暗記メーカー

暗記メーカー

​

CCM

CCM
77問 • 2年前
  • Monica Ramos
    • 通報

    問題一覧

  • 1

    RT that works in this area maintains advanced skill to provide the highest quality of care to most critically ill patients.

    ICU TEAM

  • 2

    "a service for patients with potentially recoverable conditions who can benefit from more detailed observation and invasive treatment than can safely be provided in general wards or high dependency areas."

    intensive care

  • 3

    intensive care is usually reserved for patients with ______ or established ______.

    potential or established organ failure

  • 4

    the most commonly supported organ is the

    lungs

  • 5

    the most commonly supported organ is the lungs but facilities should also exist for the_____,_____,&_____ of other organ dysfunction

    diagnosis prevention and treatment

  • 6

    five services that we provide:

    ventilator management blood gas bronchoscopy assistance specialized class administration ( nitric oxide or heliox therapy) hemodynamic monitoring

  • 7

    who are the patient to admit

    1. Patients who have or who will be needing ventilatory support 2. Patients requiring support of 2 or more organ systems 3. Patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.

  • 8

    what are the categories of organ system monitoring and support

    advanced respiratory support basic respiratory monitoring and support circulatory support neurological monitoring and support renal support

  • 9

    Mechanical ventilatory support (excluding mask CPAP or non-invasive (eg, mask) ventilation)

    advanced respiratory support

  • 10

    Possibility of a sudden, precipitous deterioration in respiratory function requiring immediate endotracheal intubation and mechanical ventilation

    advanced respiratory support

  • 11

    Need for more than 50% oxygen

    Basic respiratory monitoring and support

  • 12

    Possibility of progressive deterioration to needing advanced respiratory support

    Basic respiratory monitoring and support

  • 13

    Need for physiotherapy to clear secretions at least two hourly

    Basic respiratory monitoring and support

  • 14

    Patients recently extubated after prolonged intubation and mechanical ventilation

    Basic respiratory monitoring and support

  • 15

    Need for mask CPAP or noninvasive ventilation

    Basic respiratory monitoring and support

  • 16

    Patients who are intubated to protect the airway but require no ventilatory support and who are otherwise stable

    Basic respiratory monitoring and support

  • 17

    Need for vasoactive drugs to support arterial pressure or cardiac output

    circulatory support

  • 18

    Support for circulatory instability due to hypovolemia from any cause which is unresponsive to modest volume replacement (including post-surgical or gastrointestinal hemorrhage or hemorrhage related to a coagulopathy)

    circulatory support

  • 19

    Patients resuscitated after cardiac arrest where intensive or high dependency care is considered clinically appropriate

    circulatory support

  • 20

    Intra-aortic balloon pumping

    circulatory support

  • 21

    CNS depression, from whatever cause, sufficient to prejudice the airway and protective reflexes

    neurological monitoring and support

  • 22

    Invasive neurological monitoring

    neurological monitoring and support

  • 23

    Need for acute renal replacement therapy (hemodialysis, hemofiltration, or hemodiafiltration)

    renal support

  • 24

    _____&_______focuses on resuscitating unstable patients and allowing time for recovery or the effect of specific therapies toimprove outcomes and prevent death. We use this in the broad sense of care provided to all critically ill patients.

    Emergency and critical care

  • 25

    _________&_________ is therefore for those who are critically ill at arrival, or who were stable and subsequently deteriorated, and can be provided anywhere in the hospital: 1. 2 3 4 5

    Emergency and critical care 1. in the emergency department, 2. the intensive care unit (ICU), 3. general wards, 4. post-operative recovery units, and 5. high-dependency units

  • 26

    what are the FACTORS TO BE CONSIDERED WHEN ASSESSING SUITABILITY FOR ADMISSION TO INTENSIVE CARE

    - Diagnosis - Availability of sustainable treatment - Severity of illness - Response to treatment to date - Age - Recent cardiopulmonary arrest - Coexisting disease - Anticipated quality of life - Physiological reserve - Prognosis - The patient's wishes

  • 27

    when to admit? Patients should be admitted to ICU before their _________...

    condition reaches a point from which recovery is impossible.

  • 28

    Improves the chances of recovery Reduces the potential for organ dysfunction (extent and number) May reduce length of stay in ICU (and cost)

    EARLY REFERRAL

  • 29

    CLEAR CRITERIA MAY HELP TO IDENTIFY THOSE AT RISK AND TO TRIGGER A CALL FOR HELP FROM INTENSIVE CARE STAFF 1-11

    ● Threatened airway ● All respiratory arrests ● RR>40bpm or <8bpm ● Oxygen saturation of <90% on >50% oxygen ● All cardiac arrests ● Pulse rate >140 beats/m or <40 bpm ● Systolic blood pressure 90mmHg ● Sudden fall in level of consciousness (Glasgow coma.scale ● Repeated or prolonged seizures ● Rising arterial CO2 tension with respiratory acidosis ● ny patient giving cause for concern

  • 30

    _________,_________ and __________ or ______________ and _______which can result in a failure to identify critical illness and an under prioritization of emergency and critical care.

