Critical Care Medicine Flashcards
(36 cards)
what reduces risk of ventilator-associated pneumonia?
- head of bed elevated at least 30 degrees
- daily sedation interruption and assessment of readiness to extubate
- ETT with subglottic suction
- early exercise or mobilisation
- change ventilation circuits only if malfunctioning or visibly soiled
what reduces risk of CLABSI?
- hand hygiene
- maximal barrier precautions
- chlorhexidine skin antisepsis
- avoid femoral access
- daily review of line necessity
how to calculate MAP?
2 x diastolic + systolic pressure
divided by 3
How to improve oxygenation?
increase FiO2 or increase PEEP (to open up collapsed/flooded alveoli)
what scoring system is used to help identify patients on high flow oxygen who are at low or high risk for intubation?
ROX index
- defined as the ratio of SpO2/FiO2 (%) to respiratory rate (breaths/min)
indications for CPAP?
OSA
Pulmonary oedema
Excessive dynamic airway collapse
Preintubation/ postextubation
indications for BIPAP?
COPD exacerbation
Obesity hypoventilation syndrome
Neuromuscular disorders
with ST mode (minimum set respiration): hypoventilation, central apnoeas
first choice vasopressor/inotrope for cardiogenic shock without hypotension?
dobutamine
-> increases inotropy
- add on therapy for distributive shock with depressed cardiac function
what inotrope is indicated for use in cases of severe bradycardia in septic shock?
dopamine (high dose)
what inotrope is first choice in anaphylactic (distributive) shock?
adrenaline
- increases SVR, inotropy
- can be added to noradrenaline in septic distributive shock
first choice inotrope in cariogenic, distributive and hypovolaemic shock?
noradrenaline
Definition criteria of ARDS?
- onset within 1 wk of known ARDS insult
- Bilateral opacities on chest imaging consistent with pulmonary oedema
- Respiratory failure not related to cardiac failure or volume overload
- PF ratio <300 on at least PEEP of 5 from NIV/invasive ventilation
severity of ARDS is based on?
mild: PF ratio 200-<300
Moderate: 100-200
Severe: <100
what tx is beneficial for ARDS?
- Low Tidal volume
- Prone positioning 12-16h/day
- ECMO for those with severe refractory ARDS
Strategies to prevent postoperative atelectasis?
pain control, early mobility, secretion management with aggressive chest PT
when to offer ECMO for patients with acute exacerbation of idiopathic pulmonary fibrosis?
only offered as a bridge to lung transplant
-> outcomes after intubation and mechanical ventilation are very poor for patients with acute exacerbation of IPF, need to discuss goals of care/ palliative care strategies early
why does hypercapnic T2RF occur?
Alveolar hypoventilation
due to
1) decreased respiratory drive
e.g. central apnoea, OHS, drugs, hypothermia/ hypothyroidism, stroke, meningitis
2) low tidal volume or increased dead space relative to overall tidal volume
e.g. Neuromuscular weakness, obstructive airway disease, restrictive physiology
obesity hypoventilation syndrome is characterised by?
obesity + sleep disordered breathing + persistent daytime hypercapnia (pCO2 >45)
what ix is helpful in assessing neuromuscular weakness as a cause of hypercapnic respiratory failure?
evaluation of maximum inspiratory and expiratory pressures (usually <50% of predicted)
+
positional changes in vital capacity (usually >20% decrease in FVC while supine)
what are the 3 criteria of the qSOFA score?
- RR >22 = 1 point
- SBP <100 = 1 point
- Altered mental status = 1 point
2 or more in the setting of known or suspected infection predicts increased mortality
criteria for diagnosing septic shock?
- serum lactate > 2 despite adequate fluid resus
+
hypotension requiring vasopressors to maintain a mean arterial pressure of > 65 mmHg
what is the dose of hydrocortisone recommended by 2016 surviving sepsis campaign for refractory shock?
200mg daily
management options of nonexertional heat stroke?
evaporative cooling (water mist/ fans) with or without ice packs to lower core temp
