Critical Care Flashcards Preview

Anaesthetics, ED and Plastics > Critical Care > Flashcards

Flashcards in Critical Care Deck (70)
Loading flashcards...
1

What are NA requirements

1-2 mol / kg / day

2

What are K, Cl and Na requirements

0.5-1 mol / kg / day

3

What are fluid requirements

25-30ml / kg / day

4

What are glucose requirements

50-100g / day

5

What are levels of care

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

6

What suggests a bad airway

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

7

What is a definite airway

Gases go in and out of airway without any problem

8

What is airway maintenance

Airway open and unobstructed

9

What is airway protection

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

10

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

11

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

12

When is nasopharyngeal CI

Base of skull fracture
Underlying coagulopathy

13

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

14

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

15

When is laryngeal mask not suitable

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

16

What is used for airway protection

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

17

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

18

What does it require

Anaesthetic to be put in and for duration of care

19

What if GI obstruction

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

20

What are risks

Traumatic tube insertion
Risk of trachea-oesophageal formation = pneumonia

21

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

22

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

23

What does intubation require

Muscle relaxant as gag reflex

24

What are complications of airway management

Failure to wean of ventilator
Obstruction
Aspiration if lose reflex

25

What can cause failure to wean

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

26

What causes obstruction

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

27

What is type 1 and type 2 resp failure

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

28

If patient hyperventilating what do you do

Blood gas

29

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

30

If high CO2 what is indicated

Invasive ventilation
O2 may help slightly