    DILEMMAS IN CRITICAL CARE Low staffing levels, lack of equipment, and limited knowledge or awareness of emergency and critical care

  • 31

    ___________ and ______for either the identification of critical illness, or for the provision of emergency and critical care

    DILEMMAS IN CRITICAL CARE lack of commonly agreed definitions and criteria

  • 32

    emergency and critical care can be conflated with technologically advanced and expensive care on ICUs

    DILEMMAS IN CRITICAL CARE

  • 33

    in RESPIRATORY SUPPORT Critically ill patients should receive supplementary oxygen at sufficient concentration to maintain arterial oxygen tension of ______ or oxygen saturation of at least _____.

    arterial oxygen tension of >8kPa oxygen saturation of at least 90%.

  • 34

    in RESPIRATORY SUPPORT In patients with _________________ (type II respiratory failure) oxygen will correct the hypoxaemia but not the hypercapnia.

    depressed ventilation

  • 35

    A few patients with severe chronic lung disease are dependent on hypoxic respiratory drive, and oxygen may depress ventilation

    under respiratory support

  • 36

    3 ASSESSMENT FOR THE NEED FOR MECHANICAL VENTILATION

    1. ABG of Patient- Respiratory Acidosis 2.Type I and II ventilatory failure 3. Degree of respiratory work

  • 37

    what time of respiratory failure accur In Oxygenation-Hypoxemia ● Oxygen (low flow); high flow (HFNC) ● CPAP-Spontaneous breath + PEEP-Positive end expiratory pressure ● Atelectatic(collapsed lung)

    type 1 respiratory failure

  • 38

    what type of respiratory failure is Ventilation-Hypercapnia ● Non Invasive-BIPAP ○ IPAP-VENTILATION ○ EPAP-OXYGENATION ● Invasive-Intubate

    type 2 respiratory failure

  • 39

    Adequacy of circulation: patient with established or threatened __________ as well as _________ should be ventilated early in order to gain control of at least one major determinant of tissue oxygen delivery

    circulatory failure respiratory failure

  • 40

    4 INITIATION OF MECHANICAL VENTILATION

    1. Acute ventilatory failure 2. impending ventilatory failure 3. severe hypoxemia 4. prophylactic ventilatory support

  • 41

    ● PRIMARY INDICATION for mechanical ventilation. ● defined ph <7.30 and PaCO2 >50mmHg (higher in COPD patient) ● apnea or bradypnea

    acute ventilatory failure

  • 42

    ● occurs when a patient can maintain ONLY marginally NORMAL BLOOD GASES, BUT only at the expense of a significantly increased work of breathing. ● Increase breathing → Normal blood gas→ Muscle fatigue → Ventilatory failure increase PCO2 → acidosis

    IMPENDING VENTILATORY FAILURE

  • 43

    Spontaneous breathing __bpm and MV __ L/min

    >30 bpm >10 l/min

  • 44

    PaO2 <60mmHg on 50% or more of oxygen or <40mmHg at any FIO2. ● ALI, ARDS, Pulmonary edema, and Carbon monoxide poisoning

    severe hypoxemia

  • 45

    Hypoxemia can be assessed by measuring the ______ or _______

    PaO2, or A-a gradient [P(A-a)O2].

  • 46

    normal P(A-a02) at 21% should be _______ for every 10 years

    <4mmHg

  • 47

    is provided in clinical conditions in which the risk of pulmonary compilations, ventilatory failure or oxygenation failure is high.

    PROPHYLACTIC VENTILATORY SUPPORT

  • 48

    in ____________can can reduce work of breathing and oxygen consumption and thus preserve and rest the cardiopulmonary system and promote patient recovery.

    prophylactic ventilatory support

  • 49

    is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery,

    PROPHYLACTIC VENTILATORY SUPPORT

  • 50

    ______is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes

    shock

  • 51

    shock is defined as a state of cellular and tissue hypoxia due to either

    reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes

  • 52

    It is a life-threatening condition that occurs when the body is not getting enough blood flow.

    shock

  • 53

    __________ means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result.

    Lack of blood flow

  • 54

    _____ requires immediate treatment and can get worse very rapidly. As many as 1 in 5 people in shock will die from it.

    Shock

  • 55

    TYPES OF SHOCK

    ● Hypovolemic ● Cardiogenic ● Neurogenic ● Inflammatory (septic) ● Obstructive ● Traumatic anaphylactic shock

  • 56

    what shock is due to heart problems

    cardiogenic shock

  • 57

    what shock caused by two little blood volume

    hypovolemic shock

  • 58

    what shock caused by an allergic reaction

    anaphylactic shock

  • 59

    it occurs when rapid loss of fluids results in inadequate intravascular volume and subsequent inadequate perfusion.

