``` 3 = 25 2 = 21-24 1 = 9-11 0 = 12-20 ```

``` 3 = 131 2 = 111-130 1 = 41-50 or 91-110 0 = 51-90 ```

``` 3 = 220 2 = 91-100 1= 101-110 0 = 111-219 ```

``` 3 = 39.1 1 = 35.1-35 or 38.1-39 0 = 36-8 ```

Critically Ill patients Flashcards by Izzy Burns

EWS RR

3 = <8 or >25
2 = 21-24
1 = 9-11
0 = 12-20

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EWS SpO2

3 = <91 
2 = 92-3
1 = 94-5
0 = >96

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EWS HR

3 = <40 or >131
2 = 111-130
1 = 41-50 or 91-110 
0 = 51-90

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EWS SBP

3 = <90 or >220 
2 = 91-100
1= 101-110
0 = 111-219

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EWS AVPU

3 = CVPU 
1 = New agitation or confusion 
0 = alert

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EWS - temperature

3 = <35
2 = >39.1
1 = 35.1-35 or 38.1-39 
0 = 36-8

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SBARD

Situation - what is happening, where, who
Background - what circumstances leading up to situation
Assessment - NEWS, what do you think problem is
Recommendation - plz come + review, what should we d
Decision - are you coming to review + when

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What is the Blatchford score for?

UGI bleed
0 = likely no admission
>6 = 50% need intervention

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What is the triad of shock

low BP
Raised lactate
Signs of reduced perfusion

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Referral criteria ITU

Threatened airway 
Respiratory/cardiac arrest 
RR >40/<8
sats - <80% on >50% O2
HR - <40 or >140
SBP <90
Suddened decline in GCS by 2 points 
Repeated or prolonged seizures 
Resp acidosis and incr CO2
Any pt w/ clinical cause for concern

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Def septic shock

Tissue hypoperfusion persisting 1 hr after crystalloid admin

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Evidence of septic shock (3)

SBP <90
MAP <65
Lactate >4

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Mx sepsis 6

3 in: 
IV fl 
ABx
O2
3 out: 
UO 
Blood cultures 
Lactate

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How is AKI graded?

Rifle criteria

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What does the Rifle in the Rifle criteria stand for?

Risk 
Injury 
Failure 
Loss 
ESRD

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Mx AKI

Mostly supportive
Careful fluid balance
Med review
Tx hyperkalaemia

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PS DKA (8)

Abdo pain 
Pear drop breath 
Vomiting 
Kusmal respiration 
Polyuria, polydipsia, dehydration

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3 criteria for DKA

BM >11
Cap ketones >3
pH <7.35 or bicarb <15

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Tx DKA

Fl replacement
Insulin
Correct hypoglycaemia
Long acting insulin continued once IV insulin stopped

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PS HHS

Fatigue, lethargy, N+V
Neuro - change consciousness, headache, weakness, papilloedema
hyperviscosity –> stroke/MI
CV - dehydration, decr BP + incr HR

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Diagnosis criteria HHS

Hypovolaemia
BG >30 w/ no acidosis
Serum osm >320

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Mx HHS

Normalise osmolality
Replace fl + electrolytes 0.9% NaCl
Normalise BG

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ABG type 1 RF

O2 decr

CO2 normal or decr

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What is T1RF due to a problem with?

Oxygenation

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Conditions that cause T1RF (4)

Pneumonia/consolidation Fibrosis PE Emphysema

Mx T1RF

ABG T2RF

O2 low CO2 high Hence pH low

What is T2RF due to a problem with?

