Gem's Crit Care: Icu

Front 1

#1 early sign associated with death

Back 1

base excess -5 to -8

Front 2

Top 10 early signs associated with risk of death (in order)

Back 2

B.E -5 to -8
Partial airway obstruction
Poor peripheral circulation
more than expected drain loss
pH 7.2-7.3 (acidotic)
PaCO2 high
Decreased U/O
GCS <9-11 or fall by 2 points
Sz
SpO2 <90-95%

Front 3

True or false:
normal O2 sats excludes compromised airway

Back 3

false

Front 4

When assessing 'breathing' in a deteriorating pt, what is a good marker of the severely ill Pt?

Back 4

marked tachypnoea

Front 5

When assessing 'breathing' in a deteriorating pt, what makes you worry (5)

Back 5

1. RR > 30 (or <8)
2. unable to speak 1/2 sentence w/o pausing
3. agitated, confused, comatose
4. cyanosed of SpO2 <90%
5. deteriorating despite therapy

Front 6

What SBP signifies seriously ill?

Back 6

<90

Front 7

If LOC is due to a neurological disease, what do you check frequently?

Back 7

pupils

Front 8

In a deteriorating Pt, the more _________________ activity the Pt has, the more urgent the problem (HR, RR, BP, temp, sweating)

Back 8

sympathetic

(BP decreases when decompensating)

Front 9

Hypotension:
SBP <
DBP<

Back 9

90
60

Front 10

What are the 3 mechanisms by which BP is regulated

Back 10

1. baroreceptor reflex in carotid sinus + aortic arch
2. renin-angiotensin system
3. aldosterone

Front 11

Define anuria

Back 11

<50mL/day

Front 12

In a severely ill patient, what are 3 clinical cues that may indicate pain?

Back 12

lacrimation
diaphoresis
tachycardia

Front 13

MET call:
SBP < _____

Back 13

90

Front 14

MET call:
HR >_____ or < _____

Back 14

140
50

Front 15

MET call:
SpO2 < _______% despite additional O2

Back 15

90

Front 16

MET call:
RR >____ or <_____

Back 16

30
8

Front 17

MET call:
GCS < ____ or acute drop by ___ points

Back 17

12
2

Front 18

MET call:
urine output <____mL/kg/hour

Back 18

0.5

Front 19

Best way to position the patient when having problems with breathing

Back 19

sit up as much as possible

Front 20

What must you check regularly in the comatose patient (at the bedside)?

Back 20

BSL

Front 21

Fluid resus: when do you change from crystalloid to blood?

Back 21

if remain haemodynamically unstable after 2L of crystalloid, or earlier if obvious signs of major bleeding
--> switch to blood

Front 22

What sort of breathing is this:
irregular breaths that alternate with periods of apnoea.
Seen in ____________ lesions.

Back 22

Cluster breathing

pontine

Front 23

What sort of breathing is this:
varying tidal volumes and rates
They can keep their breathing rate more rhythmic if they consciously try.
Where is the abnormality?

Back 23

ataxic breathing

medullary chemoreceptor/medullary respiratory control centre

Front 24

Define oliguria

Back 24

<400mL/urine/day

Front 25

Which non-invasive ventilation would you use for:
asthma

Back 25

CPAP or BiPAP

Front 26

Which non-invasive ventilation would you use for:
COPD

Back 26

BiPAP

Front 27

Which non-invasive ventilation would you use for:
OSA

Back 27

CPAP

Front 28

Which non-invasive ventilation would you use for:
APO

Back 28

CPAP

Front 29

Which non-invasive ventilation would you use for:
neuromuscular disease

Back 29

BiPAP

Front 30

How does positive pressure ventilation reverse acidosis and hypercapnoea?

Back 30

increases alveolar ventilation

Front 31

How does positive pressure ventilation reverse hypoxia?

Back 31

alveolar recruitment and increase FiO2

Front 32

How does positive pressure ventilation improve cardiac fn?

Back 32

decreases LV afterload

Front 33

What are 8 complications of positive pressure ventilation?

