy (RRT)

A

Acidaemia pH < 7.2 (unresponsive)
Electrolytes K > 7 (unresponsive)
Intoxicants (Toxic alcohols, Li, ASA)
Overload of fluid (Pulmonary oedema unresponsive)
Oliguria < 200ml in 12 hour
Uraemia Urea > 35 mmol/L
- Uraemic encephalopathy
- Uraemic pericarditis
- Uraemic neuropathy
- Uraemic myopathy
- Uraemic coagulopathy

29
Q

Define AKI

A

Acute Kidney Injury

One of the following

  1. Rise in SCr by > 26.5 in < 48 hrs
  2. SCr increase by 1.5 times baseline < 7 days
  3. UO < 0.5 ml/kg/hour for > 6 hours (exclude obstruction)
30
Q

Define the RIFLE criteria

A

Criteria to classify the severity of acute kidney injury

R - Risk SCr up by > 26.5 OR 1.5 - 1.9 x baseline
UO < 0.5 ml/kg/hr for 6 - 12 hrs

I - Injury SCr up by 2.0 - 2.9 times baseline
UO < 0.5 for 12 - 24 hrs

F - Failure SCR up by > 3 times baseline
UO < 0.3 ml/kg > 24 hrs
Anuria > 12 hrs

L - Loss Needs RRT > 4 weeks

E - End Stage Needs RRT > 3 months

DA (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions