Surgery L3 - ICU

Question 1

Airway in the ICU: Non-invasive & Invasive - 6

Answer 1

Non-invasive ventilation
1. Nasal cannula
2. Oxygen mask
3. NHF (Nasal High Flow)
4. CPAP
Invasive:
1. Endotracheal tube (tube through mouth into airway)
2. Tracheostomy (incision in neck to insert tube through)

Question 2

Inotropes & Vasopressors - 3

Answer 2

1. Inotrope – increases contractile force
2. Vasopressor – reduces vasodilation
3. Both methods aim to raise blood pressure -> increases perfusion

Question 3

Electrolytes – 3

Answer 3

1. Blood gases reviewed hourly in acute illness; frequency reduces as patient improves
2. Insight into renal function
3. Nurse led e.g. PRN potassium, magnesium & phosphate

Question 3

Renal replacement therapy Indicated for – 5

Answer 3

1. Acidosis
2. Electrolyte imbalance
3. Intoxication (e.g. overdose)
4. Overload (fluid overload)
5. Uraemia (absence of urine)

Question 3

Anticoagulation – 5

Answer 3

1. Clotting can occur during filtration
2. Use either sodium citrate – calcium binds citrate to form a complex that inhibits the clotting cascade
3. Calcium then removed via the filter
4. Heparin IV infusion into the patient
5. Not suitable if active bleeds, ischaemic stroke or low platelets (or other contraindications)

Question 3

Fluid balance - 3

Answer 3

1. Fluid balance is importance = (input vs output)
2. Some medicines e.g. co-trimoxazole and labetalol provide high / excess fluid volumes for patient
3. Managed via RRT / diuretics

Question 3

Sepsis actions – 6

Answer 3

1. Ensure senior clinician presence
2. O2 if required
3. Obtain IV access, take bloods
4. Give IV Abx
5. Give IV fluids
6. Monitor