ICU

Question 1

Communication with staff

Answer 1

• conscious state
• tolerance of procedures
• stability
• movement orders
• changes in ventilation
• changes in medical management
• analgesia
• when is it convenient for me to see the patient

Question 2

Neurological tests

Answer 2

• GCS
• sedation score (RASS)
• pupil size and reactivity
• +/- intracranial pressure
• +/- cerebral perfusion pressure

Question 3

Arterial line (IAL) precautions

Answer 3

• do not bend joint with IAL
• do not dislodge

Question 4

Central line

Answer 4

• into major central vien
• measures fluid balance, venous return
• reflects R atrial pressure
• instant access for medications
• **response to fluid loading and trend important, not actual figure

Question 5

Central line precautions

Answer 5

• pneumothorax may occur after insertion (CXR)
• atrial arrhythmias may occur in side-lying
• don’t percuss over line
• if CVP <5cm H2O may not tolerate MHI or mobilisation
• if disconnected –> patient head down

Question 6

Advanced haemodynamic monitoring

Answer 6

• when become unstable
  
  • septic shock
  • extensive fluid loading
  • cardiogenic shock
  • pulmonary hypertension
  • at risk cardiac surgery
• pulmonary artery catheter
• PiCCO
• Vigilco
• LidCo

Question 7

Indications for MHI

Answer 7

• secretion removal
• prevent/reverse atelectasis
• improve compliance
• hyperoxygenation prior to suction (rare)

Question 8

MHI complications

Answer 8

• pneumothorax
• barotrauma, volutrauma
• desaturation
• decreased venous return
• decreased cardiac output

Question 9

MHI Contraindications

Answer 9

• pulmonary oedema
• severe haemoptysis
• undrained pneumothorax
• nitric oxide
• severe bronchospasm
• acute septic shock
• low BP

Question 10

MHI Precautions

Answer 10

• bullae (use manometer)
• PEEP ≥10 (use VHI)
• FiO2 ≥0.7 (use VHI)
• low lung compliance

Question 11

ARDS

Answer 11

• inflammation and increased permeability of the lungs
• 2/3 alveoli shut down due to fluid

Question 12

ARDSip

Answer 12

• intrapulmonary
• direct
• eg. pneumonia
• = consolidation

Question 13

ARDSexp

Answer 13

• extrapulmonary
• indirect
• eg. head injury, burns, fracture
• = atelectasis

Question 14

Management of ARDS

Answer 14

• baby lung concept
• limit volumes and pressure
• do not disconnect if on high PEEP

Question 15

PT treatment of ARDS

Answer 15

• do not disconnect ventilation
• do not MHI
• prevent secretion retention
  
  • positioning in prone –> 10h
  • P&V
  • closed suction

Question 16

Systemic inflammatory response sysndrome (SIRS)

Answer 16

• response to release of endotoxins
• increased HR, RR
• abnormal temp
• abnormal WCC

Question 17

Sepsis

Answer 17

• life-threatening organ dydfunction due to a dysregulated host response to infection

Question 18

Septic shock

Answer 18

persistant hypotension

lactate ≥2mmol/L

Question 19

qSOFA

Answer 19

High risk of deterioration if 2+ criteria present

1. resp rate ≥22
2. altered mental status (GCS <13)
3. systolic ≤100mmHg

Question 20

PT Management of Sepsis

Answer 20

• positioning
• P&V
• no MHI, VHI
• early passive movement or ES

Question 21

PT implications of Acute Head Injury

Answer 21

• intubated, ventilated, sedated, paralysed
• short, frequent Rx (MHI, suction)
• keep SAP, MAP stable
• head in midline, 30˚ up
• normal sized breaths with MHI

Question 22

ICU aquired weakness

Answer 22

• often LL>UL
• proximal > distal
• associated with use of neuromuscular blockers
• delays ventilator weaning
• increased ICU/hospital stay
• no specific treatment