    HYPOVOLEMIC SHOCK

  • 60

    what shock ● Diminished mean arterial pressure (MAP) and tissue perfusion as a result of loss of vasomotor tone to peripheral vascular beds ● Loss of vasoconstrictor impulses results in increased vascular capacitance, decreased venous return, and decreased cardiac output

    NEUROGENIC SHOCK

  • 61

    failure of the circulatory pump leading to diminished forward flow and subsequent tissue hypoxia

    CARDIOGENIC SHOCK

  • 62

    ________ occurs in response to an inciting agent, which causes both pro-inflammatory and anti-inflammatory immune system activation.

    Septic shock

  • 63

    ● Mechanical or anatomical obstruction impeding venous return to the heart or preventing cardiac filling ○ Decrease CO ○ Decreased peripheral perfusion

    OBSTRUCTIVE SHOCK

  • 64

    what shock combination of several insults after injury that, alone, may be insufficient to induce shock, but produce profound hypoperfusion when combined

    TRAUMATIC SHOCK

  • 65

    SIGNS SUGGESTIVE OF FAILING TISSUE PERFUSION:

    ● Tachycardia ● Confusion or diminished conscious level ● Poor peripheral perfusion (cool, cyanosed extremities, poor capillary refill, poor peripheral pulses) ● Poor urine output (<0.5ml/kg/h) ● Metabolic acidosis ● Increased blood lactate concentration

  • 66

    CAUSES OF SHOCK

    Severe bleeding Severe allergic reactions Severe burns Dehydration Heart failure Electrocution Heart attack Serious infections Head or spinal injuries

  • 67

    SIGNS AND SYMPTOMS OF SHOCK

    in compensatory shock in decompensatory shock in irreversible shock

  • 68

    WHAT SIGN AND SYMPTOMS IS: anxiety, restlessness, fear increased breathing and heart rate

    in compensatory shock

  • 69

    WHAT SIGN AND SYMPTOMS IS: ● mental status continues to deteriorate ● breathing becomes rapid and shallow, and heartbeat rapid ● skin becomes pale or ashen and cool ● nausea and thirst occur

    in decompensatory shock

  • 70

    WHAT SIGN AND SYMPTOMS IS: victim becomes unresponsive respiratory and cardiac arrest

    irreversible shock

  • 71

    RESPIRATORY MANAGEMENT OF SHOCK MANAGEMENT ● All patients with shock should receive __________ ● _____________- in cases of severe hemodynamic disturbance manifested as shock or severe hypoxemia.

    supplemental oxygen Invasive mechanical ventilation

  • 72

    Neurological failure may occur after 1-6

    head injury, poisoning, cerebral vascular accident, infections of the nervous system (meningitis or encephalitis), cardiac arrest, or as a feature of metabolic encephalopathy (such as liver failure).

  • 73

    The sequelae of neurological impairment may lead to the patient requiring intensive care. For instance, loss of consciousness may lead to ________,________&_________ that requires intubation or tracheostomy and mechanical ventilation.

    obstruction of airways, loss of protective airway reflexes, and disordered ventilation

  • 74

    neurologics support patient who need patent anesthetic drugs such as: 1. 2. to treat seizures that are resistant to conventional anti convulsant or monitoring the intracranial pressure and cerebral perfusion pressure must referred to a 1. 2.

    thiopentone or propofol high dependency or intensive care unit.

  • 75

    Patients with neuromuscular disease (for example, Guillain-Barré syndrome, myasthenia gravis) may____________________________ require because of respiratory failure, loss of airway reflexes, or aspiration.

    admission to intensive care for intubation or ventilation

  • 76

    __________- is a common complication of acute illness or trauma and the need for renal replacement therapy (________,_______ or ______) may be a factor when considering referral to intensive or high dependency care.

    Renal failure haemofiltration, haemodialysis, or their variant

  • 77

    renal support In ill patients hourly recording of urine output on the ward may give an early indication of a developing renal problem; prompt treatment, including aggressive circulatory resuscitation, may prevent this from progressing to established renal failure.

    .

