The critically ill patient from an anaesthetist’s perspective

Question 1

How are patients assessed in ED?

Answer 1

ABCDE:

• A - Airways
  
  • Talking? Unusual noises? Misting oxygen mask? Need support
• B - Breathing
  
  • Resp rate, are they struggling to breathe, sats, symmetrical breathing, sounds on asucultation/percussion?
• C - Circulation
  
  • Pale, sweaty, grey? HR and rhythym? ECG? BP? JVP? Oedema? Mucus membranes/UO? CRT? Peripheral temperature? Filling status?
• D - Disability
  
  • GCS/AVPU
  • Pupils
  • Blood sugar
  • Temp
• E - Exposure
  
  • Cathether
  • Antibiotics
  • Blood
  • Imaging

Question 2

How can the respiratory system be supported by anaethetists and ICU?

Answer 2

• Increase oxygen, FiO2
• Lung protective ventilation
• PEEP
• Advanced ventilation strategies e.g. APRV
• Proning
• Antibiotics
• Good nursing care; physio, suctioning
• ECMO: ‘lung bypass’

Question 3

How can the renal system be supported by anaethetists and ICU?

Answer 3

• Avoid further damage
  
  • Treat infection
  • Good perfusion
  • Avoid nephrotoxins
• Give them time to recover
• Renal replacement therapy (dialysis)

Question 4

How can the cardiovascular system be supported by anaethetists and ICU?

Answer 4

• Potiise coronary artery persusion i.e BP
  
  • TPR: Alpha 1 agonist (Induce vasoconstriction)
  • Preload: Give fluid to increase blood volume
  • Contractility - B1 agonist to increase HR