Week 10 Flashcards
Name some reasons for admission to the ICU.
failure of one or more organs
need for one on one nursing
post major surgery or major risk factors
postoperative respiratory failure
medical respiratory failure i.e. pneumonia
weakness of respiratory muscles i.e. GBS
major injuries i.e. multi-trauma, chest, trauma, spinal injury, head injury
How is blood pressure monitored in the ICU patient?
usually via an arterial line (invasive) to get a constant read on mean arterial pressure (MAP), aiming for >60mmHg), rather than with a cuff every 1 hour or so
allows detection of BP changes in real-time
What is a central venous line for? Where is it typically inserted?
monitoring central venous pressure (CVP, aiming for 5-15 where a loss of pressure could indicate dehydration and a rise being vessels overloaded/stiff lungs) and delivering multiple drugs at the same time
typically inserted into a large vein at the neck or chest i.e. jugular, subclavian, or even femoral in the leg, these do not ‘tissue’ (where fluid enters the surrounding area and the IV fails) like IV lines in the hand or elbow can
Why is a CXR performed each time a central venous line is inserted?
to check that the lungs have not been punctured
What needs to be done if a patient’s pupils are unequal in size or non-responsive to light?
refer to medical staff for CT ASAP as possible brain lesion
What is the purpose of insulin therapy in ICU patients?
used in both diabetic and non-diabetic patients to control blood sugar levels
research shows reduces morbidity in long-stay ICU patients and reduces time spent in ICU
What are inotropes used for in ICU patients? What are the implications for physiotherapy?
to increase cardiac output, blood pressure, and heart rate
physio implications, do not mobilise the patient (unstable BP)
How do modern-day ventilation machines use positive pressure to ventilate patients?
air is applied under positive pressure via an airway which forces gas flow into the lungs
differs to our natural negative pressure mechanism where we draw air into our lungs using the pressure gradient created between the lungs and the atmosphere
How can positive pressure ventilation affect venous return?
it decreases venous return because the intra-thoracic pressure remains positive throughout inspiration and expiration, compressing the vena cava which increases resistance to blood flow
What does PEEP stand for?
positive end-expiratory pressure
What does PS stand for
pressure support
What is the difference between PEEP and PS?
PEEP prevents the patient from moving into their closing capacity by splinting the airways open
PS provides pressure support to the patient’s inhalation/exhalation during spontaneously triggered breaths
What are some precautions to using PEEP?
patients with low BP/cardiac output or high intracranial pressure (as PEEP reduces venous return and increases ICP)
What is the implication for treating a patient with a high PEEP setting i.e. >10cmH20?
generally do not disconnect from ventilator for treatment as they need high levels of PEEP to maintain airways and anything we do in treatment will not outway that need
What is peak airway pressure? What is a normal reading or peak airway pressure?
the total pressure needed to overcome the:
-inspiratory flow resistance
-elastic recoil of the lung and chest wall
-the alveolar pressure present at the beginning of the breath (PEEP)
normal peak airway pressure 22-24