    • community-acquired acute pneumonia

    community-acquired acute pneumonia

    Monica Ramos · 21問 · 3年前

    community-acquired acute pneumonia

    community-acquired acute pneumonia

    21問 • 3年前
    Monica Ramos

    a review on respiratory infection

    a review on respiratory infection

    Monica Ramos · 18問 · 3年前

    a review on respiratory infection

    a review on respiratory infection

    18問 • 3年前
    Monica Ramos

    suctioning color

    suctioning color

    Monica Ramos · 11問 · 2年前

    suctioning color

    suctioning color

    11問 • 2年前
    Monica Ramos

    gas oxygen color

    gas oxygen color

    Monica Ramos · 11問 · 1年前

    gas oxygen color

    gas oxygen color

    11問 • 1年前
    Monica Ramos

    aerosol delivery devices

    aerosol delivery devices

    Monica Ramos · 42問 · 1年前

    aerosol delivery devices

    aerosol delivery devices

    42問 • 1年前
    Monica Ramos

    lung sounds

    lung sounds

    Monica Ramos · 35問 · 1年前

    lung sounds

    lung sounds

    35問 • 1年前
    Monica Ramos

    hypoxemic respiratory failure

    hypoxemic respiratory failure

    Monica Ramos · 32問 · 1年前

    hypoxemic respiratory failure

    hypoxemic respiratory failure

    32問 • 1年前
    Monica Ramos

    respiratory failure

    respiratory failure

    Monica Ramos · 19問 · 1年前

    respiratory failure

    respiratory failure

    19問 • 1年前
    Monica Ramos

    ARDS AND ARF

    ARDS AND ARF

    Monica Ramos · 33問 · 1年前

    ARDS AND ARF

    ARDS AND ARF

    33問 • 1年前
    Monica Ramos

    percussion and vibration

    percussion and vibration

    Monica Ramos · 21問 · 1年前

    percussion and vibration

    percussion and vibration

    21問 • 1年前
    Monica Ramos

    characteristics of MV

    characteristics of MV

    Monica Ramos · 17問 · 2年前

    characteristics of MV

    characteristics of MV

    17問 • 2年前
    Monica Ramos

    ppv

    ppv

    Monica Ramos · 37問 · 2年前

    ppv

    ppv

    37問 • 2年前
    Monica Ramos

    How mechvent work

    How mechvent work

    Monica Ramos · 17問 · 2年前

    How mechvent work

    How mechvent work

    17問 • 2年前
    Monica Ramos

    mechvent

    mechvent

    Monica Ramos · 21問 · 2年前

    mechvent

    mechvent

    21問 • 2年前
    Monica Ramos

    vital signs

    vital signs

    Monica Ramos · 39問 · 2年前

    vital signs

    vital signs

    39問 • 2年前
    Monica Ramos

    GCS

    GCS

    Monica Ramos · 30問 · 2年前

    GCS

    GCS

    30問 • 2年前
    Monica Ramos

    bedside assessment

    bedside assessment

    Monica Ramos · 70問 · 2年前

    bedside assessment

    bedside assessment

    70問 • 2年前
    Monica Ramos

    radiographic evaluation

    radiographic evaluation

    Monica Ramos · 59問 · 2年前

    radiographic evaluation

    radiographic evaluation

    59問 • 2年前
    Monica Ramos

    gross motor

    gross motor

    Monica Ramos · 10問 · 2年前

    gross motor

    gross motor

    10問 • 2年前
    Monica Ramos

    fine motor

    fine motor

    Monica Ramos · 14問 · 2年前

    fine motor

    fine motor

    14問 • 2年前
    Monica Ramos

    receptive language

    receptive language

    Monica Ramos · 11問 · 2年前

    receptive language

    receptive language

    11問 • 2年前
    Monica Ramos

    expressive language

    expressive language

    Monica Ramos · 11問 · 2年前

    expressive language

    expressive language

    11問 • 2年前
    Monica Ramos

    cognitive development

    cognitive development

    Monica Ramos · 9問 · 2年前

    cognitive development

    cognitive development

    9問 • 2年前
    Monica Ramos

    personal development

    personal development

    Monica Ramos · 8問 · 2年前

    personal development

    personal development

    8問 • 2年前
    Monica Ramos

    social development

    social development

    Monica Ramos · 10問 · 2年前

    social development

    social development

    10問 • 2年前
    Monica Ramos

    growth and development

    growth and development

    Monica Ramos · 41問 · 2年前

    growth and development

    growth and development

    41問 • 2年前
    Monica Ramos

    fetal growth and development

    fetal growth and development

    Monica Ramos · 100問 · 2年前

    fetal growth and development

    fetal growth and development

    100問 • 2年前
    Monica Ramos

    fetal growth and development 2

    fetal growth and development 2

    Monica Ramos · 14問 · 2年前

    fetal growth and development 2

    fetal growth and development 2

    14問 • 2年前
    Monica Ramos

    biostatistics

    biostatistics

    Monica Ramos · 38問 · 3年前

    biostatistics

    biostatistics

    38問 • 3年前
    Monica Ramos

    biostatistics 2

    biostatistics 2

    Monica Ramos · 45問 · 3年前

    biostatistics 2

    biostatistics 2

    45問 • 3年前
    Monica Ramos

    biostatistics 3

    biostatistics 3

