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Neurology > Intensivtherapie (insb. Covid) > Flashcards

Intensivtherapie (insb. Covid) Flashcards

1
Q

prophylaxis of deep venous thrombosis

A

LMH s.c. enoxaparin 4000 UI/d, in case of overweight 6000 UI/d, & obesity 4000 UI 2x/d, GFR < 30 ml/min UFN 5000 UI 2x/d, hight risk of bleeding intermittent pneumatic compression (evidence???)

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2
Q

Prophylaxis of stress ulcers

A

Mucosal injury: 75-100% in endoscopic studies (risk factor: respiratory failure, coagulopathy, liver disease, renal replacement therapy // protective factor: enteral feeding)
occult bleeding: 5-25 %
clinically important bleeding: 1.5 %

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3
Q

prophylaxis of stress ulcer

A

benefit: protects against clinically important bleeding
risk: increases the incidence of C. difficile
low risk patient: no prophylaxis
high risk patients: mechanical ventilation > 48 h, ICU stay > 7 d, coagulopathy, dual antiplatelet therapy, occult bleeding > 6 d, sepsis, high dose steroids, renal replacement therapy

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4
Q

ROX index

A

(saturation * FiO2)/respiratory rate

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5
Q

ROX index:

A

in patients with acure respiratory failure (ARF) and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours

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6
Q

English-German

A 
PPE: personal protective equipment 
to don: anziehen
to doff: ausziehen
gown: das Kleid 
apron: Schürze 
goggles: Schutzbrille
snuggly: kuschlig 
redeployment: Umgruppierung 
commence: beginnen 
jaw thrust: Kiefer-Handgriff
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7
Q

What is the primary parameter to recognize a respiratory deterioration?

A 
respiratory rate 
inability to talk in full sentences 
use of accessory muscles of breathing 
saturation 
increased requirement of supplementary oxygen 
late: cyanosis, drowsiness
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8
Q

symptoms of respiratory failure

A

air hunger
chest tightness
inability to breathe deeply

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9
Q

pathophysiology of respiratory failure

A

type 1 respiratory failure: problem of a gas exchange

type 2 respiratory failure: problem of hypoventilation

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10
Q

etiology of type 1 respiratory failure

A

pneumonia
heart failure, pulmonary edema
asthma (leichte Stadien)
pulmonary embolism (Perfusions-Diffusions-Mismatch)

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11
Q

etiology of type 2 respiratory failure

A

opiate toxicity: reduced respiratory drive
iatrogenic over-oxygenation in patient witho metabolic compensation of hypercapnia
neuromuscular disease
reduced chest wall compliance
increased airway resistance
severe impairment of gas exchange in COPD

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12
Q

Covid-19 symptoms

A

14% type 1 respiratory failure (dyspnoe is disproportionately mild relative to the severity of disease)
5 % critically unwell

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13
Q

pathophysiology of the respiratory syndrome in covid-19 infection

A

early phase: damage of the pulmonary blood vessels –> impaired transfer of oxygen –> oxygenation via nasal cannula
late phase: typical ARDS –> mechanical ventilation

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14
Q

symptoms of respiratory distress

A

chest tightness
inability to breath deeply
anxiety

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15
Q

target SpO2 during the covid-19 pandemic

A

92-96 % (sufficiently to alleviate dyspnoea and maintain tissue oxygenation, avoiding the potentially harmful effects of hyperoxia and conserving hospital oxygen supplies) for type 1 respiratory failure
88-92 % for type 2 respiratory failure

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16
Q

Choice of respiratory support in type 1 respiratory failure

A

nasal cannula: 1-6 L/min, FiO2 25-50%
simple face mask: 5-10 L/min, FiO2 40-60%
reservoir mask: 15 L/min FiO2 60-90 %
nasal high flow oxygen: up to 70 L/min, FiO2 up to 100 %
CPAP: 15 L/min, up to 100 % FiO2

17
Q

treatment of type 1 respiratory failure (T1RF)

A
  1. increasing the fraction of inspired oxygen (FiO2)
  2. applying positive end expiratory pressure (PEEP) by means of CPAP: opens the lower airways and increases the surface area
  3. proning: minimizes ventilation/perfusion mismatch
18
Q

What is the benefit of venturi mask?

