CC

Question 1

4 reasons for admission to CCU

Answer 1

resp support
invasive monitoring eg BP, cardiac function
renal support
dec conscious lvl

… must be reversible ! eg pneumonia, cardiac failure…

Question 2

list some aims of itu

Answer 2

maintain perfusion
remove and treat problems
allow body to recover

Question 3

2 ways that airways may be opened for patients

Answer 3

endotracheal tube and tracheostomy

Question 4

endotracheal tube is given via mouth or nose down trachea into lung, why do patients lose the ability to communicate

Answer 4

goes through voicebox

Question 5

what is the significance of the blue line on endotracheal tubes

Answer 5

allows for x ray imaging to see placement

Question 6

why are endotracheal tubes placed where the bronchi split

Answer 6

to inflate both lungs

Question 7

why is the biggest tube that is suitable for the size of a patients neck used

Answer 7

easier to breathe

Question 8

disadvantages of endotracheal tube

Answer 8

dry mouth, oral hygiene hard, moisture lesions due to tape, not for long term

Question 9

tracheostomy uses a tube that as a similar diameter to endotracheal tubes but is shorter, what might be some other benefits of tracheostomy

Answer 9

makes breathing easier
mouth can shut so no longer dry
reduces need for sedation
temporary

Question 10

what machine is used to support the pressure in the lungs

Answer 10

ventilator

Question 11

true or false it is better for ventilated patients if lungs are not overinflated and alveoli are kept only semi inflated

Answer 11

true

Question 12

what is the tidal volume that is used for ventilation and what is it based on

Answer 12

6ml/kg of predicted body weight

Question 13

true or false, systemic vascular resistance dictates arterial blood pressure

Answer 13

true

Question 14

cardiac function is measured indirectly using blood pressure from which 2 areas

Answer 14

central venous and arterial

Question 15

what different techniques exist to measure cardiac function from the left side of the heart ()

Answer 15

lidco
picco
oesophageal doppler
swan ganz

Question 16

2 sites for central line

Answer 16

internal jugular, subclavian

Question 17

give one adverse effect that may occur if central lines are placed too close to the lungs

Answer 17

pneumothorax

Question 18

give some different reasons for circulatory failure

Answer 18

inadequate preload
maldistribution
anaphylaxis
septic shock
myocardial failure

Question 19

give some causes for inadequate preload

Answer 19

dehydration
circulatory loss through trauma

Question 20

how can inadequate preload be measured

Answer 20

cvp and straight leg raise: tilt patient on bed and reassure, bp will raise in 2-3 mins

Question 21

how does straight leg raise detect inadequate preload

Answer 21

if bp rises when legs are lifted not enough circulating volume

Question 22

treatment for inadequate preload

Answer 22

fluid with crystalloid balanced salt solution
may need to give albumin too if low

Question 23

fluid with crystalloid balanced salt solution

Answer 23

maldistribution

Question 24

treatment for low afterload

Answer 24

vasoconstrictor (vasopressor)

Question 25

which heart receptors are inotropic and involved in muscle contractility

Answer 25

b1

Question 26

which receptors in the heart work on vasoconstriction of blood vessels

Answer 26

a1 and a2

Question 27

which receptor of the heart works on vasodilatation of blood vessels and bronchodilatation

Answer 27

b2

Question 28

NAd increases svr so can be used for low afterload give its AEs

Answer 28

angina and ischaemia due to increased oxygen consumption, hr

Question 29

giving industrial doses of NAd can cause vasoconstriction of fingers and digits that can lead to

Answer 29

necrosis

Question 30

why does the gut stop working on high doses of NAd

Answer 30

doesnt have enough blood to absorb anything

Question 31

dopamine can be used as a vasoconstrictor but why is it not used as much anymore

Answer 31

increased morbidity compared to adrenaline

Question 32

low dose dopamine works on which receptors in vascular tissue to cause vasodilatation

Answer 32

D1

Question 33

high dose dopamine works on which receptors of the heart

Answer 33

B1

Question 34

adverse effects of dopamine

Answer 34

tachycardia arrythmias myocardial ischaemia

Question 35

vasopressin or the synthetic version argipressin causes profound vasoconstriction and acts on which receptors