    Monica Ramos · 11問 · 3年前

    biostatistics 3

    biostatistics 3

    11問 • 3年前
    Monica Ramos

    patient assessment

    patient assessment

    Monica Ramos · 36問 · 3年前

    patient assessment

    patient assessment

    36問 • 3年前
    Monica Ramos

    ANAPHY OF RESPIRATORY SYSTEM

    ANAPHY OF RESPIRATORY SYSTEM

    Monica Ramos · 86問 · 3年前

    ANAPHY OF RESPIRATORY SYSTEM

    ANAPHY OF RESPIRATORY SYSTEM

    86問 • 3年前
    Monica Ramos

    cardiovascular examination

    cardiovascular examination

    Monica Ramos · 60問 · 3年前

    cardiovascular examination

    cardiovascular examination

    60問 • 3年前
    Monica Ramos

    physical examination of cardio

    physical examination of cardio

    Monica Ramos · 45問 · 3年前

    physical examination of cardio

    physical examination of cardio

    45問 • 3年前
    Monica Ramos

    respiratory assessment

    respiratory assessment

    Monica Ramos · 74問 · 3年前

    respiratory assessment

    respiratory assessment

    74問 • 3年前
    Monica Ramos

    action potential

    action potential

    Monica Ramos · 69問 · 2年前

    action potential

    action potential

    69問 • 2年前
    Monica Ramos

    the membrane potential

    the membrane potential

    Monica Ramos · 5問 · 2年前

    the membrane potential

    the membrane potential

    5問 • 2年前
    Monica Ramos

    ELECTROCARDIOGRAM

    ELECTROCARDIOGRAM

    Monica Ramos · 42問 · 2年前

    ELECTROCARDIOGRAM

    ELECTROCARDIOGRAM

    42問 • 2年前
    Monica Ramos

    ELECTROCARDIOGRAM 2

    ELECTROCARDIOGRAM 2

    Monica Ramos · 76問 · 2年前

    ELECTROCARDIOGRAM 2

    ELECTROCARDIOGRAM 2

    76問 • 2年前
    Monica Ramos

    cranial nerve

    cranial nerve

    Monica Ramos · 42問 · 2年前

    cranial nerve

    cranial nerve

    42問 • 2年前
    Monica Ramos

    pns/cns

    pns/cns

    Monica Ramos · 99問 · 2年前

    pns/cns

    pns/cns

    99問 • 2年前
    Monica Ramos

    communication between neurons

    communication between neurons

    Monica Ramos · 45問 · 2年前

    communication between neurons

    communication between neurons

    45問 • 2年前
    Monica Ramos

    communication between neuron 2

    communication between neuron 2

    Monica Ramos · 25問 · 2年前

    communication between neuron 2

    communication between neuron 2

    25問 • 2年前
    Monica Ramos

    data presentation

    data presentation

    Monica Ramos · 7問 · 2年前

    data presentation

    data presentation

    7問 • 2年前
    Monica Ramos

    estimation

    estimation

    Monica Ramos · 5問 · 2年前

    estimation

    estimation

    5問 • 2年前
    Monica Ramos

    counting

    counting

    Monica Ramos · 10問 · 2年前

    counting

    counting

    10問 • 2年前
    Monica Ramos

    normal distribution

    normal distribution

    Monica Ramos · 5問 · 2年前

    normal distribution

    normal distribution

    5問 • 2年前
    Monica Ramos

    hypothesis testing

    hypothesis testing

    Monica Ramos · 15問 · 2年前

    hypothesis testing

    hypothesis testing

    15問 • 2年前
    Monica Ramos

    ventilation and Gas exchange

    ventilation and Gas exchange

    Monica Ramos · 58問 · 2年前

    ventilation and Gas exchange

    ventilation and Gas exchange

    58問 • 2年前
    Monica Ramos

    physiology of Respiration

    physiology of Respiration

    Monica Ramos · 40問 · 2年前

    physiology of Respiration

    physiology of Respiration

    40問 • 2年前
    Monica Ramos

    cardiopulmonary rehabilitation

    cardiopulmonary rehabilitation

    Monica Ramos · 100問 · 2年前

    cardiopulmonary rehabilitation

    cardiopulmonary rehabilitation

    100問 • 2年前
    Monica Ramos

    covid 19 pneumonia

    covid 19 pneumonia

    Monica Ramos · 29問 · 2年前

    covid 19 pneumonia

    covid 19 pneumonia

    29問 • 2年前
    Monica Ramos

    pft

    pft

    Monica Ramos · 33問 · 2年前

    pft

    pft

    33問 • 2年前
    Monica Ramos

    long volume and ventilation tests

    long volume and ventilation tests

    Monica Ramos · 12問 · 2年前

    long volume and ventilation tests

    long volume and ventilation tests

    12問 • 2年前
    Monica Ramos

    diffusing capacity test

    diffusing capacity test

    Monica Ramos · 5問 · 2年前

    diffusing capacity test

    diffusing capacity test

    5問 • 2年前
    Monica Ramos

    assessment of hypoxemia and hypoxia and the effect of oxygen therapy

    assessment of hypoxemia and hypoxia and the effect of oxygen therapy

    Monica Ramos · 22問 · 2年前

    assessment of hypoxemia and hypoxia and the effect of oxygen therapy

    assessment of hypoxemia and hypoxia and the effect of oxygen therapy

    22問 • 2年前
    Monica Ramos

    pre and post quiz

    pre and post quiz

    Monica Ramos · 71問 · 2年前

    pre and post quiz

    pre and post quiz

    71問 • 2年前
    Monica Ramos

    quiz bee

    quiz bee

    Monica Ramos · 33問 · 1年前

