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PHYSIO 4th yr > ICU > Flashcards

ICU Flashcards

(78 cards)

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1
Q

Name the 2 types of blunt injury

A

Deceleration injury
Compression injury

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2
Q

Name 2 types of penetrating injury

A

Low-velocity injuries
High-velocity injuries

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3
Q

List 6 lethal injuries

A

Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac temponade

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4
Q

What is the primary survey provided in ER

A

ABCDE approach to rescuitation
Lethal 6 injuries
Abdominal injury (identify and manage internal bleeding)

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5
Q

What is the secondary survey for ER

A

Head to toe evaluation and history taking
Placement of lines and continuation of care from primary survey
Radiological investigations

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6
Q

List 6 hidden injuries

A

Pulmonary contusion
Myocardial contusion
Traumatic disruption of the aorta
Traumatic diaphragmatic rapture
Tracheobronchial injury
Oesophogeal trauma

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7
Q

Precautions and contraindications related to abdominal injury

A

Analgesia
Caution with drainage tubes
Caution with manual chest therapy over anterior basal lung segments
Vigorous chest percussions may cause alveolar collapse
Wound support during suction and coughing
Open abdomen - restric head tilt to 25 degrees
If abdominal compartment syndrome develops no turning of patient

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8
Q

What is a TBI

A

An alteration in brain function or other evidence of brain pathology caused by external force

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9
Q

What categories can TBI be classified based on

A

Mechanics of injury
Location of injury
Extent of injury
Severity of injury

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10
Q

What is epidural haematoma

A

Blood accumulates between the skull and dura mater
Arterial bleeding from middle meningeal artery
Temporal or temporo-parietal region often affected

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11
Q

What is subdural haematoma

A

Blood accumulated between dura mater and arachnoid meninges
Haematoma occurs due to damage occurring cerebral cortex and venous sinus

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12
Q

What is subarachnoid haematoma

A

Bleeding in the subarachnoid space
Ruptured aneurysms occur here (can be Traumatic or not)

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13
Q

What is intracerebral haematoma

A

Collection of fluid in the brain tissue
Majority of lesions occur in the frontal and temporal lobes

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14
Q

What is primary head injury

A

The initial Traumatic force applied to the head that causes neuronal damage due to contusion, damage to blood vessels and axonal injury

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15
Q

What is a secondary head injury

A

The delayed non-mechanical damage that develops hours and days after the primary injury

The degree of secondary damage depends on duration of cerebral ischemia and intracranial hypertension

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16
Q

What are the factors that lead to ischemia

A

Hypoxaemia
Systemic hypotension
Cerebral hypo-perfusion
Inflammatory processes
Cerebral oedema
Hypercapnia

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17
Q

Factors that influence outcomes of a patient following a TBI

A

Severity of primary and secondary injuries
Low GCS findings on presentation
Advanced age
Presence of comorbidities

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18
Q

What is the GCS rating of Severity of TBI

A

Mild (13,14)
Moderate (9-12)
Severe (3-8)

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19
Q

What is intracranial pressure

A

Pressure within three cranium
Influenced by :
Blood volume, brain tissue and CSF in rigid skull

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20
Q

Name the ICP monitoring devices

A

Epidural sensor
Subdural bolt
Subarachnoid bolt
Parenchymal catheter
Intraventricular catheter

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21
Q

Factors that may increase ICP

A

Suction
Head movements
Turning
Head down positions
MHI
manual techniques
Seizures
Pain
Anxiety
Increased BP and abdominal pressure

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22
Q

Late signs of raised ICP

A

GCS of 3/10 or 3/15
Abnormal motor response (abnormal posture or flaccidity)
Cushing’s response (hypertension, bradycardia, increased temp and altered respiratory pattern)

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23
Q

What is cerebral perfusion pressure

A

The BP gradient across the brain

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24
Q

Contraindications for physiotherapy management

A

Cardiovascular instability
Neurological instability I.e seizures
Non-reactive dialted pupils
Temp above 40 degrees
Nasal suction with base of skull fracture
Haematological instability (platelets lower than 50x10^9L)

