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Royal college IM > Critical Care > Flashcards

Critical Care Flashcards

(54 cards)

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1
Q

4 stages of anesthesia

A
  1. Induction
  2. Excitement or delirium
  3. surgical anesthesia
  4. Overdose
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2
Q

Indications for intubation

A

respiratory failure
Apnea
GCS<8
airway injury
Impeding compromise to airway
Trauma
electively
self extubation

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3
Q

Contraindications to intubation

A

severe airway trauma or obstruction

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4
Q

4 principles of airway management

A
  1. is the airway patent
  2. is an advanced airway indicated
  3. is proper placement of advanced airway confirmed
  4. is tube secure and placement confirmed frequently
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5
Q

narrowest area of adult airway

A

glottis

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6
Q

4 D’s of a difficult airway

A

distortion
disproportion
dysmobility
dentition

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7
Q

how much oxygen is needed for pre oxygenation in controlled intubation

A

end tidal oxygen should be 80% if possible
100%FiO2

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8
Q

confirming tube placement

A

return of end tidal CO2 for minimum of 4 breath cycles
equal chest rise
misting of tube
equal AE on Auscultation

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9
Q

Equipment/ set up required for intubation

A

Airway cart
Bag Valve Mask
Crash Cart
Difficult Airway cart
Equipment for monitoring
Suction
Ventilator
IV Pump
Meds
Good IV access
aspirate the stomach
have fluids ready
Vasopressor

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10
Q

Meds For induction

A

Sedative: propofol, etomidate,
paretic: ROC, Sux
analgesia fentanyl etc.

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11
Q

checking tube placement on CXR

A

2CM above carina

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12
Q

Indications for RSI

A

emergency/ urgent need to intubate
Assumed full stomach
Risk of Aspiration e.g. UGIB

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13
Q

positive pressure breath test

A

in controlled intubations BVM breath given before paralytic to ensure patient can be ventilated prior to paralytic.

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14
Q

differences between RSI and controlled induction

A

no positive pressure breath test (increased risk of aspiration)
Drugs usually pushed one after another
Cric pressure required

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15
Q

difficult airway guideline

A

BURP
Bouje
Blade

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16
Q

etomidate

A

0.3-0.4mg/kg

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17
Q

fentanyl

A

2-10mcg/kg

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18
Q

propofol

A

1-2.5mg/kg

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19
Q

midazolam

A

0.1-0.3mg/kg

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20
Q

ketamine

A
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21
Q

Rocuronium

A

0.6-1.2mg/kg

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22
Q

Succinylcholine

Study These Flashcards
A

1-2mg/kg
DOA 5-7 mins
Deplorarising NMBA
wait for muscle fasciculations to stop

CI: Burns, spinal cord injuries, hyperkalemia, neurological injuries.

23
Q

complications of intubation

Study These Flashcards
A

Right mainstream intubation
oesophageal intubation
injury to airway
pneumothorax
air leak from bronchial injury

24
Q

indications for surgery in cerebral hemispheric hematoma

Study These Flashcards
A

> 50ml volume
frontal or temporal hemorrhage >20ml with midline shift>5mm and/ or cistern compression with decreased GCS

