Medical HDU

Question 1

airway

Answer 1

intact/risk to airway/adjuncts

Question 2

breathing

Answer 2

RR, sats, FiO2, NIV
examination of chest
recent abg
recent CXR

Question 3

circulation

Answer 3

blood pressure, heart rate
inotropes/vasopressors/antihypertensives
examination - CRT, JVP, oedema, pallor, heart sounds
local ischaemia - arterial lines
peripheral ischaemia - vasopressors
haemoglobin 
ecg

Question 4

renal

Answer 4

fluid input and output
hydration status
urinalysis
U+E, bicarb, calcium, Mg, phosphate

Question 5

GI and nutrition

Answer 5

weight
nutrition intake
risk of refeeding? pabrinex, thiamine
bowels, vomiting, diarrhoea
abdo and liver disease signs
LFT, BG and ketones

Question 6

neurological

Answer 6

GCS/AVPU
pupils
neurological exam
swallow

Question 7

sepsis

Answer 7

lines - time since insertion 
culture
temp
CRP, WBC, lactate
antibiotics?

Question 8

endocrine

Answer 8

diabetic? ketones and insulin

steroids

Question 9

coagulation

Answer 9

platelets

thromboprophylaxis

Question 10

Type 1 resp failure

Answer 10

PaO2 <8kPa and low or normal PaCO2

Question 11

Type 2 resp failure

Answer 11

PaO2 <8kPa and PaCO2 >6kPa

Question 12

acute hypercapnic resp failure

Answer 12

acidotic, high PaCO2

normal bicarbonate

Question 13

chronic hypercapnic respiratory failure

Answer 13

near normal ph, high PCO2

high bicarbonate

Question 14

causes of type 1 resp failure

Answer 14

V/Q mismatch

• pneumonia
• PE
• acute asthma
• pneumothorax/pleural effusion

Question 15

Type 2 resp failure causes

Answer 15

reduced ventilatory drive
- opiates
- COPD
- morbid obesity 
- head injury
reduced chest wall movement
exhaustion

Question 16

oxygen for hypoxic patient

Answer 16

15L reservoir mask

Question 17

target Sa)2

Answer 17

94-98%

hypercapnic resp failure = 88-92%

Question 18

how much oxygen can nasal cannulae provide?

Answer 18

2L/min

Question 19

cautions with NIV

Answer 19

basal skull fractures
CSF leak
undrained pneumothorax

Question 20

2 types of NIV

Answer 20

CPAP and BiPAP

Question 21

explain CPAP

Answer 21

reduces work of inspiratory muscles and overcomes negative intrathoracic pressure to prevent collapse of alveoli

Question 22

indications for CPAP

Answer 22

Type 1 resp failure

Question 23

Indications for BiPAP

Answer 23

Type 2 resp failure

• acute COPD
• pneumonia

Question 24

NIV contraindications

Answer 24

vomiting
recent facial surgery
(bowel obstruction, confusion)

Question 25

assessing NIV response

Answer 25

``` O2 sats, RR, HR, bp abg conscious level chest wall movement accessory muscles use ```

Question 26

what is stroke volume affected by?

Answer 26

preload and afterload

Question 27

preload

Answer 27

according to starlings law increased end diastolic volume increases stretch on myocardial fibres increased contraction and increased SV

Question 28

afterload

Answer 28

systemic vascular resistance | as SVR increases the CO decreases

Question 29

signs of inadequate tissue perfusion

Answer 29

``` oliguria/anuria confusion cold, clammy skin reduced pulse volume increased RR, HR low bp lactic acidaemia prolonged CRT ```

Question 30

4 types of shock

Answer 30

obstructive cardiogenic hypovolaemic distributive

Question 31

causes of obstructive shock

Answer 31

massive PE tamponade tension pneumothorax R ventricular failure

Question 32

cardiogenic shock

Answer 32

MI, arrhythmia, valvular lesion

Question 33

hypovolaemic shock

Answer 33

blood or fluid loss

Question 34

distributive shock

Answer 34

septic, anaphylactic, neurogenic

Question 35

SIRS criteria

Answer 35

2 or more of - HR >90 - Temp <36 or >38 - RR >20 - WCC

Question 36

sepsis definition

Answer 36

SIRS and infection

Question 37

severe sepsis

Answer 37

sepsis and inadequate organ perfusion

Question 38

septic shock

Answer 38

sepsis and hypotension/inadequate organ perfusion despite fluid resus

Question 39

Indications for CVC

Answer 39

``` access for drugs - amiodarone, inotrope poor peripheral access chemotherapy plasma exchange dialysis monitoring and blood sampling ```

Question 40

CI to CVC

Answer 40

coagulopathy haemothorax vessel thrombosis pacemaker ipsilateral side

Question 41

complications of CVC

Answer 41

``` haemorrhage arrhythmia cardiac tamponade thoracic duct injury infection air embolus ```