Assessment of the critically ill patient

Question 1

Airway interventions (beginner)

Answer 1

Head tilt chin lift, jaw thrust, suction, oral airways, nasal airways

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Question 2

Airway interventions (advanced)

Answer 2

Nebulised adrenaline for stridor, Supraglottic airways (iGel/LMA), Intubation, Front of neck access (cricothyroidotomy)

Question 3

Once airways open

Answer 3

15 litres of oxygen via non rebreathe mask (even in COPD patients but always re assess)

Question 4

Breathing interventions

Answer 4

Position changes
Consider assisted inhalation with self inflating back if resp rate below 10

Question 5

Circulation assessment

Answer 5

Colour, examine peripheries, (pulse, bp, cap refill), hypotension (later sign if young), decreased urine output, lactate

Question 6

What can cause inadequate tissue perfusion

Answer 6

Loss of volume- hypokalaemia
Pump failure - eg MI
Vasodilation - sepsis, anaphylaxis, neurogenic

Lactate is a marker

Question 7

Clinical features of lactate

Answer 7

Lactate builds up in anaerobic metabolism. Not always reliable though as lactate could be normal if area of dying tissue is so far gone that it cannot re enter circulation due to complete infarction

Question 8

BP =

Answer 8

HR x SV x SVR

Question 9

Disability assessment

Answer 9

AVPU, pupil size/response, posture, BM, pain relief, temperature

Question 10

Causes of disability

Answer 10

Inadequate perfusion of the brain, sedative side effects, decreased BM, toxins and poisons, CVA (strokes), increased ICP

Question 11

Warming the patient is good except for

Answer 11

Cardiac arrest

Question 12

Triad of death in trauma

Answer 12

Hypoxia, hypothermia, and acidosis

Coagulopathic, clot in the wrong place

Question 13

Acute severe asthma presentation

Answer 13

PEF 33-50% best or predicted
RR > 24
HR >110
Inability to complete sentences in 1 breath

Question 14

Management for severe asthma

Answer 14

Nebulised salbutamol (5mg) O2 driven, repeat as needed

Nebulised ipratropium (500mcg) O2 driven

Hydrocortisone 100mg IV or Prednisolone 50-60mg po

MgSO4 IV 1.2-2g (seek guidance)

Question 15

What may happen when you give salbutamol

Answer 15

Lactate and HR will be high with appropriate amounts of salbutamol

Question 16

Nebulised therapy in severe asthma needs to be

Answer 16

Back to back

Question 17

Dont give magnesium when

Answer 17

If very septic or old

Question 18

Life threatening asthma

Answer 18

Severe asthma plus one of the following

PEF <33%, SPO2 <92%, PaO2 <8kpa, normal PaCO2

silent chest, cyanosis, poor respiratory effort, arrhythmias, exhaustion/low GCS

Question 19

What is a pre terminal sign in asthma

Answer 19

Increased PaCO2

Question 20

Sepsis

Answer 20

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 21

Septic shock

Answer 21

Subset of sepsis where particularly profound circulatory cellular an metabolic abnormalities substantially increased mortality

Question 22

When to start sepsis screen

Answer 22

Has NEWS score of 5 or above
Looks unwell
Has had recent chemo
Has lactate 2mmol/L or above

Question 23

Causes of hypovolaemia

Answer 23

Haemorrhagic (external, drains, GI tract, abdomen), fluid loss (D and V, polyuria, pancreatitis), iatrogenic (diuretics, inadequate fluid prescription), trauma (chest, abdo, pelvic, long bones)

Question 24

Bradycardia management

Answer 24

Atropine 500mcg IV, repeat to a max total dose of 3mg, external cardiac pacing

Question 25

Adverse signs of bradycardia

Answer 25

Low BP, HR <40, heart failure, ventricular arrhythmias compromising BP

Question 26

Bradycardia poor indications

Answer 26

Recent asystole, mobitz II Av block, QRS pauses >3 secs, 3rd degree HB with increased QRS

Question 27

tachyarrythmia

Answer 27

Sedate and synchronised cardioversion if unstable

Stable VT - amiodarone 300mg 20-60min

Question 28

Stable SVT

Answer 28

Vagal manoeuvres, adenosine 6mg 12mg 12mg

Question 29

Stable tachy AF

Answer 29

Amiodarone 300mg 20-60 min if onset <48 hours, B blocker IV or digoxin IV

Question 30

What to watch out for AAA

Answer 30

Be careful giving blood thinners in suspected MI to rule out presence of AAA

Question 31

Additions to MONA IV

Answer 31

Second antiplatelet, monitor for hyperglycaemia

Question 32

Gold standard for STEMI

Answer 32

PPCI - door to balloon 120mins

Question 33

Intra abdominal pathology

Answer 33

Obstruction, perforation, collection