A

It delivers a precise FiO2 in patients who are susceptible to T2RF

19
Q

contraindication of CPAP

A

agitated, uncooperative patient
rediced condcious level with inability to protect airway
facial burns or trauma
persistent vomiting
unstable cardiorespiratory status or respiratory arrest
copious respiratory secretions
nond-drained pneumothorax

20
Q

Targtets to treat type 2 respiratory failure (T2RF)

A

increasing the minute centilation: product of respiratory rate and tidal volume

  1. increasing the respiratory rate: beyond a certain level, further increases of respiratory rate do not clear more carbon dioxide due to dead-space ventilation of airways
  2. increasing of tidal volume
21
Q

Indication of Non-invasive ventilation: high level of evidence

A

hypercapnic COPD exacerbation

pulmonary edema,

22
Q

physiologic inspiratory negative pressure

A

-4…-5 cmH2O

23
Q

Define a CPAP

A

airway pressure remains positive during the entire breathing cycle through the application of a certain level of positive end-expiratory pressure

24
Q

Difference of CPAP and NIV

A

during CPAP the patient breathes spontaneously and does all the work of breathing

25
Q

Why do not use CPAP mode on a ventilator connected to helmet?

A

because of the risk of CO2 rebreathing

26
Q

CPAP nach Boussignac

A

In einem speziell geformten Kunststoffzylinder wird das Beatmungsgas durch seitliche Kanäle geführt. Durch die Verjüngung der Kanäle in distaler Richtung erhöht sich die Strömungsgeschwindigkeit des Gases. Aus den Kanälen wird das Beatmungsgas mit dieser hohen Geschwindigkeit in das Zentrum des Zylinders geleitet und verwirbelt dort. Dieser Wirbel erzeugt einen steuerbaren Druck, dass virtuelle Ventil, durch welches der Patient ohne einen zusätzlichen mechanischen Widerstand ausatmen kann. Das System ist auf diese Weise jederzeit offen und gewährleistet gleichzeitig auf der Patientenseite den gewünschten positiven Druck. Zusätzlich wird der erzeugte Druck über ein Nebenstromverfahren gemessen und der Wert auf einem Manometer dargestellt. Die Orientierungsgröße für den gewählten Druck ist dabei der Wert zum Ende der Exspiration, der PEEP.

Die Größe des PEEP hängt hierbei von der Menge des zugeführten Gases ab. Eine Einstellung des PEEP erfolgt bei CPAP nach
Boussignac einzig über die Regulierung der Durchflussrate des Beatmungsgases. Der PEEP kann somit stufenlos an die Bedürfnisse des Patienten angepasst werden. Es sind keine unterschiedlichen Ventile für die verschiedenen PEEP-Werte notwendig.

27
Q

Principle of noninvasive positive pressure ventilation (NIPPV)

A

requires mechanical ventilator
during expiration keeps a preset PEEP level
during inspiration provides a preset level of positive pressure
the patient and the ventilator share the work of breathing

28
Q

contraindications of NIPPV

A 
coma
inability to clear secretions 
haemodynamic instability and shock 
gastroenteric non controlled bleeding 
recent upper GI or airways surgery 
problems in device positioning, intolerance
29
Q

Which monitoring during NIV?

A

clinical evaluation
heart reat, blood pressure, ECG
SpO2
BGA, lactate

30
Q

Which monitoring during NIV?

A

clinical evaluation: vital signs, mental status, skin, capillary refill
heart reat, blood pressure, ECG
SpO2
BGA, lactate

31
Q

Prediction of NIV failure

A 
HACOR score:
Heart rate 
acidosis
consciousness
oxygenation
respiratory rate 
if >=5 after 1 h of NIV: highly predictable for NIV failure
32
Q

Risk of NIV

A

Risk of the contaminations, viral mask may be applied

33
Q

Predict difficult airway

A 
5 mallampati score III or IV 
2 OSAS
1 reduced mobility of cervical spine 
1 limited mouth openin < 3 cm 
1 coma 
1 secere hypoxemia < 80 % 
1 nonanesthesiologist
34
Q

ARDS: Definitionskriterien

A
  1. respiratorische Insuffizienz binnen 7 d nach angenommenem Erstereignis
  2. Horowitz < 300
  3. bipulmonale Infiltrate im CXR bei Ausschluss vom kardialen Lungenödem

Neurology (5 decks)

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