Critical Care Medicine Flashcards
(44 cards)
What are some typical features of a critical care unit?
- px are typically critically ill - suffering medical emergencies
- px need continuous monitoring (ie vitals, O2, BP, Temp)
- px often on more specialist equipment - ie ventilator, NG tubes
- px are often bed boud - reduced mobility and often recover slowly (increased risk for DVT)
- px are: nurse = 1 : 1
- px are often ✅ sedated, ✅ ventilated, ✅ and on RRT
- px leave not as fit as they came prior to being admitted - they need to be fit and likely to survice the intensieve care given on ITU ( extremely frail px may not survive and thus it may not be an option for them).
What care is offered in an ITU unit/ critical care unit?
- airway + breathing support 🫁
- circulatory support 🫀
- sedation and analgesia 💊
- sepsis management 🦠
- Renal Replacement Therapy 🫘
What are the goals of offering the 5 types of care in critical care medicine?
- they prioritise and allow px to recover from the reason for admission
- maintain oxygen perfusion around the body - avoid decline
- treat and remove problems and address new problems that the px may develop
What types of patients may be admitted to critical care?
Patients who have respiratory failure - ie *pneumonia, acute asthma, Covid - 19 *
Patients with cardiac instability - ie stroke, HTN crises, severe sepsis, septic shock etc
Px with neurlogical emergencies - stroke, status epileptics, TBI
Px who are acutely ill; medical emergencies - severe burns, DKA, sepsis , post op after medicl surgerys
What equipment is typically used for respiratory support?
A ventilator - which is used to deliver oxygen and remove co2 for patients who are unable to breathe properly
Give two examples of invasive mechanical ventilation?
- Endo - tracheal tube
- Tracheostomy
What is an ET tube?
It is a tube inserted via the mouth (adult) or the nose (kids) that that pumps oxygen and remove co2 to and from the lungs.
What is the benefit/ purpose of the balloon/cuff inside an ET tube?
The balloon/cuff inside is used to prevent aspiration into the lungs and to reduce the risk of pneumonia, as well as sealing the airways to prevent leaks as well as securing the tube in place to prevent accidental displacement
What are the negatives / downsides of being fitted with an ET tube?
- px cant talk - consent + communication implicated!
- px cant clean teeth alone - autonomy + hygiene
- more difficult to breath
- px may get very dry lips + mouth bc they cant close lips fully - v uncomfortable
What is a tracheostomy and why is it preferred among px requiring ventilation support?
This is a breathing tube inserted via a hole in the neck into the trachea allowing air to be pumped in
Px prefer it and it has a >er compliance bc it bypasses the mouth and so the oral complications associated with ET tube (ie dry mouth, consent, discomfort, communication , hygiene, etc are less of a problem).
What is the one semi downside for the patient, using a tracheostomy?
- it will leave a scar on their neck
What is the goal of mechanical ventilation in px requiring respiratory support?
- to keep the alveoli open and therefore allowing them to contract and relax gently to allow for adequate gas exchange.
⚠️ must avoid inflating TOO MUCH O2 via ventilation
What might happen if we inflate TOO much oxygen via ventilation?
- 💥 barotrauma - ie the alveoli SNAPS
- O2 toxicity ⛽️
What is the absolute limit of O2 we can administer/ prescribe?
- no more than 6mL/kg
- kg - lean body weight
What are the 3 main causes/ presentations of circulatory failure?
- Inadequate pre - load
- myocardial failure
- maldistribution
What is inadequate pre - load?
When there isn’t enough blood returning back to the heart to fill the ventricles properly.
- this may be due to hypovolemic - xs diuresis, vasodilation etc - basically there is not enough blood or fluid in the body and thus there is not enough blood to return to the heart.
How do we measure circulatory function?
Indirectly by looking at
- ABP (mainly used)
- CO ( LiDCO, PiCCO)
- bloods - troponin (increased in MI) and BNP (increased in HF)
What are the two main lines we use fir IV administration?
- Arterial line - obvs this is not IV its IA
- Central Venous Catheter
What is the arterial line usually ised for and where can we insert it along the body?
- ABP
- radial, brachial and femoral artery
Where is the Central venous catheter inserted along the body and what is it typically used for?
- IJV, subclavian, femoral vein (last resort!)
- used for drug administration, fluid resus, parenteral nutrition
What is the benefit of using a multi - lumen CVC line?
We can administer multiple drugs that are incompatible with eachother at the same time
- we can get 2, 3, 4,5 , 7 lumen lines
What do we prescribe to treat inadequate pre - load?
- BOLUS injection of 500ml of a crystalloid solution over 15 mins
(Resus!)
What are the investigations we would do first regardig assessing for inadequate pre - load?
Passive / straight leg raise
- if the px BP increases - rx fluid
- if the px BP is the same - no fluid is needed
What is myocardial failure?
Cardiogenic shock where the patients CO is extremely LOW
(The px heart is not pumping enough blood out to the body!)