Answer 35

V1

Question 36

how can myocardial failure be measured

Answer 36

low CO

Question 37

treatment for what condition would be appropriate with an inotrope

Answer 37

myocardial failure

Question 38

example of an inotrope that can be used that is also a racemic mixture

Answer 38

dobutamine

Question 39

what does dobutamine do to the heart

Answer 39

increases contractility by agonising a and b receptors

Question 40

dobutamine AEs

Answer 40

tachycardia arrythmias can lead to increased myocardial oxygen consumption ischaemia tolerance

Question 41

adrenaline increases contractility and hr and is an agonist for which receptors in the heart

Answer 41

a1, b1, b2

Question 42

adrenaline AEs

Answer 42

tachycardia myocardial ischaemia arrythmias sudden death

Question 43

vasodilators aim to decrease afterload by enabling the heart to beat more efficiently and is usually something nitrate donating, eg

Answer 43

gtn, isosorbide dinitrate

Question 44

sedation and analgesia aims to keep patients patients comfortable and rousable however may require sedation holidays, what are these and why are they a good thing

Answer 44

stopping drug every morning, prevents accumulation, gets off ventilator quicker and avoids associated pneumonia

Question 45

opioid infusions may be used as analgesia, morphine may be used but name other more renal/ hepatic dysfunction friendly options

Answer 45

fentanyl and alfentanil

Question 46

give a non opioid analgesic that may be used for itu patients

Answer 46

paracetamol

Question 47

list 2 agents that may be used for sedation

Answer 47

propofol and benzodiazepine

Question 48

3 different antipsychotic drugs that may be used for delirium

Answer 48

haloperidol olanzapine quetiapine

Question 49

alpha 2 adrenergic agonists activate central inhibitory x receptors to exhibit a depressive effect on cns function in order to work an antipsychotics

Answer 49

a2

Question 50

instead of alpha 2 adrenergic agonists what drug may be useful in withdrawal states

Answer 50

clonidine dexmedetomidine

Question 51

non depolarising agents are used as paralysing agents however patients must have adequate analgesia and sedation on board, why are paralysing agents limited in use

Answer 51

difficulty in ventilation and neuroinjury

Question 52

renal support for patients is continuous instead of intermittent, what can be used to achieve this

Answer 52

filtration, dialysis or mixture of both

Question 53

when to consider sepsis

Answer 53

RR 22, altered mental state, systolic less than 100

Question 54

give 2 complications of uti in elderly patients

Answer 54

sepsis and severe confusion

Question 55

septic shock means vasopressor therapy is needed to maintain MAP (mean arterial pressure) equal or above x hg

Answer 55

65

Question 56

septic shock is associated with a lactate above x mmol/l despite adequate fluid resus

Answer 56

2

Question 57

can phosphate and magnesium be administered through the same line

Answer 57

no - will precipitate

Question 58

if there is acidosis, how would you rule out a respiratory cause?

Answer 58

if CO2 is also low and bicarbonate is low

Question 59

why is CO2 low in metabolic acidosis

Answer 59

respiratory system compensates by breathing

Question 60

what elec if given too fast will kill

Answer 60

potassium! strong sols given peripherally --> extravasation, tissue necrossi

Question 61

is cockroft-gault creatnine valid for septic patients

Answer 61

no px needs to be stable

Question 62

what to consider for renal impairment

Answer 62

does drug accumulate, does drug worsen impairment, does metabolite accumulate

Question 63

what affect does benzylpenicillin have on the CNS

Answer 63

irritation of brain meninges

Question 64

what is needed after critical care

Answer 64

rehabilitation, support groups

Question 65

what to give instead of oral antidiabetics in reduced consciousness

Answer 65

continuous infusion

Question 66

causes of ST depression

Answer 66

digoxin, hypokalaemia, NSTEMI

Question 67

why may hydrocortisone be given with NAd

Answer 67

reduces the amount of NAd needed