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MRCS Critical care > Definition > Flashcards

Definition Flashcards

(50 cards)

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1
Q

Henderson Hasselback equation

A

H20 + CO2 = H2CO3 = H+ + HCO3-

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2
Q

Chloride shift

A

exchange of bicarbonate and chloride across RBC membrane

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3
Q

Buffer

A

Limit the change of pH by binding or releasing H+

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4
Q

Categories of Acute limb ischaemia

A

1 - Not immediately threatened
2a - Salvageable, partial sensory deficit
2b - salvageable, partial motor deficit
3 - amputation

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5
Q

reperfusion injury

A

revascularisation leads to increase venous return from ischaemic tissue containing toxic metabolites
This leads to SIRS - hypotension, MODS, arrythmia

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6
Q

Acute tubular necrosis

A

Damage to renal tubular cells 2ry to ischaemic insult or nephrotoxin
Causes - hypoperfusion, aminoglycosides, contrast, Mb, myeloma

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7
Q

Acute respiratory distress syndrome

A

Acute respiratory failure and non cardiogenic pulmonary oedema
Hypoxaemia and reduced lung compliance, which is refractory to Oxygen therapy
Normal pulmonary artery wedge pressure - <18mmHg
PaO2/FiO2 ratio reduces

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8
Q

Pain

A

unpleasant sensory and emotional experience associated with actual or potential tissue damage
Carried by A delta and C fibres - dorsal horn of spinal cord - thalamus - somatosensory cortex

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9
Q

Allodynia

A

Increased sensation of pain from normally non painful stimuli
Caused by cross talk of sympathetic or A beta and nociceptive fibres

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10
Q

Neuropathic pain

A

Results of damage to the pain signalling pathway

present as numbness or burning

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11
Q

Apnoea test

A

1) increase FiO2 to 1.0 check Sats >95% then lower resp rate
2) Once ETCO2 >6.0, and check PaCO2 >6.0
3) disconnect ventilator and give O2 5L/min via endotrachial catheter for 5mins, if PaCO2 raises by 0.5kPa - loss of respiratory drive

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12
Q

second degree burn

A

burns that have penetrated into the deep dermal layer of the skin
pink, painful, branches, blisters

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13
Q

Burn’s unit referral

A 
Size - 5% in child, 10% in adults
Age - <5, >60
Chemical
Electrical
Face, Hands, Feet, perineum, flexures, circumferential 
Inhalation injury
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14
Q

Frank-Starling law

A

Stroke volume of the heart increases in response to an increase in the volume of blood in the left ventricle

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15
Q

Myoglobin

A

Oxygen binding protein found in the muscle

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16
Q

Charcot’s triad

A

RUQ pain, jaundice, pyrexia

Ascending cholangitis

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17
Q

Disseminated intravascular coagulation

A

pathological consumptive coagulopathy
generation and deposition of fibrin - microvascular thrombi in various organ
Consumption of coagulation factors, platelets and activation of fibrinolysis leads to bleeding
Low Hb, PLt, fibrinogen and high PT/APTT/DDimer

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18
Q

Massive blood transfusion

A

> 50% of replacement of blood volume in 12 hours

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19
Q

Hypothermia

A

core body temperature <35
May lead to
metabolic acidosis, hypocalcaemia, cardiac arrythmia, enzyme dysfunction, shift in haemoglobin dissociation curve, platelet dysfunction

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20
Q

Signs of hypovolemia

A 
pale
anxious
sinus tachy
hypotension
oliguria
cool/clammy 
slow CRT
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21
Q

Fat embolism

Study These Flashcards
A

Clinical diagnosis
Circulating fat globules in the circulation and pulmonary parenchyma
Trauma - pelvis, femur, tibia; IM nailing; major burns
Non trumatic - BM transplant, pancreatitis
petechial rash over axilla, neck, sternum
low sats
confusion

22
Q

Areas of portosystemic shunt

Study These Flashcards
A 
lower oesophagus
umbilical
retroperitoneal
bare area of liver
patent ductus venosus
upper anal canal
23
Q

oesophageal varices

Study These Flashcards
A

bulging veins secondary to back pressure due to portal hypertension at the portosystemic anastomosis
rule of 2/3
2/3 of cirrhosis leads to portal HTN
2/3 of portal HTN leads to oesophageal varices
2/3 of oesophageal varices presents with bleed

