Medical HDU Flashcards
airway
intact/risk to airway/adjuncts
breathing
RR, sats, FiO2, NIV
examination of chest
recent abg
recent CXR
circulation
blood pressure, heart rate inotropes/vasopressors/antihypertensives examination - CRT, JVP, oedema, pallor, heart sounds local ischaemia - arterial lines peripheral ischaemia - vasopressors haemoglobin ecg
renal
fluid input and output
hydration status
urinalysis
U+E, bicarb, calcium, Mg, phosphate
GI and nutrition
weight nutrition intake risk of refeeding? pabrinex, thiamine bowels, vomiting, diarrhoea abdo and liver disease signs LFT, BG and ketones
neurological
GCS/AVPU
pupils
neurological exam
swallow
sepsis
lines - time since insertion culture temp CRP, WBC, lactate antibiotics?
endocrine
diabetic? ketones and insulin
steroids
coagulation
platelets
thromboprophylaxis
Type 1 resp failure
PaO2 <8kPa and low or normal PaCO2
Type 2 resp failure
PaO2 <8kPa and PaCO2 >6kPa
acute hypercapnic resp failure
acidotic, high PaCO2
normal bicarbonate
chronic hypercapnic respiratory failure
near normal ph, high PCO2
high bicarbonate
causes of type 1 resp failure
V/Q mismatch
- pneumonia
- PE
- acute asthma
- pneumothorax/pleural effusion
Type 2 resp failure causes
reduced ventilatory drive - opiates - COPD - morbid obesity - head injury reduced chest wall movement exhaustion
oxygen for hypoxic patient
15L reservoir mask
target Sa)2
94-98%
hypercapnic resp failure = 88-92%
how much oxygen can nasal cannulae provide?
2L/min
cautions with NIV
basal skull fractures
CSF leak
undrained pneumothorax
2 types of NIV
CPAP and BiPAP
explain CPAP
reduces work of inspiratory muscles and overcomes negative intrathoracic pressure to prevent collapse of alveoli
indications for CPAP
Type 1 resp failure
Indications for BiPAP
Type 2 resp failure
- acute COPD
- pneumonia
NIV contraindications
vomiting
recent facial surgery
(bowel obstruction, confusion)
assessing NIV response
O2 sats, RR, HR, bp abg conscious level chest wall movement accessory muscles use
what is stroke volume affected by?
preload and afterload
preload
according to starlings law
increased end diastolic volume increases stretch on myocardial fibres
increased contraction and increased SV
afterload
systemic vascular resistance
as SVR increases the CO decreases
signs of inadequate tissue perfusion
oliguria/anuria confusion cold, clammy skin reduced pulse volume increased RR, HR low bp lactic acidaemia prolonged CRT
4 types of shock
obstructive
cardiogenic
hypovolaemic
distributive
causes of obstructive shock
massive PE
tamponade
tension pneumothorax
R ventricular failure
cardiogenic shock
MI, arrhythmia, valvular lesion
hypovolaemic shock
blood or fluid loss
distributive shock
septic, anaphylactic, neurogenic
SIRS criteria
2 or more of
- HR >90
- Temp <36 or >38
- RR >20
- WCC
sepsis definition
SIRS and infection
severe sepsis
sepsis and inadequate organ perfusion
septic shock
sepsis and hypotension/inadequate organ perfusion despite fluid resus
Indications for CVC
access for drugs - amiodarone, inotrope poor peripheral access chemotherapy plasma exchange dialysis monitoring and blood sampling
CI to CVC
coagulopathy
haemothorax
vessel thrombosis
pacemaker ipsilateral side
complications of CVC
haemorrhage arrhythmia cardiac tamponade thoracic duct injury infection air embolus