    quiz bee

    quiz bee

    33問 • 1年前
    Monica Ramos

    問題一覧

  • 1

    RT that works in this area maintains advanced skill to provide the highest quality of care to most critically ill patients.

    ICU TEAM

  • 2

    "a service for patients with potentially recoverable conditions who can benefit from more detailed observation and invasive treatment than can safely be provided in general wards or high dependency areas."

    intensive care

  • 3

    intensive care is usually reserved for patients with ______ or established ______.

    potential or established organ failure

  • 4

    the most commonly supported organ is the

    lungs

  • 5

    the most commonly supported organ is the lungs but facilities should also exist for the_____,_____,&_____ of other organ dysfunction

    diagnosis prevention and treatment

  • 6

    five services that we provide:

    ventilator management blood gas bronchoscopy assistance specialized class administration ( nitric oxide or heliox therapy) hemodynamic monitoring

  • 7

    who are the patient to admit

    1. Patients who have or who will be needing ventilatory support 2. Patients requiring support of 2 or more organ systems 3. Patients with chronic impairment of one or more organ systems who also require support for an acute reversible failure of another organ.

  • 8

    what are the categories of organ system monitoring and support

    advanced respiratory support basic respiratory monitoring and support circulatory support neurological monitoring and support renal support

  • 9

    Mechanical ventilatory support (excluding mask CPAP or non-invasive (eg, mask) ventilation)

    advanced respiratory support

  • 10

    Possibility of a sudden, precipitous deterioration in respiratory function requiring immediate endotracheal intubation and mechanical ventilation

    advanced respiratory support

  • 11

    Need for more than 50% oxygen

    Basic respiratory monitoring and support

  • 12

    Possibility of progressive deterioration to needing advanced respiratory support

    Basic respiratory monitoring and support

  • 13

    Need for physiotherapy to clear secretions at least two hourly

    Basic respiratory monitoring and support

  • 14

    Patients recently extubated after prolonged intubation and mechanical ventilation

    Basic respiratory monitoring and support

  • 15

    Need for mask CPAP or noninvasive ventilation

    Basic respiratory monitoring and support

  • 16

    Patients who are intubated to protect the airway but require no ventilatory support and who are otherwise stable

    Basic respiratory monitoring and support

  • 17

    Need for vasoactive drugs to support arterial pressure or cardiac output

    circulatory support

  • 18

    Support for circulatory instability due to hypovolemia from any cause which is unresponsive to modest volume replacement (including post-surgical or gastrointestinal hemorrhage or hemorrhage related to a coagulopathy)

    circulatory support

  • 19

    Patients resuscitated after cardiac arrest where intensive or high dependency care is considered clinically appropriate

    circulatory support

  • 20

    Intra-aortic balloon pumping

    circulatory support

  • 21

    CNS depression, from whatever cause, sufficient to prejudice the airway and protective reflexes

    neurological monitoring and support

  • 22

    Invasive neurological monitoring

    neurological monitoring and support

  • 23

    Need for acute renal replacement therapy (hemodialysis, hemofiltration, or hemodiafiltration)

    renal support

  • 24

    _____&_______focuses on resuscitating unstable patients and allowing time for recovery or the effect of specific therapies toimprove outcomes and prevent death. We use this in the broad sense of care provided to all critically ill patients.

    Emergency and critical care

  • 25

    _________&_________ is therefore for those who are critically ill at arrival, or who were stable and subsequently deteriorated, and can be provided anywhere in the hospital: 1. 2 3 4 5

    Emergency and critical care 1. in the emergency department, 2. the intensive care unit (ICU), 3. general wards, 4. post-operative recovery units, and 5. high-dependency units

  • 26

    what are the FACTORS TO BE CONSIDERED WHEN ASSESSING SUITABILITY FOR ADMISSION TO INTENSIVE CARE

    - Diagnosis - Availability of sustainable treatment - Severity of illness - Response to treatment to date - Age - Recent cardiopulmonary arrest - Coexisting disease - Anticipated quality of life - Physiological reserve - Prognosis - The patient's wishes

  • 27

    when to admit? Patients should be admitted to ICU before their _________...

    condition reaches a point from which recovery is impossible.

