(A) - ICU

Question 1

What are the different levels of patient care in hospital?

Answer 1

Level 1 patients managed on a general acute ward
Level 2 patients managed on the high dependency unit
Level 3 patients managed on the intensive care unit

Question 2

What type of patients are usually admitted to ICU?

Answer 2

Patients with organ failure
Patients requiring organ support
Patients needing close physiological monitoring

Question 3

What level of care does the ICU provide?

Answer 3

Highest level of care
Advanced organ support
Intensive monitoring

Question 4

Common reasons for admission to intensive care?

Answer 4

Post major surgery such as aortic aneurysm repair
Severe sepsis
Major trauma
Post cardiac arrest
Acute organ failure including respiratory renal or liver failure

Question 5

What two main factors are considered when deciding ICU admission?

Answer 5

Reversibility of the acute illness
Baseline physiological reserve and pre illness health

Question 6

Why may ICU admission be inappropriate for some patients?

Answer 6

Low likelihood of survival
Advanced terminal illness
Burden of invasive treatment outweighs benefit

Question 7

What scoring systems are used to predict mortality in ICU patients?

Answer 7

APACHE score
SAPS score
MPM score

Question 8

Why is nutrition important in critically ill patients?

Answer 8

Patients are hypermetabolic
Nutritional requirements are increased
Malnutrition worsens outcomes

Question 9

What is total parenteral nutrition (TPN)?

Answer 9

Intravenous nutrition providing all nutritional requirements
Used when the GI tract cannot be used

Question 10

Why is TPN given through a central line?

Answer 10

TPN is irritant to veins
High risk of thrombophlebitis if given peripherally

Question 11

What are common complications of ICU admission?

Answer 11

Ventilator associated lung injury
Ventilator associated pneumonia
Catheter related bloodstream infection
Catheter associated urinary tract infection
Stress related mucosal disease
Delirium
Venous thromboembolism
Critical illness myopathy
Critical illness neuropathy

Question 12

What causes ventilator associated lung injury?

Answer 12

Over inflation of alveoli
High airway pressures
Inflammatory lung damage

Question 13

What types of lung injury can mechanical ventilation cause?

Answer 13

Volutrauma from over distension
Barotrauma from pressure changes
Inflammation

Question 14

What are potential long term consequences of ventilator associated lung injury?

Answer 14

Pulmonary fibrosis
Reduced lung function
Recurrent infections
Cor pulmonale

Question 15

How can ventilator associated pneumonia be prevented?

Answer 15

Head of bed elevated to 30 degrees
Good oral hygiene
Regular mouth care

Question 16

How can catheter related bloodstream infections be reduced?

Answer 16

Use impregnated catheters
Remove lines as soon as no longer required

Question 17

How can catheter associated urinary tract infections be reduced?

Answer 17

Avoid unnecessary urinary catheters
Remove catheters early

Question 18

What is stress related mucosal disease?

Answer 18

Erosion of gastric mucosa in critically ill patients
Caused by impaired gastric blood flow

Give PPIs, H2 receptor antagonists, early NG feeding

Question 19

What are trophic feeds?

Answer 19

Small volume enteral feeds
Provide gastrointestinal protection
Not sufficient to meet full nutritional needs

Question 20

Why is delirium common in ICU patients?

Answer 20

Critical illness
Pain
Infection
Hypoxia
Electrolyte imbalance
Medications

Question 21

What tool is used to identify delirium in ICU?

Answer 21

Confusion Assessment Method (CAM)

Question 22

What medication may be used to sedate agitated ICU patients?

Answer 22

Dexmedetomidine

Question 23

What is critical illness myopathy?

Answer 23

Muscle wasting and weakness during critical illness
Affects limb and respiratory muscles

Give corticosteroids
Neuromuscular blocking agents

Question 24

What are the consequences of critical illness myopathy?

Answer 24

Difficulty weaning from ventilation
Long term weakness
Reduced quality of life

Question 25

What is critical illness polyneuropathy?

Answer 25

Degeneration of sensory and motor nerves in ICU patients Often occurs with myopathy

Question 26

What are features of critical illness polyneuropathy?

Answer 26

Symmetrical weakness Reduced reflexes Reduced muscle tone

Question 27

How can the risk of critical illness polyneuropathy be reduced?

Answer 27

Good glycaemic control