Ventilation

Cause T2RF (4)

NM eg. MG/DMD/MND Brainstem - OD/trauma Obesity

Mx T2RF

Bipap/NIV

Features moderate acute asthma attack (4)

PEFR 50-75% predicted Normal speech RR <25 HR <110

Features severe acute asthma attack (4)

PEFR 33-50% Can't complete sentances RR >25 Pulse >110

Features life threatening asthma attack (5)

``` PEFR <33% O2 <92% Silent chest, cyanosed Decr HR/BP Exhaustion, confusion, coma ```

Mx acute asthma

A-->E MgSO4 IV aminophylline IV salbutamol

Features of acute severe COPD exaccerbation (6)

``` SOB Cough Wheeze Incr sputum Decr O2 Acute confusion ```

Mx acute COPD exaccerbation

A-->E Incr freq bronchodilator therapy --> nebs Prednisolone 30mg ABx e.g. amox

Mx anaphylaxsis

A-->E Adrenaline 1 in 1,000 - repeat ev 5mins (IM) Hydrocortisone - 200mg chlorphenamine - 10mg

what blood test can be used after anaphylaxis

Serum tryptase

Mx pulmonary oedema

O2 furosemide Morphine BP meds

What are the 3 types of post-operative bleeding?

Primary Reactive Secondary

Primary post operative bleeding

Within the intraoperative period

Reactive post operative bleeding

Within 24hrs

What is reactive post operative bleeding due to?

Cut vessel

Secondary post operative bleeding

7-10 days post-op

What is secondary post operative bleeding due to?

Infection eroding vessels

Signs post-op bleed (7)

``` Incr HR Incr RR Decr BP (late sign) Dizzy Agitated Visible bleed Decr UO ```

Mx post-op bleed

``` A-->E IV access Fl resus Read operation notes Direct P to visible bleed Urgent sr review Blood transfusion/major haemorrhage protocol Return to threatre?? ```

PS major GI haemorrhage (4)

Haematemesis Melaena Pain Collapse

Oesophageal causes major GI haemorrhage (4)

Oesophagitis Cancer M-W tear Varices

Gastric causes major GI haemorrhage (3)

Gastric cancer Gastritis Ulcer

PS - oesophagitis

Small vol fresh blood streaks vomit Spontaenous cessation GORD Sx precede

PS oesophageal cancer

Small vol blood Dysphagia Wt loss

PS M-W tear (2)

Small - mod vol bright red blood | Repeated vomiting

PS oesophageal Varices (3)

large vol fresh blood If swallowed --> melaena Haemodynamic compromise

PS Gastric Ca (3)

Frank haematemesis or mixed w/ vomit Dyspepsia Decr W/night sweats

PS Gastritis (2)

Haemaemesis Epigastric pain Assoc w/ NSAID use

Mx UGI haemorrhage

``` A-->E Calculate Blatchford + Rockall score Bloods + O-ve transfusion Airway control Varices - Terlipressin before endoscopy/banding OGD - 24hrs of admin ```

Who should have surgery for UGI haemorrhage (4)

>60 Continued bleed despite endoscopy Rec bleeding Known CVD

Sx of bacterial meningitis

``` headache fever N+V Photophobia Drowsiness Seizures ```

CSF appearance bacterial meningitis (4)

Cloudy Decr glucose Incr protein 10-5000 WBC, polymorphs

Ix bacterial meningitis

``` FBC CRP Coag Glucose ABG LP ```

Mx STEMI

``` MOANA Morphine (5mpg) O2 Antiemetics - 10mg metocloperamide Nitrates Aspirin ``` PCI = gold standard

Mx NSTEMI / UA

``` BROMANCE B-blockers Reassure O2 Morphine aspirin Nitrates Clopidogrel Enoxaparin ```

cardiac arrest - Non-shockable rhythm Mx

Immediately resume CPR | 10ml 1:10,000 Adrenaline ev 3-5mins

cardiac arrest - shockable rhythms Mx

1 shock Immediately resume CPR after Adrenaline every 3-5mins (10ml 1:10,000) 300mg IV Amiodarone after 3 shocks

Reversible causes of cardiac arrest (4H's + 4Ts)

``` Hypoxia Hypovolaemia Hypothermia Hypo/hyperkalaemia Toxins Tamponade Tension pneumothorax Thrombosis ```

What are the 2 shockable rhythms

VF | VT

What are the 2 non-shockable rhythms

PEA | asystole

What is post arrest syndrome

Brain injury Myocardial dysfunction Systemic ischaemic response

Critically Ill patients Flashcards

(69 cards)