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25
Define DIC (Disseminated intravascular coagulation)
A condition in which small blood clots develop throughout the bloodstream blocking small blood vessels due to overactive proteins
26
What is phase 1 of DIC
Thrombotic phase Numerous small thrombi and emboli form throughout the microvasculature causing blockage of circulation and ischemic organ damage.
27
What is phase 2 of DIC
Fibrinolytic phase The fibrin degradation products suppress thrombin and have an anti-haemostatic effect aggravating bleeding
28
Risk factors for the development of DIC
Blood transfusion reaction Cancer Pancreatitis Liver disease Infection of blood Pregnancy complications Recent surgery or anesthesia
29
Signs and symptoms of excessive blood clotting
Chest pain with shirtless of breath (PE) Pain, swelling and redness if DVT Headaches, speech changes, paralysis and dizziness (stroke) Heart attack
30
Signs and symptoms of internal bleeding
Blood in your urine Blood in stools (dark, tarry colour) Headaches, double vision and seizures
31
Define acute renal failure
Sudden loss of the ability of the kidneys to excrete waste, concentrated urine, conserve electrolytes and maintain fluid balance in the body
32
Comorbidities associated with development of ARF
Hypertension Diabetes Chronic heart failure Liver disease Obesity Chronic infection Autoimmune disease
33
Clinical presentation of ARF
Decreased urine output Swelling of the legs, ankle and feet Shortness of breath Fatigue Fever Loss of appetite Arrhythmia Nausea and vomiting Confusion Joint pain Coma and seizures Nosebleed
34
Symptoms of ARDS
cyanosis Decreased respiratory compliance Hypoxemia Acute onset of severe dyspnoea
35
Risk factors for development of ARDS
Sepsis Multiple blood transfusions Pnuemonia Drug overdose Near drowning DIC multiple trauma Diabetes
36
Classification of ARDS
Primary or secondary
37
Primary ARDS
Failure of lungs alone Direct pulmonary injury e.g near drowning, gastric Aspiration
38
Secondary ARDS
Failure of lungs due to systemic disease Sepsis Multiple trauma Multiple transfusions
39
List the 3 stages of ARDS
Exudative Poliferative Fibrotic
40
Exudative phase
1st week of onset symptoms Increased pulmonary vascular permeability leading to alveolar oedema Intrapulmonary shunt causes severe hypoxemia Surfactant lost due to oedema Damage to type 1 and 2 pnuemocytes Decreased lung compliance Pt presents with dyspnoea and tachypnoea
41
Poliferative phase
Week 1-2 Activation of type 2 pnuemocytes and fibroblasts Lung compliance decreased and become heavy Airway and lung tissue resistance increase
42
Fibrotic phase
More than 2 weeks Macroscopically coarse cobble-stoned lungs Excessive depositions of collagen and diffuse fibrosis Further decreased lung compliance
43
Benefits of prone position
Decrease intrapulmonary shunt Decrease mortality Decrease the amount of FIO2 needed Improves oxygenation No haemodynamic complication
44
Advantages of negative pressure ventilator
Decreased risk for pnuemonia Decreased need for sedation Less decrease in cardiac output Cheaper than positive pressure ventilation Comfortable for patient Easy to wean patient
45
Disadvantages for negative pressure ventilation
Difficulty to suction pt Inability to generate high intrapulmonary pressures Limited access to the pt body Contraindicated where you cannot maintain upper airway Pressure sores
46
Indications for mechanical ventilation
PaO2 less than 60mmHg Inability to clear secretions independently Increasing exhaustion of respiratory muscles Increased confusion and inability to protect airway Loss of bulbar function Life threatening disorder of another system Elective preoperative ventilation Therapeutic hyperventilation GCS of 8 or lower with TBI CNS depression Burns above 50% BSA OR 40% with inhalation injury
47
Signs of Tracheal tube obstruction
Patient anxiety Use of the accessory muscles and possible nasal flaring Dismissed breathe sounds on auscultation High PIP and low tidal volume readings
48
What is the purpose of hemodynamic monitoring ?
To determine the patient's efficacy of cardiac function and to determine their fluid replacement needs
49
What are the associated complications associated with Swann-Ganz Catheter
