Lecture 4 - Critical Care and the Role of the Pharmacist Flashcards
Name the 4 different names for critical care
Critical care
ITU
ICU
HDU
Define level 0
Patients who’s needs can be met through normal ward care in an acute hospital
Define level 1
Patient at risk of deteriorating or those relocated from higher levels of care who’s needs can be met on an cute ward with additional advice and support from the critical care team
Define level 2
Patients requiring more detailed observation or intervention including support for a single failing organ system or post-operative care or those ‘stepping down’ from level 3 care
Define level 3
Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least 2 organ systems. This includes all complex patients requiring support for multi-organ failure
Name some examples of people that come to critical care
Post-op
serious short-term condition e.g. cardiac arrest
serious infections e.g. pneumonia and sepsis
Shock - septic or circulatory
Trauma
Pancreatitis
Renal failure requiring renal replacement therapy (RRT)
Severe neurological conditions - Guilliain Barre
Name the types of non-invasive respiratory support
Nasal canula
Oxygen mask
Nasal High Flow (NHF)
CPAP
Name the types of invasive respiratory support
Endotracheal tube
Tracheostomy
What are the reasons for invasive respiratory support?
Protect the airway
Treat profound hyperaemia
post-operative - major surgery
progressive weakness of both the inspiratory and expiratory muscles
Rest exhausted patients - RR>30/min
Avoid or control hypercapnia
When is sedation used?
Alleviation of pain
Facilitation tolerance and reduce distress
endotracheal tubes
to augment the effectiveness treatment (some distressing settings)
Seizure control or management of intra-cranial pressure etc
Reduce anxiety and control agitation
During neuromuscular blockade
Reasons for analgesia use in critical care
Polytrauma
Post-op pain
Precipitating medical illness
Placement of drains
Prolonged immobility
Nursing care and therapy interventions
Endotracheal tube
Placement of lines
Give an example of a opioid anaesthetic
Alfentanil
Give an example of general anaesthetic
Propofol
What is the target mean arterial pressure (MAP)?
Probe inserted indirectly into the artery for a more accurate reading >65 (most patients), >80 (in CVD event
What happens if we do not address circulation?
If not addressed we the shock
Not getting enough oxygen going to where we need it
Deficiency of blood flow to the peripheral tissues of the body
Cellular hypoxia and metabolic acidosis
What can ICU delirium impact on?
Patients recovery
Increase morbidity
Mortality
Length of hospital stay
Name the two types of delirium
Hyperactive delirium
Hypoactive delirium
Mixed - move between the two subjects
Define hyperactive delirium
Really restless
Heightened arousal, restlessness, agitation, aggression
Define hypoactive delirium
Sleepiness, lack of interest in daily activities, quiet and withdrawn
Define CAM-ICU
Measures clarity of thought in ICU patients by measuring judgement and attentiveness
What are the non-pharmacological treatments for delirium?
Optimising environmental factors
Reduce noise, reassure, and re-orientate
Provide glasses/ hearing aids
Music therapy
Encourage normal sleep by optimising light and disturbance
Consider melatonin
Name the pharmacological treatments for delirium
Haloperidol, Clonidine, Quetiapine. Olanzapine
Define hypernatraemia
Dehydrated/ sodium overload
- High levels of sodium
Define hyponatraemia
Dilutional / SIADH
- Low levels of sodium
