SC02 - Anesthesiology - ICU Flashcards

1
Q

ICU
- Functions
- Staffing

A

Intensive Care Unit (ICU) function:

  • Therapy for life-threatening illnesses, injuries and complications
  • monitoring of potentially life-threatening conditions and organ function
  • provides special expertise and facilities for vital organ support
  • Salvage reversible end-organ damage for eventual recovery

Staffing:
- Nurse: patient ratio of 1:1 for ventilated patient, 1:2 for lower acuity
- Qualifications in Intensive Care, ALS
- Doctors: Physicians, Anesthesiologists
- Support: Surgeons, Physiotherapists, Pharmacists, Dieticians, Microbiologists

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2
Q

Types of intensive monitoring in ICU

A

Cardiovascular:
- ECG, CVP, invasive arterial bloodpressure monitoring, temperature

Renal:
- RFT, UO (foley)

Respiratory:
- RR, Waveform capnograph (intubated)

Neurological:
- EEG

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3
Q

Modalities of life support in ICU

A

Respiratory:
- Invasive/ non-invasive ventilators, High flow O2

Renal:
- Plasmapheresis, Hemofiltration, Hemodialysis, Peritoneal dialysis, Cytokine adsorption

Cardiocirculatory:
- Extracorporeal circulation, temperature regulator, CPR

Hepatic:
- Hepatic coma care, Liver dialysis (Molecular Adsorbent Recycling System (MARS) (outdated))

Neurological:
- Acute coma care, acute post-infectious polyneuropathy care

Drug:
- Overdose/ desensitization care

Others:
- Metabolic: thyroid storms, DKA, electrolytes
- Obstetric emergencies
- Burns/ wound complications

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4
Q

Triage logic for ICU admission

A
  • Patient consent/ preference
  • Disease severity/ prognosis
  • Reversibility of condition or organ damage
  • Quality of Life: co-morbidities, disease progression and expected sequalae after admisssion
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5
Q

Pros and Cons of ICU admission

A

Pro:
- Life-saving
- Intensive therapy and monitoring to salvage important organ function

Cons:
- Invasive procedures
- Infection risks/ nosocomial infections
- Loss of self-esteem/ psychosocial co-morbidities
- Delirium development and long-term cognitive impairmen
- Long-term performance status impairment

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6
Q

Life-sustaining processes that can be withdrawn under patient consent

A

DNR/ DNACPR
Withdrawal of circulatory support: Inotropes, Vasopressors, blood products…
Withdrawal of ventilator/ limitation of ventilator settings
Withdrawal of Renal replacement therapy

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7
Q

End-points to measure ICU outcome

A
  • Absolute mortality rate
  • Standardized Mortality Ratio (SMR): mortality of one ICU unit compared to reference data base,
     APACHE Score (Acute Physiology and Chronic Health Evaluation)
     SAPS Score (Simplified Acute Physiology Score)
     MPM (Mortality Prediction Model)
  • Quality of life during stay and after discharge
  • Subjective opinion of patient comfort
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8
Q

Outlin APACHE score for ICU outcomeS

A
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9
Q

Definition of ARDS

A
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