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VMS4008 > Management of the Critically Ill Patient > Flashcards

Management of the Critically Ill Patient Flashcards

1
Q

What is ABC

A

Airway, breathing, Circulation

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2
Q

MEDB?

A

Minium Emergency Database

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3
Q

How to Triage?

A
  • Prioritizing
  • Key biody systems
  • Bring diagnostics to the patient POC
  • Criteria: bleeding, resp, CRt, wounds/ fract
  • MEDB
  • Other POC tests: ECG, BP, oximetry
  • Serial analysis!
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4
Q

What tends to be our MEDB?

A
  • PCV
  • TSP
  • BUN
  • Glucose
  • Blood lactate
  • Blood smear
  • Potassium
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5
Q

How do we go about stabilisation?

A
  • give oxygen
  • Place IV cath
  • Stop any obvious bleeding- CCPR?
  • Analgesics and other drugs
  • MEB, POCUS?
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6
Q

Describe the Secondary survery

A
  • After primary survey and initial stabilisation
  • Nose-to-tail exam
  • Further diagnostics if stable
  • Make sure owner on board with £££
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7
Q

What is SIRS ?

A

Systemic inflammatory response syndrome -> inflammatory mediators enter circulation - progression same for each disease

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8
Q

How happens as a result of SIRS?

A
  • Peripheral vaso-dilation
  • Micro-capillary blood shunting
  • Inc capillary permeability
  • Depressed cardiac function
  • Multiple organ dysfunction
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9
Q

What is MODS

A

Multiple Organ Dysfunction (Syndrome)

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10
Q

What does MODS affct?

A
  • Respiratory
  • CV
  • Renal ysfunction
  • Haematological ysfunction
  • GI dysfunction
  • Liver
  • Nervosu system dysfunction
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11
Q

What prophylactic monitoring/tx can we do against MODS

A
  • Peripheral vasodilation
  • Inc capillary permeability
  • Depressed cardiac function
  • Target organ dysfunction
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12
Q

What is Kirby’s rule of 20 ?

A

All parameters to monitor in critically ill patients

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13
Q

What to think about for Fluid Balance?

A
  • Is it indicated?
  • What type of fluids?
  • Ho much?
  • Rate?
  • How to monitor (CRT, HR, MM, Temp, PCV …)
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14
Q

When should we be cautious with when admin of fluids?

A
  • Respiratory distress (can get oedema)
  • Head trauma
  • Bleeding (can be triggered)
  • Heart dx (volume overload)
  • False impressions
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15
Q

Recap of Fluid Therapy basics

A
  • Fluid require= Replacement + Maintenance + Ongoing losses
  • Replacement = BW x dehydration x 10= ml rq
  • Maintenance = (BWx30) + 70 = ml rq
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16
Q

What are signs of circulatory overload?

A
  • Restlessness
  • Shivering
  • Tahcypnoea
  • Crackles
  • Coughing
  • Oedema
17
Q

How to monitor Oxygenation & ventilation?

A
  • CLinical exam
  • Blood fas eval
  • Pulse oximetry
  • Supplement oxygen (mask, cage, flow by)
18
Q

BP= … x ….

A

BP = CO x VR (with CO= HRxSV)

19
Q

What should MAP be?

A

above 60mmHg ; Systolic > 80mmHg

20
Q

What are different BP measurement options ?

A
  • doppler -> systolic BP only
  • Oscillometric machine -> systolic, diastolic, MAP
  • Invasive monitoring -> catheter in dorsal pedal artery measures arterial pressure
21
Q

Normal glucose?

A

3.3-5.5 mmol/L

22
Q

If low blood glucose how would you supplement glucose?

A
  • 50% dextrose at 0.5-1ml/ kg
  • Dilute with sterile water to prevent hemolysis
  • Add to drip fluid as CRI (to not get an immediate drop after bolus)
23
Q

What causes of dec blood glucose?

A
  • sepsis (SIRS, MODS)
  • Puppies and kittens
  • certain toxins (xylitol)
  • Paraneoplasti hypoglycaemia
  • Insulinoma
  • Insulin overdose
  • Working dogs
24
Q

What causes of INC blood glucose?

A
  • Stress
  • Diabetes mellitus
  • Oer supplementation
  • Cranial trauma
  • Severe pancreatitis
25
Q

What are the two types of Hypothermia?

A

Primary - exposure
Secondary - (SIRS etc)

26
Q

Describe Hyperthermia

A
  • temp > 41°C
  • Do not cool febrile patients if under 41
  • Always cool heat stroke patients
  • Seizures & muscle activity can cause this
  • Dont go below 39°C
27
Q

Role of albumin?

A

Oncotic pull, carrier protein, tissue healing (>70% of oncotic pressure)

  • Maintain > 20g/L
28
Q

Persistent hypoalbuminemia associated with ….

A

poor prognosis

29
Q

How can we make up for low albumin ?

A
  • Plasma transfusion
  • Albumin transfusions
  • Synthetic colloids
30
Q

What electrolyte disorders commonly found in critically ill patients?

A
  • Hypokalaemia & hypocalcemia
  • Refeeding syndrome: hypoG, hypoK, hypoP, hypo Mg
  • Diabetic ketoacidosis= hypoK & hypoPhos
  • Renal failure: hyperphos & hyper- or hypokalaemia
31
Q

Most important electrolyte to monitor for?

A

Potassium ->important in vomiting / anorexic patients

Add to fluids! Max rate 0.5 mEq/kg/hr

32
Q

Describe evaluation of mentation?

A
  • Level of consciousness
  • Aware of surroundings
  • Coma scale
  • Seizures
    -hypoglycaemia
  • IC pressure
  • Oxygen
33
Q

Role of Nutrition in CIPs?

A
  • Higher metbaolic needs
  • GIt barrier breakdown and malabsoprtion
  • dec immunity
  • Disrupted microflora
  • Dec organ function
  • delayed wound healing
  • dec muscle strength
34
Q

What is Refeeing syndrome ?

A
  • Rapid reintroduction of food after prolonged undernourishment
  • Intracellular shifting of electrolytes and glucose that can be fatal
35
Q

Describe normal ranges of urine output

A

Normal = 1-2ml/kg/h
Oliguria = <0.5-1ml/kg/h
Polyuria = >2ml/kg/h

36
Q

Coagulation considerations?

A
  • Hyper-coagulable
  • Hypo-coagulable
  • DIC
  • Loss of clotting factors or platelets

Tx: vit K and/or Plasma

VMS4008 (10 decks)

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