Critical Care

Question 1

What is level 1 care?

Answer 1

Ward based care

Patient doesn’t require organ support

Question 2

What is an example of level 1 care?

Answer 2

IV cannulation

Oxygen by facemask

Question 3

What is level 2 care?

Answer 3

High dependency unit
Patient requires organ support for ONLY ONE organ
Excludes mechanical ventilation

Question 4

how many nurses are assigned to each patient in level 2 care?

Answer 4

HDU - 1 nurse to 2 patients

Question 5

what is an example of level 2 care?

Answer 5

Invasive blood pressure monitoring

renal haemophiltration

Question 6

What is level 3 care?

Answer 6

Intensive care unit
Includes mechanical ventilation
Organ support for TWO OR MORE organs

Question 7

What is the nurse: patient ratio in level 3 care?

Answer 7

1 nurse to 1 patient

Question 8

What is type 1 respiratory failure?

Answer 8

When there is a ventilation-perfusion mismatch (V/Q).

Low V/Q - when there is enough blood but not enough air (asthma)
High V/Q - when there is enough air but not enough blood (pulmonary embolism)

Question 9

What are the oxygen and carbon dioxide levels lie in type 1 respiratory failure?

Answer 9

Oxygen - low

Carbon dioxide - normal

Question 10

What is type 2 respiratory failure?

Answer 10

this is caused by alveolar hypoventilation - the lungs can’t oxygenate and blow off CO2

Question 11

What are the carbon dioxide and oxygen levels like in type 2 respiratory failure?

Answer 11

Oxygen - low
Carbon dioxide - high

(2 things wrong)

Question 12

What are causes of type 2 respiratory failure?

Answer 12

COPD
Motor neurone disease
Guillan-Barre syndrome
Pulmonary fibrosis 
Opiates
Rib fracture

Question 13

What are types of non-invasive oxygen therapy?

Answer 13

Nasal Cannula (ward based or high flow)
Simple face mask
Face mask (non-rebreather)
Non-invasive ventilation
Positive end expiratory pressure

Question 14

What are types of invasive ventilation?

Answer 14

ECHMO
Endotracheal tube
Tracheostomy

Question 15

How much oxygen can you give through a nasal cannula on a NORMAL ward?

Answer 15

2-4L/min (25-30% air)

Question 16

How much oxygen can you give through a normal face mask?

Answer 16

4-10L/min (40% oxygen max)

Question 17

How much oxygen can you give through a non-rebreather/trauma mask?

Answer 17

up to 15L/min (90% oxygen max)

Question 18

What are venter masks?

Answer 18

These deliver an EXACT amount of oxygen - used in COPD patients who are at risk of retaining C02 if oxygen flow is too high.

Question 19

How much oxygen can you give through a HIGH FLOW nasal cannula?

Answer 19

Critical care -
Up to 60L/min

(it adds a small amount of positive pressure)

Question 20

Which methods of oxygenation can be used on the normal ward?

Answer 20

Normal nasal cannula
Normal face mask
Non-rebreather mask

Question 21

What are the two types of non-invasive ventilation?

Answer 21

CPAP

BiPAP

Question 22

What is CPAP?

Answer 22

Contours positive airway pressure.

Question 23

What is BiPAP?

Answer 23

Bilevel positive airway pressure - a cycle of alternating pressures.

Question 24

What is the point of non-invasive pressure?

Answer 24

Applied a positive pressure to keep the lungs and airways open.

Question 25

Which methods are used in severe respiratory failure?

Answer 25

Endotracheal tube ECHMO Tracheostomy The ETT and Trash are both required to be connected to a ventilator at all times.

Question 26

When is a tracheostomy indicated?

Answer 26

If the person requires long term invasive ventilation, as endotracheal tube doesn't allow for talking, eating etc.

Question 27

What is extracorporeal membrane oxygenation?

Answer 27

When blood is removed from the body to be oxygenated and for carbon dioxide to be removed.

Question 28

what is shock?

Answer 28

Acute circulatory failure resulting in inadequate tissue perfusion leading to cellular hypoxia.

Question 29

What are the main 4 types of shock?

Answer 29

Distributive - septic (main) cardiogenic - pump/heart failure Hypovolaemic - dehydration or trauma Obstructive - pneumothorax, PE Others - neurogenic, anaphylactic (both causing dilation in the wrong places)

Question 30

what is septic shock?

Answer 30

this is a severe drop in arterial blood pressure which leads to inadequate tissue perfusion.

Question 31

what is cardiac output?

Answer 31

Heart rate x stroke volume

Question 32

What is an arterial line?

Answer 32

A cannula which is inserted into an artery. Takes blood pressure can take Arterial blood gas NEVER used for giving medication.

Question 33

where are arterial lines inserted?

Answer 33

Mostly radial artery | sometimes brachial artery

Question 34

What is a central line?

Answer 34

A long thin tube with 3-5 lumens inserted into a vein, the tip sits in the vena cava.

Question 35

How long can a central line be kept in for?

Answer 35

7-10 days.

Question 36

What are central lines used for?

Answer 36

Can give drugs take blood samples measure central venous pressure

Question 37

which drugs are given through a central line?

Answer 37

``` Drugs that would irritate the body if it was given through the periphery: Ionotropes potassium based amiodarone noradrenaline ```

Question 38

Where are the central lines put in?

Answer 38

Internal jugular vein subclavian vein femoral vein

Question 39

which medication is given when there is a heart pump failure?

Answer 39

Ionotropes - supports contractility.

Question 40

what is dobutamine?

Answer 40

Beta agonist - only causes increase in heart rate and contractility. (doesn't affect periphery) Only used if you're confident the problem is directly of the heart).

Question 41

What is metaraminol?

Answer 41

Alpha 1 agonist Slight beta agonist causes vasoconstriction of blood vessels and heart

Question 42

when is metaraminol used?

Answer 42

In septic shock can be given peripherally or centrally.

Question 43

what is noradrenaline?

Answer 43

Alpha agonist with a little bit of beta agonist, more potent than metaraminol. Only given through central line

Question 44

when is noradrenaline used?

Answer 44

in septic shock

Question 45

what do inotropes do?

Answer 45

Alter the contractility of a muscle - can increase or decrease depending on whether the inotrope is positive or negative.

Question 46

what are colloids?

Answer 46

Not used much anymore. | Fluid with large osmotic molecules.

Question 47

what are crystalloids?

Answer 47

Small molecule fluids, 0.9% saline, plasma, dextrose

Question 48

what are examples of fluid maintenance vs fluid resuscitation?

Answer 48

Maintenance - giving fluid because person can't eat/drink | resuscitation - giving fluid for septic shock

Question 49

how much fluid can you give at one time?

Answer 49

250-500mls.

Question 50

who might be at risk of fluid overload?

Answer 50

Chronic heart failure patients.

Question 51

what is a fluid challenge?

Answer 51

when you give as much fluid as possible as quick as possible then wait to see if they improve. If they don't - call it quits and use medication (vasopressors and inotropes).

Question 52

What are vasopressors?

Answer 52

medications which cause vasoconstriction, increase blood pressure.

Question 52

What are vasopressors?

Answer 52

medications which cause vasoconstriction, increase blood pressure.