  • 28

    Improves the chances of recovery Reduces the potential for organ dysfunction (extent and number) May reduce length of stay in ICU (and cost)

    EARLY REFERRAL

  • 29

    CLEAR CRITERIA MAY HELP TO IDENTIFY THOSE AT RISK AND TO TRIGGER A CALL FOR HELP FROM INTENSIVE CARE STAFF 1-11

    ● Threatened airway ● All respiratory arrests ● RR>40bpm or <8bpm ● Oxygen saturation of <90% on >50% oxygen ● All cardiac arrests ● Pulse rate >140 beats/m or <40 bpm ● Systolic blood pressure 90mmHg ● Sudden fall in level of consciousness (Glasgow coma.scale ● Repeated or prolonged seizures ● Rising arterial CO2 tension with respiratory acidosis ● ny patient giving cause for concern

  • 30

    _________,_________ and __________ or ______________ and _______which can result in a failure to identify critical illness and an under prioritization of emergency and critical care.

    DILEMMAS IN CRITICAL CARE Low staffing levels, lack of equipment, and limited knowledge or awareness of emergency and critical care

  • 31

    ___________ and ______for either the identification of critical illness, or for the provision of emergency and critical care

    DILEMMAS IN CRITICAL CARE lack of commonly agreed definitions and criteria

  • 32

    emergency and critical care can be conflated with technologically advanced and expensive care on ICUs

    DILEMMAS IN CRITICAL CARE

  • 33

    in RESPIRATORY SUPPORT Critically ill patients should receive supplementary oxygen at sufficient concentration to maintain arterial oxygen tension of ______ or oxygen saturation of at least _____.

    arterial oxygen tension of >8kPa oxygen saturation of at least 90%.

  • 34

    in RESPIRATORY SUPPORT In patients with _________________ (type II respiratory failure) oxygen will correct the hypoxaemia but not the hypercapnia.

    depressed ventilation

  • 35

    A few patients with severe chronic lung disease are dependent on hypoxic respiratory drive, and oxygen may depress ventilation

    under respiratory support

  • 36

    3 ASSESSMENT FOR THE NEED FOR MECHANICAL VENTILATION

    1. ABG of Patient- Respiratory Acidosis 2.Type I and II ventilatory failure 3. Degree of respiratory work

  • 37

    what time of respiratory failure accur In Oxygenation-Hypoxemia ● Oxygen (low flow); high flow (HFNC) ● CPAP-Spontaneous breath + PEEP-Positive end expiratory pressure ● Atelectatic(collapsed lung)

    type 1 respiratory failure

  • 38

    what type of respiratory failure is Ventilation-Hypercapnia ● Non Invasive-BIPAP ○ IPAP-VENTILATION ○ EPAP-OXYGENATION ● Invasive-Intubate

    type 2 respiratory failure

  • 39

    Adequacy of circulation: patient with established or threatened __________ as well as _________ should be ventilated early in order to gain control of at least one major determinant of tissue oxygen delivery

    circulatory failure respiratory failure

  • 40

    4 INITIATION OF MECHANICAL VENTILATION

    1. Acute ventilatory failure 2. impending ventilatory failure 3. severe hypoxemia 4. prophylactic ventilatory support

  • 41

    ● PRIMARY INDICATION for mechanical ventilation. ● defined ph <7.30 and PaCO2 >50mmHg (higher in COPD patient) ● apnea or bradypnea

    acute ventilatory failure

  • 42

    ● occurs when a patient can maintain ONLY marginally NORMAL BLOOD GASES, BUT only at the expense of a significantly increased work of breathing. ● Increase breathing → Normal blood gas→ Muscle fatigue → Ventilatory failure increase PCO2 → acidosis

    IMPENDING VENTILATORY FAILURE

  • 43

    Spontaneous breathing __bpm and MV __ L/min

    >30 bpm >10 l/min

  • 44

    PaO2 <60mmHg on 50% or more of oxygen or <40mmHg at any FIO2. ● ALI, ARDS, Pulmonary edema, and Carbon monoxide poisoning

    severe hypoxemia

  • 45

    Hypoxemia can be assessed by measuring the ______ or _______

    PaO2, or A-a gradient [P(A-a)O2].

  • 46

    normal P(A-a02) at 21% should be _______ for every 10 years

    <4mmHg

  • 47

    is provided in clinical conditions in which the risk of pulmonary compilations, ventilatory failure or oxygenation failure is high.