Back 33

FACE
1. pressure ulcers on nasal bridge
2. facial/ocular abrasions
3. increased intraocular pressure
4. oronasal dryness

HEAD
5. raised ICP

LUNGS
6. air swallowing --> abdo distention --> vomiting --> ASPIRATION

CARDIO
7. hypotension if hypovolaemic

PSYCH
8. claustrophobia/anxiety/agitiation/impaired communication and nutrition

Front 34

Adverse effects of IV opiates:
RESP (3)

Back 34

1. depression
2. apnoea
3. bronchospasm

Front 35

Adverse effects of IV opiates:
Cardiao (2)

Back 35

1. bradycardia
2. hypotension

Front 36

Adverse effects of IV opiates:
NEURO (5)

Back 36

1. confusion/delirium
2. dys/euphoria
3. sedation
4. cough suppression
5. meiosis

Front 37

Adverse effects of IV opiates:
SKIN (4)

Back 37

1. pruritis
2. flushing
3. sweating
4. urticaria

Front 38

Adverse effects of IV opiates:
GU (1)

Back 38

urinary retention

Front 39

Adverse effects of IV opiates:
MSK (1)

Back 39

myoclonus

Front 40

FiO2 of nasal prongs

Back 40

FiO2 starts at 24% for 1L/min and increases 4% for each L/min up to 44% for 6 Lmin

Front 41

Shock, major trauma, near drowning, status epilepticus
- what O2 therapy do you start them on?

When they're stable, what is your aim for SpO2?

Back 41

high flow O2 15L/min through reservoir mask

when stable, maintain target SpO2 94-98%

Front 42

Asthma attach, pneumonia, lung cancer, P.E, pleural effusion, pneumothorax
- what O2 therapy do you start them on?
- UNLESS SpO2 <___% (and not at risk of hypercapnic resp failure), then you start them on ______________________

Back 42

moderate O2 therapy (only if hypoxic; i.e SpO2 <95%)
Nasal prongs 2-6L/min
or
Hudson mask 5-10L/min

If SpO2 <85%, start on high flow O2 15L/min through reservoir mask

Front 43

Target SpO2 for COPD CO2 retainers

Back 43

88-92%

Front 44

Hypoxic respiratory failure occurs when _______ < or = _____mmHg

Hypercarbic respiratory failure occurs when _______ > or = _____mmHg

Back 44

60

50

Front 45

Which has diurnal variation:
pancreatitis
or
PUD

Back 45

PUD

Front 46

duodenal or gastric ulcer historically relieved by eating?

Back 46

duodenal

Front 47

Dx:
severe abdo pain
PR bleeding
Hx vascular disease, AF

Back 47

mesenteric ischaemia

Front 48

Which 2 things can cause severe abdo pain and haematuria?

Back 48

1. AAA
2. renal colic

=> must always exclude AAA when suspect renal colic

Front 49

NEVER MAKE THE DIAGNOSIS OF
RENAL COLIC IN A PATIENT > 50
WITHOUT FIRST
ASKING YOURSELF
“________ ____________ ____ ______?”

Back 49

COULD THIS BE AAA

Front 50

You suspect AAA:
Haemodynamically Unstable = ______________
Steps in mgmt?

Back 50

rupture

2x widebore IVC
avoid IV fluids unless SBP <80-90
analgaesia
control HTN

SURGERY

Front 51

You suspect AAA:
Haemodynamically stable = ______________
Steps in mgmt?

Back 51

Symptomatic aneurysm

2x widebore IVC
avoid IV fluids unless SBP <80-90
analgaesia
control HTN

CT ABDO
if this is positive for leaking or rupture --> surgery

Front 52

If you suspect a AAA and the Pt is haemodynamically stable, what Ix do you do?

Back 52

CT abdo

(an U/S can confirm or rule out aneurysm, but cannot rue out leakage/imminent rupture)

Front 53

Dx:
severe abdo pain
but on examination, the abdo is non-tender

Back 53

mesenteric ischaemia

Front 54

Acute mesenteric ischaemia is usually due to obstruction of the _____________ ______________ artery

Back 54

superior
mesenteric

Front 55

When mesenteric ischaemia is suspected as a cause of the abdominal symptoms, what Ix do you do?

Back 55

urgent angiogram/CT angiogram

Front 56

Mesenteric ischaemia:
When an angiogram:
- confirms the diagnosis: Rx?
- reveals venous thrombosis or non-occlusive mesenteric ischaemia: Rx?

Back 56

Surgery (vascular reconstruction)

anticoagulants or vasodilators