25
indications for surgery with posterior fossa hematoma
brainstem compression distortion of the 4th ventricle effacement of basal cisterns obstructive hydrocephalus
26
diabetes insipidus DDAVP dose
2 mcg
27
indications for surgery epidural hematoma
>30ml Volume thickness>15mm midline >5mm Acute with impaired consciousness focal neurology.
28
parameters for TBI patients
normal oxygenation 60-80 Normocapnia 30-35 MAP 70-90 Na 140-145 Normal ICP of approx. 10
29
initial TBI management
Basic labs inc. electrolytes, coags, VBG Optimize coagulation inc. tranexamic acid CT head +/- vascular imaging Optimize BP MAP 70-90 use Norepi imperic hypertonic saline seizure prophylaxis Aggresive fever management avoid hyponatremia
30
drugs to avoid in TBI
steroids Should initially avoid Lasix, and antihypertensives.
31
Norepinephrine
1st line pressor in Sepsis Dose 0.03 – 0.35 ug/kg/min * Alpha 1 > beta activity 1 peripheral vasoconstriction with smaller amount of cardiac inotropy Inc HR, SVR, CO, PCWP
32
Vasopressin
Dose is often non-titratable à 0.03 U/min (2.4 U/hr) * Add when Norepinephrine is at 0.1-0.2 ug/kg/min * Often second line in septic shock dec. HR CO Inc. SVR, PCWP
33
Epinephrine
* Consider if inotropy needed (ie. Concurrent cardiomyopathy) or brady * Increases lactate, so cannot use as a resuscitation measure * May precipitate arrhythmias (Both alpha 1 and beta 1 activity) Dec. PCWP Inc. HR, SVR, CO
34
Phenylephrine
Pure alpha 1 agonism * Add if significant tachyarrhythmias * Caution if concern of increasing afterload dec. HR, CO Inc SVR, PCWP
35
Dobutamine
Inc HR, CO Decrease SVR, PCWP
36
dopamine
Inc. HR, SVR, CO, PCWP
37
milrinone
inc HR, CO Dec. SVR, PCWP
38
contraindication to NIPPV
* Facial surgery, facial trauma, airway obstruction * Decreased LOC (*relative) * Inability to clear secretions * Respiratory arrest * Hemodynamic instability (reduces preload) * Indication for intubation (e.g. airway protection)
39
how to decrease PaCO2 on a vent
- Increase RR - Increase tidal volume (minute ventilation = RR * Vt)
40
how to increase O2 on vent
Increase FiO2 - Increase PEEP - Extend inspiratory time Affect O2 delivery: é cardiac output, é Hb ê O2 consumption: treat fever, agitation Remove pulm vasodilators (eg nitroprusside)
41
Benefits of Invasive mechanical ventilation
Improved VQ mismatching Reduced shunt physiology Improved oxygen delivery
42
Risks of Invasive mechanical ventilation
Ventilator induced lung injury Ventilator associated pneumonia Organ failure Neuromuscular weakness Ventilator dependence
43
symptoms of early salicylate toxicity
Tinnitus Nausea and vomiting hyperventilation Fever
44
late symptoms of salicylate toxicity
pulmonary oedema (non-cariogenic) coma/ seizures arrhythmia thrombocytopenia AKI
45
causes of high anion gap
ketones Tylenol Salicylates Lactate
46
treating salicylate poisoning
sodium bicarb aiming for alkalosis around 7.5-7.59 fluid resuscitation glucose (brain depleted of glucose even if serum is normal) intubation is dangerous as will require high minute volumes to maintain alkalosis Nephro consult for dialysis CRRT is NOT adequate!
47
indications to use digibind
1. acute ingestion of 10mg or more 2. K>5 3. hypo perfusion 4. life threatening arrhythmia
48
ECG changes with toxic levels of digoxin
first degree heart block paroxysmal atrial tachycardia regularized atrial fibrilation univocal or multifocal PVC's ventricular bigeminy Bidirectional VT
49
ECG changes with therapeutic levels of digoxin
sagging of ST segments flattened T waves U waves Shortened QT
50
medications that increase digoxin levels
medications that inhibit p-glycoprotein - amiodarone - carvedilol - ranolazine - ticagrelor - verapamil - tacrolimus - cyclosporin - azithromycin, erythromycin, clarithromycin - azole antifungals
51
medications that decrease digoxin levels
p- glycoprotein agonists - Carbamazepine, fosphenytoin, phenobarbital - rifampin
52
how to treat gas trapping on vent
treat anything reversible e.g. bronchodilators, suctioning, steroids change I:E ratio to 1:4 or 1:5 lower the respiratory rate decrease Vt increase PEEP to counter the increased work of breathing last line: disconnect vent and press on chest, Heliox, ECCOR2, high frequency oscillation.
53
symptoms of serotonin syndrome
autonomic neuromuscular hyperactivity change in mental status
54
symptoms of neuroleptic malignant syndrome
Fever Autonomic Rigidity HYPOREFLEXIVE Change in mental status

Royal college IM (18 decks)

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