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Medicine > ITU > Flashcards

ITU Flashcards

1
Q

What is a MEWS score? (2)

A

Modified Early Warning Score

Score >4 indicates patients who should be given immediate priority and considered for HDU or ITU care.

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2
Q

What factros are taken into a MEWS score calculation? (4)

A 
RR
HR
Systolic BP
Urine output
Temp
Neurological status
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3
Q

Define shock. (2)

A

Acute circulatory failure with inadequate or inaapropriately distributed tissue perfusion resulting in reduced oxygen delivery to the tissues.

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4
Q

name 3 types of shock. (3)

A 
Cardiogenic
Anaphylactic
Septic
Hypovolaemic
Mechanical
Neurogenic
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5
Q

What is the pathophysiology of anaphylaxis? (3)

A

Massive release of mediators from mast cells and basophils
Induced by IgE with trigger antigens
Causes increased vascular permeability, vasodilatation and respiratory smooth muscle contraction.

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6
Q

What is the management of anaphylactic shock? (4)

A

Remove cause
Oxygen- high flow
Adrenaline: 500mcg IM, repeat after 5 mins
Fluids: 500-1000ml 0.9% saline IV
Chlorphenamine: 10mg IV or IM
Hydrocortisone: 200mg IV or IM
Admit for observation for 6-8 hours in case of second late reaction
Prevention of further attacks: identify trigger, carry epipen, medic alert bracelet

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7
Q

Describe the clinical features associated with hypovolaemic shock. (3)

A

Increased sympathetic tone

  • tachycardia
  • sweating
  • peripheral vasconstriction
  • cold clammy skin
  • slow capillary refill

Later: hypotension, oliguria, tachypnoea, confusion and restlessness.

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8
Q

What are the clinical features of anaphylactic shock? (2)

A 
Onset of symptoms within 5-60 minutes of antigen exposure.
Profound vasodilatation (warm peripheries and hypotension)
urticaria, wheezing, stridor (laryngeal oedema)
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9
Q

What are the clinical features of mechanical shock? (3)

A

Cardiac tamponade: Muffled heart sounds, pulsus paradoxicus (pulse fades on inspiration), elevated JVP, Kussmaul’s sign (JVP increases on inspirarion)
Massive PE: Signs of right heart strain, rasied JVP with prominent a waves, RV heave and a loud pulmonary second sound.

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10
Q

Name 2 causes of SIRS. (2)

A

Systemic inflammatory response syndrome can be caused by severe burns, trauma, and acute pancreatitis

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11
Q

Define sepsis. (2)

A 
Systemic inflammatory response syndrome associated with infection.
Two or more of;
 - Temperature of >38' or 90bpm
 - Tachypnoea RR>20
 - WCC >12 or <4
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12
Q

Define SIRS. (4)

A

Two or more of;

  • Temperature of >38’ or 90bpm
  • Tachypnoea RR>20
  • WCC >12 or <4
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13
Q

What is severe sepsis? (2)

A

Sepsis with dysfunction of one or more organs.

Kidneys, Coagulation, Respiration, Liver.

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14
Q

What is septic shock? (2)

A

Persisting tissue hypoperfusion after a fluid challenge

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15
Q

What is the basis of treatment for sepsis? (6)

A 
Give high flow oxygen
Give IV fluids
Give empirical antibiotics
Take blood cultures
Monitor lactate
Monitor urine output
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16
Q

Name 2 invasive methods of measuring blood pressure. (2)

A

Intra-arterial cannula: usually in the radial artery
Central venous pressure: cannula into SVC or RA.
Pulmonary artery catheters

17
Q

What are the two types of respiratory failure? (2)

What would the results from ABG show? (2)

A

Type 1: PaO2 <8kpa and PaCO2 high, caused by alveolar hypoventilation.

18
Q

name 4 causes of type 1 respiratory failure. (4)

A
  • Pulmonary oedema
  • Pneumonia
  • Pneumothorax
  • PE
  • COPD
  • Fibrosis
  • ARDS
  • Acute severe asthma
  • Right to left cardiac shunts
19
Q

Name 3 causes of Type 2 respiratory failure. (3)

A
  • COPD
  • Life threatening severe asthma
  • Respiratory muscle weakness eg GBS
  • respiratory centre depression eg opioids
  • Sleep apnoea
  • Chest wall deformities
  • Inhaled foreign body
20
Q

Name 3 areas of management to be considered in a patient with respiratory failure. (3)

A

Hypoxia/hypercapnia: give supplemental oxygen
Control secretions
Treatment of infection
Control of airway obstruction
Limitation of pulmonary oedema
Control of electrolyte imbalances that can cause respiratory muscle weakness eg hypokalaemia, hypophosphataemia, undernutrition.

21
Q

What form of non invasive ventilation should be used in a patient with type 1 respiratory failure? (1)

A

Continuous positive airways pressure

22
Q

Which form of non-invasive ventilation is used primarily for patients with an acute exacerbation of COPD? (1)

A

Bilevel Positive airways pressure

Used in persistent decompensated respiratory acidosis

23
Q

What is IPPV? (1)

A

Intermittent Positive pressure ventilation requires tracheal intubation and therefore anaesthesia.

24
Q

Name 2 indications for IPPV. (2)

A

Intermittent positive pressure ventilation is indicated in;

  • acute respiratory failure
  • acute ventilatory failure eg myasthenia gravis
  • Guillain-Barre syndrome
  • Prophylactic postoperative patients
  • Head injury
  • Trauma
  • Severe LV failure
  • Coma with breathing difficulties
25
Q

Name 2 major complications of intubation and assisted ventilation. (2)

A

Trauma to the upper respiratory tract due to ET tube
Secondary pulmonary infection
Barotrauma - overdistention of the lungs and alveolar rupture may present as tension pneumothorax
Reduction in cardiac output - increased intra-throacic pressure during ventilation impairs cardiac filling
Abdominal distension caused by intestinal ileus
Increased ADH and reduced ANP secretion - causes salt adn water retention.

26
Q

What are acute lung injury and acute respiratory distress syndrome? (3)

A

respiratory distress occurring with stiff lungs, diffuse bilateral pulmonary infiltrates, refractory hypoxaemia, in the presence of a recognised preceipitating cause and in the absence of cardiogenic pulmonary oedema.

27
Q

name 2 causes of ARDS or ALI. (2)

A 
Sepsis
Pancreatitis
Trauma
Burns
Fat or amniotic fluid embolism
Aspiration pneumonia
Cardiopulmonary bypass
28
Q

describe the pathophysiology of ARDS. (3)

A

Pulmonary oedema
caused by increased vascular permeability
caused by the release of inflammatory mediators.
Haemorrhagic intra-alveolar exudate forms
which is rich in platelets, fibrin and clotting factors.
Changes may result in progressive pulmonary fibrosis.

Medicine (14 decks)

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