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PHTY3250 > L18: Physiotherapy in Intensive Care II (Common Conditions in ICU) > Flashcards

L18: Physiotherapy in Intensive Care II (Common Conditions in ICU) Flashcards

1
Q

What are 5 conditions in ICU?

A
  1. ARDS
    • acute respiratory distress syndrome
  2. SIRS, Sepsis, septic shock
    • systemic inflammatory response syndrome
  3. Acute head injury
  4. Intensive care unit acquired weakness (ICUAW)
  5. Ventilator associated pneumonia
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2
Q

What are 7 causes of ARDS?

A
  1. Multitrauma
  2. Loss of blood > 3litres
  3. Head injury
  4. Burns
  5. Pneumonia
  6. Pancreatitis
  7. Near drowning

ie major insult to body

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3
Q

What is the definition of Acute Respiratory Distress Syndrome (ARDS)?

A
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4
Q

What is the cirteria for oxygenation for mild, moderate and severe ARDS?

A
  • MILD
    • 200 mm Hg <pao2></pao2>
    </pao2>
  • MODERATE
    • 100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg with PEEP ≥5 cm H2O
  • SEVERE
    • PaO2/FIO2 < 100 mm Hg with PEEP ≥5 cm H2O
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5
Q

What are 7 trigger results in release of inflammatory mediators?

A
  1. Alveolar oedema, resulting from endothelial injury and microvascular permeability
  2. Leakage of protein into alveoli
  3. Proliferation of alveolar epithelial type 2 cells
  4. Increased fibroblast activity
  5. Shunting ie decreased gas exchange
  6. Reduced FRC
  7. Cytokines, proteases and lipid mediators (Inflammation)
  • Increased distance –> worsen gas exchange
  • Partially atelectatic, very heard –> harder to inflate
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6
Q

What are 4 characteristics of Intrapulmonary (Direct) (ARDSip)?

A
  1. Consolidation
  2. CT Scan
    1. Consolidation + Ground Glass Opacification
    2. Evenly distributed areas of inflammation and oedema
  3. Alveolar filling
    1. Fibrin
    2. Blood cells
    3. Collagen
  4. Stiff lung
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7
Q

What are 5 characteristics of Extrapulmonary (Indirect) (ARDSexp)?

A
  1. Atelectasis
  2. CT scan
    1. Ground glass dominant
    2. Oedema, atelectasis, early hyaline membrane
    3. Pliable
    4. Area responsible for improved gas exchange
    5. Localized in the middle lung regions
  3. Microvascular congestion
  4. Stiff thoracoabdominal cage
  5. Compliant lung
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8
Q

What are 6 management of ARDS?

A
  1. Concept of “baby” lung
  2. Volutrauma, barotrauma, atelectrauma
  3. Limit volumes and pressure
  4. High levels of PEEP (If alveolar shuts down , next breath –> splint open)
  5. “Open lung” technique ie don’t disconnect PEEP
  6. Additional treatments
    • Eg Prone positioning
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9
Q

What are 4 characteristics of ventilator induced lung injury?

A
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10
Q

What are 5 implications for PT treatment of ARDS?

A
  1. Disconnecting patient from Ventilation may reduce FRC, cause Atelectrauma
  2. MHI may cause volutrauma, barotrauma, atelectrauma
  3. However, need to prevent secretion retention
    • Consider positioning, percussion, vibration, closed suction
  4. Extrapulmonary causes may be more amenable to MHI than intrapulmonary causes
  5. In long term cases lung becomes fibrotic. May be able to use MHI but be careful of large pressures (? use pressure manometer)
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11
Q

What are 6 characteristics of prone positioning in ICU?

A
  1. Recruitment of dorsal lung
  2. Increased homogenous distribution of ventilation and perfusion
  3. V/Q improves
  4. Improvement in compliance on returning to supine
  5. Improvement in oxygenation maintained when returning to supine.
  6. CT changes evident - reinflation of dorsal areas
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12
Q
A
  1. SIRS – Systemic Inflammatory Response Syndrome
    1. Response to release of Endotoxins
    2. Eg Burns, Trauma, Post transplant, head injury
  2. NB Initiating insult may be infective or non-infective
    1. Abnormal values for just sitting/without doing anything
  3. HR ≥ 90 beats/min can be 140-160beats/min
  4. To ≥ 39o or ≤ 36o
  5. Respirations ≥20/min
  6. WBC count ≥12,000/mm3 or ≤4,000/mm3 or >10% immature neutrophils

Swabbed to see if they have infection

Implications for PT

  • Often still haemodynamically stable – able to exercise, tilt table, Rx respiratory system
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13
Q

What is the definition split of sepsis 3?

A
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14
Q

What is the definition of sepsis 3?

A
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15
Q

What is the qSOFA criteria of sepsis 3?