Invasive monitoring (pulmonary artery catheter) Pulmonary infarction Perforation Of the pulmonary artery Ballon can rapture leading to pulmonary embolism Catheter kink and intra cardiac knotting Pneumothorax
50
What's to remember with cardiac function index
Normal (4.5-6.5l/min) If less than norm pt may not tolerate techniques increasing demand of myocardium
51
What to remember with pulmonary occlusion pressure (PAOP)
Normal 6-12 mmHg If low pt may not be able to tolate positive pressure techniques (MHI, VHI or upright sitting)
52
What to remember with systemic vascular resistance (SVR)
Normal (700-1600 dyn/s cm3) If low pt may not tolerate positive pressure interventions
53
What is hypoxia
Inadequate deliver of oxygen to body tissues (PaO2 less than 60mmHg)
54
List the pathophysiology Basis of hypoxemia
V/Q mismatch Hypoventilation Diffusion limitation
55
List the different types of hypoxemia
Anaemic hypoxemia Stagnant hypoxemia Histotoxic hypoxemia Hypoxic hypoxemia
56
Clinical features of hypoxemia
Restlessness Confusion Sweating Tachycardia Hypertension Cyanosis
57
Worsening neurological signs of hypoxemia
Blurred vision Tunnel vision Loss of coordination Impaired judgement Convulsions
58
Long-term effects of hypoxemia
Pulmonary hypertension Death Cardiac arrthymias Tissue damage and organ dysfunction
59
What is non-invasive ventilation
Delivery of mechanical ventilation to the longs with techniques that do not involve the endotracheal airway
60
Aims of non-invasive ventilation
Improve gas exchange Optimize lung volumes Reduce WOB
61
List non-invasive ventilation
Negative pressure vent Abdominal displacement vent Positive pressure vent Diaphragm pace (stimulate phrenic nerve) Glassopharyngeal breathing
62
Explain how does the negative pressure vent works
It's works by delivery pressure below the atmospheric pressure increasing transpulmonary pressure to increase and the atmospheric pressure in the mouth to inflate the alveolar Exhalation is passive
63
Explain how does the abdominal vent work
Patient relies on the displacement of the abdominal visceral organ encourage motion of the diaphragm and ventilation
64
Explain how does the positive pressure vent work
Delivering of increased pressure of gas (above atmospheric pressure) to the airways causing alveolar distensing pressure therefore inflating the lungs
65
What is CiPAP
continous positive airway pressure During both inhalation and Exhalation
66
Benefits of CPAP
Constant p during inhalation and Exhalation increased FRC opens collapsed alveolar Less intrapulmonary shunting occurs Improved oxygenation
67
What is BiPAP ?
Cycles between 2 different positive pressures
68
List the 2 different kinds of BiPAP
Inspiratory PAP Expiratory PAP
69
List the short term goal of NIPPV
Reduce work of breathing Improve or stabilize gas exchange Optimize pt comfort Good patient ventilator synchrony Minimize risk Avoid intubation where possible
70
List long term goal of NIPPV
Improve sleep duration quality Enhance functional status Prolong survival
71
List the 3 stages of shock
Preshock Frank shock Refractory shock
72
List the types of shock?
Cardiogenic shock Hypovolaemic shock Neurogenic shock Septic shock
73
List the classification of ICU acquired Weakness
Critical illness polyneuropathy (CIP) Critical illness myopathy (CIM) Critical illness neuromyopathy (CINM)
74
Name the problems that critically I'll patients often present with
Increased WOB decreased lung volume and lung compliance Decreased mucociliary clearance and secretion retention Decreased gas exchange Weakness of extremely and resp muscles
75
Complications following OHS
post operative pulmonary complications Cardiovascular instability Sternal complications Stroke Hemorrhage Myocardial ischemia
76
List the risk factors for sternal complications (Pre-screen)
Smoking Diabetes Obesity COPD large chest circumference Females with large breasts
77
List pathophysiological basis of hypoxemia
VQ mismatch Hypoventilation Diffusion limitation
78
List the different types of hypoxaemia
Anaemic hypoxemia Stagnant hypoxemia Histotoxic hypoxemia Hypoxic hypoxemia

PHYSIO 4th yr (3 decks)

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