Organ failure Flashcards
What possible causes when respiratory failure does not respond to therapy?
Untreated bacterial infection Sputum retention Pneumothorax Inadequate bronchodilator therapy Pulmonary oedema Dysrhythmia Inappropriate sedation Wrong diagnosis
What are indications to NIV?
pH 6,5 despite controlled oxygen therapy
RR >25
Breathlessness with accessory muscle use and paradox abdominal motion
Contraindications to NIV?
Resp ac
What are the physiological effects ob EPAP?
Keeping airway open Increase alveolar ventilation improves oxygenation Increases FRC Increases intrathoracic pressure --> reduce preload
What are the physiological effects of IPAP?
Reduces effort of breathing
Improves tidal volume
Improves CO2 removal
What is the mechanism of raised CO2 when giving O2 that is not losing the CO2 drive?
O2 –> loss of pulmonary constriction –> increase of ventilatory/perfusion mismatch –> increased respiratory rate –> increased ventilation of dead space
What mechanisms can cause excessive fluid in lungs resulting in pulmonary oedema?
Increased hydrostatic pressure in lung capillaries (HF, neurogenic, fluid overload)
Decreased osmotic pressure (loss protein)
Capillary leakage (SIRS, ARDS, neurogenic)
Negative pressure in alveoli (inspiration against resistance)
Stages of pulmonary oedema?
Pulmonary hypertension due to high pressures LA/LV
Reflectoric dyspnea
Overwhelmed lymphatic drainage
Alveolar fluid
Aggravated breathlessness and stress from patient
Increased afterload and HR
cumination in rapid onset of pulmonary oedema
Why would preload need to be reduced in acute heart failure with pulmonary oedema?
Improve ventricular performance
Reduce pulmonary venes pressure
How is fast heart rates non-beneficial in heart failure? When is this of significance?
Impairs diastolic filling. AF in conditions with impaired diastolic filling such as mitral stenosis.
Where would you hear
A) Mitral stenosis?
B) Mitral regurgitation?
A) Apex (diastolic, just after systolic)
B) Apec (holosystolic)
What are intrinsic renal mechanisms to cause acute renal failure? (4)
Glomerular (systemic disease)
Vascular disease (vasculitis, coagulopathy)
Acute tubular necrosis (ischemic)
Interstitial nephritis (drugs)
När vid hyperkalem indicerat med A) glukos-insulindropp? B) Calcium-glukonat C) Natriumbikarbonat? Vilka ytterligare behandlingar att överväga?
A) K >6
B) K >6,5
C) K >7
Salbutamol, furosemid, resonium, hemodialys
Why is early ultrasound of kidneys advicable in acute renal insufficiency?
Exclude postrenal obstruction
Number shape and size of kidneys of value in diagnostics.
Which medications are known for causing renal damage?
NSAIDS
ACEi
Aminoglycosides
Kontrast
What is important in evaluating possible infection in patient with liver disease?
Patients with liver failure ar relatively immunocompromised. Could llack pyrexia and leukocytosis.
6 life-threatening features of liver failure?
Hypoxemia Hypoglycemia GI-bleeding Coma Hypovolemia Multiple organ failure
Never diagnose primary hyperventilation until ………………………………….. has been excluded.
Diabetic ketoacidosis.
In which patients should acute adrenal insuficiency be suspected?
Unexplained hypotension Mild hyponatremia Earlier corticosterodi therapy Pigmentation Weight loss, vomiting, anorexia preceding
What measures when suspected adreanal insufficiency?
drax s-cortisol and ACTH
Give Hydrocortison 100 mg iv
