Common ICU Pathologies

Question 1

______ = poor distribution of blood at the microcirculatory level

Answer 1

shock

Question 2

4 types of shock?

Answer 2

1. hypovolemic
2. cariogenic
3. distributive
4. miscellaneous

Question 3

_______ shock = blood loss

Answer 3

hypovolemic

Question 4

_______ shock = heart damage

Answer 4

cardiogenic

Question 5

3 types of distributive shock?

Answer 5

1. septic
2. anaphylactic
3. neurogenic

Question 6

_____ = life threatening condition that arises when the bodies response to an infection injures its own tissues and organs

Answer 6

sepsis

Question 7

Sepsis occurs when the release of __________ _______ in response to an infection exceeds the boundaries of the local environment, leading to a more _______ response

Answer 7

proinflammatory mediators; generalized

Question 8

3 symptoms in the quick sepsis related organ failure assessments (qSofa)?

Answer 8

1. resp rate >/= 22 minute
2. altered mentation (GCS <15, RASS < 0)
3. systolic BP = 100mmHg

Question 9

Pt’s are defined as septic if they have a score of < or = to ___ on the SOFA

Answer 9

2

Question 10

Pt’s with septic shock can be identified with a clinical construct of sepsis with what 2 things?

Answer 10

1. persistent hypotension requiring vasopressors to maintain MAP >/= to 65mmHg despite adequate circulating volume (aka not hypovolemic)
2. serum lactate level >2mmol/L despite adequate volume resuscitation

Question 11

In septic shock, immune system spirals out of control; normal response to infection is local, but in septic shock the inflammatory response occurs systematically causing widespread _______ and vascular _______

Answer 11

vasodilation; permeability

Question 12

Sepsis hospital mortality is in excess of __%

Answer 12

40

Question 13

Common complication of septic shock?

Answer 13

ARDS

Question 14

_____ ____ ____ = presence of altered organ function / altered systems in acutely ill individuals

Answer 14

multiple organ failure (/dysfunction syndrome)

Question 15

In many pts sepsis can lead to significant ____ _____

Answer 15

brain injury

Question 16

Typically MAP must be kept over ____

Answer 16

65

Question 17

Fluids used to treat sepsis include colloids, crystalloids, starches and high chloride (T/F)

Answer 17

FASLE; just colloids and crystalloids

Question 18

Vasopressors should be used __-__ hours after onset of sepsis

Answer 18

1-6

Question 19

Pts with sepsis should be placed in deep sedation immediately at onset (T/F)

Answer 19

FALSE; no deep sedation

Question 20

_____ = severe form of acute lung injury that occurs when there is trauma to the lungs leading to inflammation and fluid build up in lungs

Answer 20

ARDS

Question 21

Essential pathophysiology of ARDS is increased pulmonary ______ ______

Answer 21

microvascular permeability

Question 22

In ARDS, a diffuse inflammatory reaction occurs and fluid leads from circulating _____ into lung tissue

Answer 22

blood

Question 23

In ARDS, ______ fills up alveoli; excess alveolar fluid mixes with normal lung ________ and can destabilize the alveoli, allowing them to collapse leading to impaired gas exchange and resp failure

Answer 23

edema; surfactant

Question 24

ARDS damage to elastic tissue creates a _____ lung ;______ membranes (scarring) forms in alveoli which impairs gas exchange further

Answer 24

stiff; hyaline

Question 25

Onset of ARDS must be acute as defined within ___ days of some defined event (often sepsis or shock related)

Answer 25

7

Question 26

Most ARDS occurs within __ hours of recognition of presumed trigger

Answer 26

72

Question 27

Bilateral opacities consisted with pulmonary oedema must be present on CT or CXR for dx of ARDS (T/F)

Answer 27

TRUE

Question 28

3 dx criteria for ARDS?

Answer 28

1. onset 2. pulmonary edema 3. resp failure not explained by cardiac or fluid overload

Question 29

3 treatments for ARDS?

Answer 29

1. intubation 2. pharmacological management of underlying trigger 3. prone positioning

Question 30

Secretion clearance techniques are very effective for ARDS (T/F)

Answer 30

FALSE - may further irritate the lungs

Question 31

___% of ICU pts will have denervation and muscle fibre damage

Answer 31

40

Question 32

__% of ICU pt's just have muscle fibres affected (critical illness myopathy) and __% of pt's just have neural root plexus or nerve damage (critical illness neuropathy)

Answer 32

5

Question 33

5 risk factors / indices of suspicion for neuropathy?

Answer 33

1. <7 days in ICU 2. ventilator dependent 3. sepsis / major surgery 4. prolonged antibiotics, paralytics or steroids 5. multiple invasive procedures or medications

Question 34

In critical illness polyneuropathy, when cells are unable to use O2 that they get and hence cannot generate an action potential, this condition is called _______ _____

Answer 34

bioenergetic failure

Question 35

5 s/s of critical illness polyneuropathy?

Answer 35

1. Functional limitations 2. weakness of distal limbs 3. weakness of resp muscles 4. DTR reduced or absent 5. sensory loss

Question 36

Ventilator associated pneumonia definition?

Answer 36

hospital acquired pneumonia with a person who has been on a ventilator for more than 48 hours

Question 37

5 ways to prevent ventilator associated pneumonia?

Answer 37

1. HOB >30 deg 2. hand washing 3. postural changes 4. regular mouth care 5. tracheostomy for long term ventilation

Question 38

6 lung pathologies secretion clearance techniques will not help with?

Answer 38

1. shock 2. sepsis 3. ARDS 4. CHF / acute HF / pulmonary edema 5. pleural effusions