A
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16
Q

What are 5 management of sepsis?

A
  1. Treat infection aggressively ie source control NB If respiratory Rx source
    1. Can be respiratory, joint, small cut
    2. Get infected tissue out (wash out –> might not even close wound –> next day –> wash out again)
  2. Management of respiratory failure, renal failure
  3. Early antibiotics
    1. If you suspect they have sepsis, give general antibiotics (without antibiotics –> increased risk of mortality)
  4. Often cardiovascular failure
  5. Requires
    1. Aggressive volume resuscitation + vasopressors
    2. Haemodynamic monitoring
17
Q
A
  1. Early
    1. ↑ Cardiac output (CO) and ↓ Systemic vascular resistance (SVR)
    2. Vasodilatation
  2. Increasing inotropes/vasopressors
  3. Positive pressure (MHI, VHI) dangerous
  4. Look at all values - SVR, CO, PAOP
  5. Normal CO and ↑ SVR – safer

NB Can still do positioning, percussion, vibration if unstable ie source control

18
Q

What is the prognosis of sepsis?

A
19
Q

What are 2 types of acute head injury?

A
  1. Primary Brain Damage
    1. Diffuse brain injury, diffuse axonal injury
    2. Mass lesion
      1. Subdural /extradural haematoma
      2. Intracerebral haemorrhage
  2. Secondary
    1. Cerebral oedema
    2. Ischaemia
    3. Airway, Arterial blood gases
    4. Iatrogenic
20
Q

What are 2 types of primary brain damage as acute head injury?

A
  1. Diffuse brain injury, diffuse axonal injury
  2. Mass lesion
    1. Subdural /extradural haematoma
      • Bleeding –> clot –> presses on brain (better prognosis than diffused brain injury)
    2. Intracerebral haemorrhage

What happens at the scene

21
Q

What are 4 types of secondary brain damage as acute head injury?

A
  1. Cerebral oedema
  2. Ischaemia
  3. Airway, Arterial blood gases
  4. Iatrogenic
22
Q

What is the intracranical pressure-volume curve?

A
23
Q

What are 4 characteristics of cerebral perfusion pressure?

A
  1. Clinical evaluation of level of tissue oxygenation in neurosurgical patients
  2. CPP = MAP - ICP
  3. Usually kept at > 70mmHg (inotropes eg Noradrenaline)
  4. If CPP < 40mmHg, tissue perfusion fails
24
Q

What is teh effect of arterial blood gases on CBF?

A
25
Q

What are 10 medical management of a head injury patient?

A
26
Q

What is pupil size and reactivity?

A
27
Q

What is the modified glasgow coma scale?

A
28
Q

What are the 5 common technique of intracranial pressure monitoring?

A
29
Q

What are 5 implications for PT in head injury?

A
  1. Intubated, ventilated, sedated, paralysed to rest brain and ensure optimal ABG’s
  2. Assess chest vs head ie CXR, CT scan
  3. Keep Rx short, frequently if necessary
    • Pressure will not go up if this is followed (rather than 1 long/extended Rx
  4. Keep SAP, MAP stable
  5. Keep head in midline, 30o head up
    • If not, might lock the jugular –> increase volume –> increase pressure
  6. EtCO2 constant
30
Q

What is the effect of physiotherapy ICU?

A
31
Q

What is the overview of the mechanism and consequences of the metabolic response to critical illness?

A
32
Q

What are 8 characteristics of ICUAW?

A
  1. Weakness following stay in ICU
  2. MRC scale < 48/60
  3. Often lower limbs> upper limbs
  4. Proximal > distal
  5. Associated with use of neuromuscular blockers (Vecuronium, steroids, nitric oxide)
  6. Also delays ventilator weaning – weak diaphragm
  7. Increases ICU and hospital stay
  8. No specific Rx - rehabilitation
33
Q
A
34
Q

What is the medical research council (MRC) score?

A
35
Q

What are 3 prevention of ICUAW while still sedated?

A
  1. Electrical stimulation
  2. Cycling
  3. Passive movements
36
Q

What are 3 prevention of ICUAW when awake and co-operative?

A
  1. Active movements
  2. Resisted movements
  3. SOOB, SOEOB, Sit to stand
37
Q

What are 3 characteristics of ventilator associated pneumonia (VAP)?

A
  1. Infection> 48 hours after admission ventilation
  2. Mortality 20-50% - 70%
  3. Prolong ventilation and LOS ICU
38
Q

What are 7 prevention of ventilator associated pneumonia (VAP)?

A
  1. Handwashing
  2. Non invasive ventilation
  3. Aspiration Subglottic Secretions
  4. Stress ulcer prophylaxis
  5. Selective digestive contamination
  6. Early tracheotomy
  7. Positioning
    1. Semi-recumbent
    2. Continuous movement

PHTY3250 (20 decks)

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