Critical Care Flashcards by Eilidh Seaton

What are NA requirements

1-2 mol / kg / day

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What are K, Cl and Na requirements

0.5-1 mol / kg / day

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What are fluid requirements

25-30ml / kg / day

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What are glucose requirements

50-100g / day

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What are levels of care

0 = primary 
1 = ward
2.= HDU (single-organ)
3 = ITU (multi-organ / invasive ventilation)

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What suggests a bad airway

Sea-saw breathing
Tracheal tug
Stridor 
Recession
Silent = very worrying

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What is a definite airway

Gases go in and out of airway without any problem

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What is airway maintenance

Airway open and unobstructed

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What is airway protection

Cuffed tube in trachea to protect from contamination
Only air enters lung
e.g. intubation from endotracheal tube or tracheostomy

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What is simple airway management

Head tilt, chin lift, Jaw thrust

Caution if head and neck trauma
Caution in AS due to risk of fracture
RA / Down - atlanto-axial subluxation

Adjunt
- Nasopharyngeal
- Oropharyneal - Guedeel
- Laryngeal mask 
Maintain airways but DON'T protect

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What is a nasopharyngeal airway and when is it used

Inserted into nostril if reduced GCS
Measure from tip of nose to triages
Well tolerated in low GCS
Ideal if seizure and can’t insert OPA

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When is nasopharyngeal CI

Base of skull fracture

Underlying coagulopathy

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What is an oropharyngeal airway

Used as bridge to more definite as no sedation required but can only tolerate if unconscious
Measure from angle of jaw to teeth
Female = orange
Male = green

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What is a laryngeal mask

Sits in pharynx above vocal cord
Paralysis not required so can use if just anaesthesia
- If short procedure or low risk

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When is laryngeal mask not suitable

High pressure ventilation
If not fasted as risk of aspiration as no protection against reflux
Morbid obesity

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What is used for airway protection

Endotracheal tube (intubation) 
Tracheostomy
- Performed by ENT surgeon 
Cricothyroiectomy 
- Used in emergency

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What is endotracheal tube good for

Protecting airway
Cuffed tube seals of trachea
Allow high pressure gas into lungs and not other places
Long and short term ventilation

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What does it require

Anaesthetic to be put in and for duration of care

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What if GI obstruction

High risk of aspiration so do rapid induction with pressure to occlude oesophagus then insert

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What are risks

Traumatic tube insertion

Risk of trachea-oesophageal formation = pneumonia

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What is tracheostomy good for

Weaning of ventilator
Awake as hole in neck so gag reflex not hit
Can suction to stop infection so useful if weak and can’t cough
Reduces work of breathing

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Why do you intubate

Protect airway from gastric content
If need tight control of blood gas
If shared airway with risk of blood contamination (surgery in same place)
If restricted acess

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What does intubation require

Muscle relaxant as gag reflex

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What are complications of airway management

Failure to wean of ventilator
Obstruction
Aspiration if lose reflex

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What can cause failure to wean

If suxamethonium apnoea due to cholinesterase deficiency / myasthenia So take longer to break down relaxant

What causes obstruction

Ineffective triple manoeuvre Airway device malposition Laynrgospasm if light plains of anaesthesia

What is type 1 and type 2 resp failure

Type 1 = low O2 | Type 2 = low O2 and high CO2

If patient hyperventilating what do you do

Blood gas

How can you give oxygen and at what rate

High flow nasal cannula = 2-4l at 20-30% O2 Hudson face mask = 4-10l at 40% O2 Trauma / non-rebreathe = 15l at 80-90% Venturi - 24-28l CPAP Intubation and ventilation ECMO

If high CO2 what is indicated

Invasive ventilation | O2 may help slightly

What happens if getting tired

No matter how much oxygen you give it won't work | Want to ventilate for as short a time as possible

Blood gas

YES

What makes up CO

HR x SV

What affects SV

Preload Contractility Afterload Very hard to measure

How do you measure BP

BP cuff Arterial line = more accurate Important to measure but doesn't reflex CO accurately Can have good pressure and poor CO

How do you speed up heart

CHronotrope

How do you slow down heart

How do you improve contractility

Inotrope - B1 agonist | Requires central line

How do you affect afterload

Vasopressor = alpha 1 agonist

How do you improve preload

Fluids

What is better than a cannula

Central line Can put stronger drugs through Stays in for longer 7-10 ays

How do you measure result to drugs What is a good marker of hypo perfusion

``` BP UO Conscious level Lactate - marker of hypo-perfusion >2 = abnormal >4 = very serious ```

What are crystalloids and when are they useful

Small molecules of electrolyte Saline / plasmaLyte Maintain osmolality Used for resus if vasodilated to fill

What are colloid and when are they useful

Big molecules | Rarely used unless bleeding to death

What do recent guidelines for sepsis suggest

30ml / kg fluid | Switch to vasopressor if no longer work

What is the risk of large quantities of IV saline

Hypercholoaemic acidosis as high volume of Na and Cl

What is now favoured

PlasmaLyte as more balanced

What is not recommended post surgery

5% dextrose

If patient haemodynaimcally stable and euvolaemic what do you do

Restart oral

When should you review

If low Na <20

If patient oedematous but hypovolaemic

Treat hypovolaemia first Then follow with -ve balance of Na and H20 Monitor Na excretion levels

Look at table with values of electrolyte of fluid

How can you get IV access

``` Peripheral venous cannula Central line IO Tunnelled lines PICC - peripherally inserted central cannula ```

What are cannula unsuitable for

Vasoactive drugs e.g. inotrope | TPN

What size of cannula

``` If stable = smaller cannula The larger the number the smaller the cannula as can fit 22 in etc Grey = biggest Green Pink Blue Yellow = smallest ```

What should you avoid in DM

Feet

What is 1st line route for central line

Internal jugular | USS guided

What has higher risk of infection

Femora but easier to site

What is most common area for IO

Anteromedial aspect of proximal tibial = most common Distal femur Humeral head

When do you do IO

Paediatric | If perisperhal will be difficult as shut down

What are Tunneled lines good for

Long term use

When do you intubate

GCS <8

When is head tilt, chin lift CI

C-spine injury AS RA - atlantoaxial subluxation Disc protrusion

If unconscious patient how do you assess

DRABCDE

If respiratory effort + normal sounds

Airway patient | Continue BLS

If respiratory effort + abnormal sounds e.g. snoring (tongue blocking) or stridor

Suggests partial obstruction

If respiratory effort + non ventilation

Suggest complete obstruction | May have tracheal tug or sea saw breathing

What do you do if obstruction

Triple manoeuvre - HT / CL / JT Insert simple airway - NP / OP LMA - laryngeal = next Endotracheal tube

What else once airway established

Bag / mask and vent

If can find radial pulse what does this suggest

BP systolic >90

Critical Care Flashcards

(70 cards)