    PROPHYLACTIC VENTILATORY SUPPORT

  • 48

    in ____________can can reduce work of breathing and oxygen consumption and thus preserve and rest the cardiopulmonary system and promote patient recovery.

    prophylactic ventilatory support

  • 49

    is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery,

    PROPHYLACTIC VENTILATORY SUPPORT

  • 50

    ______is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes

    shock

  • 51

    shock is defined as a state of cellular and tissue hypoxia due to either

    reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes

  • 52

    It is a life-threatening condition that occurs when the body is not getting enough blood flow.

    shock

  • 53

    __________ means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result.

    Lack of blood flow

  • 54

    _____ requires immediate treatment and can get worse very rapidly. As many as 1 in 5 people in shock will die from it.

    Shock

  • 55

    TYPES OF SHOCK

    ● Hypovolemic ● Cardiogenic ● Neurogenic ● Inflammatory (septic) ● Obstructive ● Traumatic anaphylactic shock

  • 56

    what shock is due to heart problems

    cardiogenic shock

  • 57

    what shock caused by two little blood volume

    hypovolemic shock

  • 58

    what shock caused by an allergic reaction

    anaphylactic shock

  • 59

    it occurs when rapid loss of fluids results in inadequate intravascular volume and subsequent inadequate perfusion.

    HYPOVOLEMIC SHOCK

  • 60

    what shock ● Diminished mean arterial pressure (MAP) and tissue perfusion as a result of loss of vasomotor tone to peripheral vascular beds ● Loss of vasoconstrictor impulses results in increased vascular capacitance, decreased venous return, and decreased cardiac output

    NEUROGENIC SHOCK

  • 61

    failure of the circulatory pump leading to diminished forward flow and subsequent tissue hypoxia

    CARDIOGENIC SHOCK

  • 62

    ________ occurs in response to an inciting agent, which causes both pro-inflammatory and anti-inflammatory immune system activation.

    Septic shock

  • 63

    ● Mechanical or anatomical obstruction impeding venous return to the heart or preventing cardiac filling ○ Decrease CO ○ Decreased peripheral perfusion

    OBSTRUCTIVE SHOCK

  • 64

    what shock combination of several insults after injury that, alone, may be insufficient to induce shock, but produce profound hypoperfusion when combined

    TRAUMATIC SHOCK

  • 65

    SIGNS SUGGESTIVE OF FAILING TISSUE PERFUSION:

    ● Tachycardia ● Confusion or diminished conscious level ● Poor peripheral perfusion (cool, cyanosed extremities, poor capillary refill, poor peripheral pulses) ● Poor urine output (<0.5ml/kg/h) ● Metabolic acidosis ● Increased blood lactate concentration

  • 66

    CAUSES OF SHOCK

    Severe bleeding Severe allergic reactions Severe burns Dehydration Heart failure Electrocution Heart attack Serious infections Head or spinal injuries

  • 67

    SIGNS AND SYMPTOMS OF SHOCK

    in compensatory shock in decompensatory shock in irreversible shock

  • 68

    WHAT SIGN AND SYMPTOMS IS: anxiety, restlessness, fear increased breathing and heart rate

    in compensatory shock

  • 69

    WHAT SIGN AND SYMPTOMS IS: ● mental status continues to deteriorate ● breathing becomes rapid and shallow, and heartbeat rapid ● skin becomes pale or ashen and cool ● nausea and thirst occur

    in decompensatory shock

  • 70

    WHAT SIGN AND SYMPTOMS IS: victim becomes unresponsive respiratory and cardiac arrest

    irreversible shock

  • 71

    RESPIRATORY MANAGEMENT OF SHOCK MANAGEMENT ● All patients with shock should receive __________ ● _____________- in cases of severe hemodynamic disturbance manifested as shock or severe hypoxemia.

    supplemental oxygen Invasive mechanical ventilation

  • 72

    Neurological failure may occur after 1-6

    head injury, poisoning, cerebral vascular accident, infections of the nervous system (meningitis or encephalitis), cardiac arrest, or as a feature of metabolic encephalopathy (such as liver failure).

  • 73

    The sequelae of neurological impairment may lead to the patient requiring intensive care. For instance, loss of consciousness may lead to ________,________&_________ that requires intubation or tracheostomy and mechanical ventilation.

    obstruction of airways, loss of protective airway reflexes, and disordered ventilation

  • 74

    neurologics support patient who need patent anesthetic drugs such as: 1. 2. to treat seizures that are resistant to conventional anti convulsant or monitoring the intracranial pressure and cerebral perfusion pressure must referred to a 1. 2.

    thiopentone or propofol high dependency or intensive care unit.

  • 75

    Patients with neuromuscular disease (for example, Guillain-Barré syndrome, myasthenia gravis) may____________________________ require because of respiratory failure, loss of airway reflexes, or aspiration.

    admission to intensive care for intubation or ventilation

  • 76

    __________- is a common complication of acute illness or trauma and the need for renal replacement therapy (________,_______ or ______) may be a factor when considering referral to intensive or high dependency care.

    Renal failure haemofiltration, haemodialysis, or their variant

  • 77

    renal support In ill patients hourly recording of urine output on the ward may give an early indication of a developing renal problem; prompt treatment, including aggressive circulatory resuscitation, may prevent this from progressing to established renal failure.

    .