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ICU > Ref to critical care > Flashcards

Ref to critical care Flashcards

1
Q

fluids in hypovolaemic

A

30ml/kg crystalloid

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2
Q

AVPU correlation to GCS

A

A 12-15
V 8-11
P 4-7
U 3

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3
Q

MAP =

A

MAP = CO X SVR

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4
Q

CO =

A

CO = HR X SV

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5
Q

Factors affecting stroke volume

A

preload (influenced by venous return and circulating blood volume), contractility, afterload

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6
Q

What is CaO2?

Calculation

A

oxygen concentration of blood
=(O2 in Hb)+(O2 in solution)
=(1.34 x Hb x Sp02 x 0.01) + (0.023 x PaO2)

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7
Q

How to calculate DO2

A

DO2 = CaO2 X CO

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8
Q

Why is actual DO2 less in septic shock

A

Oxygenated blood is mal-distributed in the micro circulation

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9
Q

What is Vo2? How to calculate

A

Oxygen consumption

VO2 = CO X (Ca02 - CvO2)

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10
Q

Name 3 reasons for invasive monitoring

A

Abnormal physiology that fails to normalise quickly with simple measures

Unstable haemodynamic condition or potential for rapid deterioration

Use of drugs (vasopressors and inotropes) that can alter cardiovascular physiology rapidly

Intra-arterial lines are used for frequent blood analysis

Central IV access to enable the delivery of multiple infusions e.g. drugs (including veno-irritant
drugs), fluids and parenteral nutrition

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11
Q

Complications of art lines - name 4

A 
Failure,
 disconnection and bleeding,
 thrombosis, 
ischemia, 
haematoma
, infection, 
aneurysm,
inadvertent injection of irritant drugs
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12
Q

Types of central line

A

Multilumen – several lumens exist so that multiple infusions are possible.

Wide bore – may be multilumen. Used for rapid administration of fluid, other catheters may be
passed down the large lumen – e.g. PAF catheter or pacing wires

Single lumen – often tunnelled - usually for parenteral nutrition or chemotherapy. Not often used
in ICU (multiple lumens required, as lines often need to be changed in ICU)
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13
Q

Complications central line early vs late - name 3 of each

A

Early:
Damage to veins or adjacent structures, e.g. artery, nerve or thoracic duct
Pneumothorax (especially subclavian route)
Arrhythmias
Air embolism
Puncture of great vessels or heart

Late
Infection (reduced incidence at subclavian)
Extravasation of irritant drugs
Air embolism (if left open)
Bleeding
Catheter breakage
Catheter knotting
Penetration of vessel wall or heart
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14
Q

Ways of monitoring CO in ICU

A

Pulmonary Artery Flotation Catheter (PAFC)
PiCCO (pulse-induced contour cardiac output)
LiDCO (Lithium)
Oesophageal Doppler Monitor (ODM)

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15
Q

Advantages/ limitations of Oesophageal Doppler Monitor (ODM)

A

Advantages
Ease of use.
Minimally invasive.

Complications and disadvantages
Not easy (but possible) to use in awake patients
Risk of oesophageal damage (small)
Unable to use – oesophageal tear, coarctation and aortic balloon pump
Readings depend on probe position

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16
Q

How does LiDCO work

A

Injection on lithium into vein - then sensor measures lithium as it goes past in artery

17
Q

How does PiCCO work

A

A special arterial line (with a thermistor to measure temperature) is inserted into the brachial or
femoral artery

intermittent thermodilution (fig. 1) is also performed - cold solution is injected into a central vein,
the temperature is detected by a thermistor in the arterial line and, similar to the PAF catheter, the
temperature change can be used to calculate the cardiac output.
18
Q

What are the levels 0-3 in hospital

A

Level 0 Patients whose needs can be met through normal ward care in an acute
hospital.

Level 1 Patients at risk of their condition deteriorating, or those recently relocated from
higher levels of care whose needs can be met on an acute ward with additional
advice and support from the critical care team.

Level 2 Patients requiring more detailed observation or intervention including support for
a single failing organ system or postoperative care, and those stepping down
from higher levels of care.

Level 3 Patients requiring advanced respiratory support alone or basic respiratory
support together with support of at least two organ systems. This level included
all complex patients requiring support for multi-organ failure.

19
Q

Frank starling law basically means ?

A

increase preload -> increased ventricular stretch -> increase contractility -> increase CO

20
Q

What is CVP essentially measure? Easiest way to measure ? usual value ?

A

preload

Use lumen on central line

2-10mmHg

21
Q

When do you see increased CVP ?

Decreased?

A

R heart dysfunction
fluid over load
tamponade

hypovolemia
venodilation

22
Q

Causes of increased Pul artery pressure ? usual reading

A

L heart failure
pulm HTN
mitral stenosis / regurg
Atrial septal defect

20-30 / 10-20 mmHg

ICU (8 decks)

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