Intensive Care Unit Flashcards

1
Q

What is Intensive Care?

A

Specialist hospital wards that provide treatment and monitor for people who are severely ill, also called as critical care or intensive therapy units(ITU).

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2
Q

Who invented ICU?

A

Copenhagen 1952 by
Dr Bjorn ibsen

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3
Q

What’s the Good in ICU?

A

Physiological monitoring
Organ support and lots of nursing

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4
Q

What is Physiological monitoring ?

A

Basic non-invasive monitoring -ECG, BP, Spo2
Invasicve Monitoring- CVP,IABP,Cardiac output, intracranial pressure

Respiratory monitoring- ETCO2, Ventilatory Parameters

Point of care testing - Blood gas analysis, and usually Hb/Hct, Na, K, Cl, Ca, Lac
also sometimes TEG, TnI, etc. (unit specific)

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5
Q

What are the indications for Monitoring?

A

Diagnosis: data may help differentiate between alternative diagnoses.
e.g. PAC: ARDS vs. cardiogenic pulmonary oedema
Surveillance: at risk of deterioration where rapid detection and intervention will modify outcome.
e.g. ICP monitoring in TBI.
Guiding Treatment: monitor response to therapy and adjust.
e.g. BP/CO response to vasoactive drugs

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6
Q

what is Non-invasive monitoring?

Quite useful !

A

continuous ECG
NIBP
Pulse oximetry

Ischaemia is poorly seen in Continuous ECG

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7
Q

What is NOn-invasive blood pressure?

A

Measures Systolic/Diastolic/Mean(MAP)
AF may lead to inaccuracy
Wrong cuff size may overestimate BP

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8
Q

What is Mean Arterial Pressure?

Good number is 65

A

MAP=DBP+SBP-DBP/3

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9
Q

What is Pulse pressure?

A

difference between the diastolic and systolic

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10
Q

Invasive monitoring

A

Indications are diagnosis, surveillance, titration of therapy but it can also monitor some parameters which cannot be monitored non- invasively e.g ICP, CO

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11
Q

Invasive pressure monitoring

A
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12
Q

What is Central Venuous pressure

A

Very low values (<4mmHg) imply hypovolaemia
Very high values (>18mmHg) suggest pump failure

Requires central line:
Infection risk (CLABSI)
Pneumothorax
Bleeding
Thrombosis

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13
Q

Invasive Blood pressure ?

Very Useful !

A

Systolic/Mean/Diastolic
beat to beat measure

Waveform gives more information
* Contractility
* Filling status
Requires arterial cannula:
* Bleeding risk
* Thrombosis/Embolism( VERY BAD)
* Can draw blood for ABG

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14
Q

Intracranial Pressure monitoring is placed for?

A

Traumatic brain injury
Head injuries and increase the ICP

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15
Q

What is Cardiac output Monitoring?

A
  • Variety of technologies
  • Useful to diagnose cause of shock
  • May be useful to guide treatment
  • Continuous monitors all invasive
  • Most require central and arterial lines
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16
Q

End Tidal CO2

A
17
Q

What are the 3 goals?

A

Management of the critically ill patient:
* Keeping them alive (maintaining vital functions)
* Treating the underlying disease
* Preventing new problems

18
Q

Stuff that keeps you alive…

A

Airway (Airway Maintenance)
Breathing (Respiratory Support)
Circulation (Circulatory Support)
Excretion (Liver & Kidney replacement)
Nutrition (Enteral/Parenteral Nutrition

19
Q

What do you do in Airway?

A

Head Tilt- chin lift
Jaw thrust

Airway Adjuncts
* oropharangeal
* Nasopharangeal
Laryngeal Mask Airway(maintain airway, hands-free, simple to insert, can attach breathing circuit, do not protect from aspiration)
Eye gel looks same as Laryngeal mask

20
Q

Orotracheal Intubation

A

Protects” the airway
Considered if airway reflexes absent (GCS <8).
Requires training
Complications:
Oesophageal intubation
Airway trauma/bleeding
You can’t do it so get help.
Patients die from lack of oxygen not lack of a tube

21
Q

What is Tracheotomy?

Goes straight into the trachea!

A

Definitive long term airway
Surgical or Percutaneous

22
Q

What is CPAP?

Good for lungs

CPAP for pts with Sleep apnoea is Nasal is different to this!

A

Continuous Positive Airways Pressure
Does not ventilate
Expands lung
 work of breathing
Uncomfortable
Pressure sores

Pressure volume curve

Good for plp with HF

23
Q

What is HFNO? expand the lungs

NEW one, can talk, can eat!!!!

A

High Flow Nasal Oxygen
Does not ventilate
Expands lung
work of breathing
the flow is so fast and if pt keep their mouth close, they can get positive pressure of the lungs (100%)

24
Q

What is BIPAP/NIPPV?

lots on respiratory wards & good for COPD

A

Similar mask to CPAP
Same problems
Two pressure levels
Ventilates
Requires co-operation
Low pressures

have 2 diif levels of pressure - gas flow into the lungs and out again when the pressure is low.

25
Q

what is Invasive Mechanical Ventilation?

A

Requires definitive airway (ETT/TT) - life support machine - it is good if the lung is really bad

26
Q

What is ECMO ?

A

Extracorporaeal Membrane Oxygenation

27
Q

What do you do for Circulation?

A

IV cannule
IV fluids
Vasoactive Drugs( only in ICU since it’s dangerous drugs and given through central line )

meds - Catecholamines/Vasopressin analogues

28
Q

What is the common vasoactive drugs?

A
  • Adrenaline - alpha and Beta -inoconstrictor
  • Dobutamine -beta agonist -inodilator
  • Dopamine -mainly D agonist some catecholamine effects -weak inoconstrictor
  • Noradrenaline - alpha and B agonist- mainly vasoconstrictor
  • Phenylephrine - alpha agonist-pure vasoconstrictor
  • Vasopressin - v1 &v2 agonist -pure vasoconstrictor
  • Terlipressin -v1»v2- vasoconstrictor long t1/2
29
Q

What is Cardiac pacing?

A

When the heart rate is too low (remember:
CO = HR x SV)
Drugs buy time: atropine/isoprenaline etc.

30
Q

what is Ventricular Assist Devices?

A

Highly specialist
Few centres

31
Q

What is Enternal Feed?

A

NG tube
NJ tube ( goes further to pyloric sphincter)

32
Q
A