Critical Care Medicine

Question 1

What are the four levels of care in critical care?

Answer 1

0, 1, 2, 3

Level 0: No specific care needed; Level 1: Enhanced care with constant monitoring; Level 2: Non-invasive BP monitoring or ventilation; Level 3: Intensive care with 1-1 nursing.

Question 2

What is the goal of critical care?

Answer 2

• Maintenance of O2 perfusion to organs
• Remove/treat the problem
• Let body recover

Prolonged bed rest can lead to loss of muscle function and strength.

Question 3

What methods are used to open airways in critical care?

Answer 3

• Endo-tracheal tubes
• Tracheostomies

Endo-tracheal tubes can be inserted through the mouth or nose, while tracheostomies provide comfort and easier weaning from ventilation.

Question 4

What complications can arise from overventilation?

Answer 4

Barotrauma leading to scarring and long-term damage

Excessive air pressure can cause alveoli to snap.

Question 5

What is used to measure cardiac function in critical care?

Answer 5

• Central venous blood pressure
• Arterial blood pressure
• LiDCO (lithium dilution)
• PiCCO (thermal dilution)
• Oesophageal dopplers

These methods assess the function of the heart and circulation.

Question 6

What are the causes of circulatory failure?

Answer 6

• Inadequate preload
• Maldistribution (e.g. septic shock)
• Myocardial failure

Each cause can be assessed and treated accordingly.

Question 7

What is the action of Noradrenaline?

Answer 7

Acts on beta-1 and alpha-1 receptors, increasing SVR and HR

Can cause arrhythmias and decreased organ perfusion.

Question 8

What are the adverse effects of Adrenaline?

Answer 8

• Myocardial ischaemia
• Tachycardia
• Sudden death

Adrenaline acts on beta-1, beta-2, and alpha-1 receptors.

Question 9

What is the role of Dopamine at low doses?

Answer 9

Acts as a vasodilator

At high doses, it acts on beta-1 receptors and can cause tachycardia and arrhythmias.

Question 10

What do Inotropes do?

Answer 10

Affect muscle fibers and change the force of heart contractions

They can be positive or negative inotropic agents.

Question 11

What are some common analgesics used in critical care?

Answer 11

• Opioids
• Paracetamol

Remifentanil is considered the safest opioid for patients with renal or hepatic impairment.

Question 12

What are the types of sedation drugs used in critical care?

Answer 12

• Benzodiazepines
• Propofol
• Anti-psychotic agents

Benzodiazepines can accumulate in renal/hepatic impairment.

Question 13

What is the effect of alpha2-adrenergic agonists?

Answer 13

Activate central inhibitory alpha2 receptors, causing a depressive effect on the CNS

Clonidine is often used for withdrawal states.

Question 14

What are the risks associated with paralysing agents?

Answer 14

Can cause neuro-injury

Atracurium is an example used in severe asthma attacks or head injuries.

Question 15

What criteria suggest sepsis?

Answer 15

• RR >22/min
• Altered mental state
• NEWS2 >5
• SBP <100mmHg

These indicators require immediate assessment and intervention.

Question 16

What is the recommended maintenance for MAP in patients needing vasopressors?

Answer 16

Maintain MAP >65 mmHg and lactate <2mmol/L

This is crucial for proper organ perfusion.

Question 17

What is the maximum rate for potassium replacement via peripheral line?

Answer 17

40mmol/L

Administering potassium too quickly can lead to severe complications.

Question 18

What indicates metabolic acidosis in a patient?

Answer 18

Low CO2 and low bicarbonate

This condition can indicate an underlying metabolic issue.

Question 19

What should be considered after critical care?

Answer 19

• Rehabilitation
• Long-term follow-ups
• Support groups

Patients may experience scarring or altered mental states post-critical care.

Question 20

What is important to consider on admission for elderly patients?

Answer 20

Frailty

It significantly impacts their care and outcomes.