24
Q

Sengstaken Blakemore tube

Study These Flashcards
A

NG tube with two balloon (one above and below GOJ)
Inflated under radiological guidance
Used for 24 hrs
Can cause ischaemia, perforation, aspiration pneumonia

25
TIPSS
Tansjugular intrahepatic porto systemic shunt Hepatic vein is cannulated from IJV using needle under fluoroscopy Stent is inserted between hepatic and portal vein Can lead to encephalopathy
26
False localising sign
6th nerve palsy due to raised ICP/herniation | Compression of the nerve not damage to nucleus
27
Secondary brain injury
injury insulted secondary to the primary injury prevented by Intubation, Sedation, PaCO2 <5.0, nurse at 45 degrees, CVP, Arterial line, ICP monitor, Mannitol
28
Cerebral perfusion pressure
MAP - ICP pressure gradient that drives oxygen delivery to the brain >65mmHg (MAP 90, ICP25)
29
Cerebral blood flow
autoregulated between 50-150mmHg | regulated by myogenic reflex and C02 and O2
30
Monroe Kellie doctrine
States that skull contains a certain amount of brain, blood and CSF Any SOL leads to displace the others
31
Difference between CSF and plasma
``` PCO2 is higher Lower pH low protein low glucose high chloride low cholesterol ```
32
CSF circulation
``` Choroid plexus Lateral Ventricles Foramen Monroe Third ventricle Cerebral Aquaduct Fourth ventricle Foramen of Luschka & Magendie Subarachnoid space Arachnoid granulation ```
33
Respiration
Transportation of Oxygen to tissue and carbon dioxide outside the tissue
34
Minute ventilation
RR x tidal volume | Amount of air inspired per minute
35
Ischaemia
Abnormal reduction in the blood supply or drainage of a tissue/organ
36
Infarct
consequence of an ischaemic insult resulting in tissue death
37
Respiratory quotient
ratio of CO2 excretion to O2 consumption which determines which food is being metabolised during cellular respiration RQ= CO2/O2
38
Ranson criteria
``` For non-gallstone pancreatitis Age >55 WCC >16 Glucose >11.2 LDH >350 AST>250 ``` ``` 48hrs Hct drop by >10% Urea increase by 1.79 Ca <2.00 PaO2 60mmHg Base deficit 4 Fluid required >6L ```
39
Pancreatic pseudocyst
encapsulated fluid collection encased by fibrous capsule caused by leakage of enzyme-rich fluid, usually around 4 weeks Can form anywhere along the pancreas Seen in lesser sac obstructing gastroepiploic foramen
40
shock
inadequate tissue perfusion for metabolic requirement
41
coronary perfusion pressure
systemic diastolic arterial pressure - left ventricular end diastolic pressure
42
sedation
alteration in consciousness/analgesia/anxiety used for diagnostic/therapeutic procedure of short duration contraindicated - unstable patient, long lasting, no observation Need to have reversal meds as well
43
light sedation
maintain airway with intact reflex respond to stimuli anxiolytic effect
44
deep sedation
airway is not necessary patent, may need support | repeated and painful stimuli needed for response
45
General anaesthesia
airway is not protected | patient not rousable
46
sepsis
life threatening organ dysfunction due to a dysregulated host response to infection
47
Septic shock
persistent hypotension requiring vasopressor to maintain a MAP of 65mmHg or having a serum lactate >2 despite adequate volume resuscitation
48
Steroid
organic compound that contains a characteristic arrangement of 4 cycloalkane rings that are joined together
49
ASA
``` American society of anaesthesiologist 1 - healthy 2- mild systemic disease 3 - severe systemic disease 4 - severe systemic disease with constant threats to life 5 - morbidund 6 - brainstem dead ```
50
LEMON assessment
Look - facial trauma, small mandible, short neck Evaluate - 3 fingers between incisors, 3 fingers hyoid to chin, 2 fingers thyroid notch to floor of mouth Mallanpati score Obstruction Neck mobility

MRCS Critical care (1 decks)

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