My Acute Medicine
Card Set Information
My Acute Medicine
ALI AKI ARDS ICU IV fluids EPI
ALI, AKI, ARDS, ICU, IV fluids and EPI
What is the significance of common obs measured in ICU?
: Tachycardia related to poor outcome >120bpm
: Tachypnoea in many acute diseases. >20r/min
: Lowers in sepsis/blood loss.
: Any effect suggests an effect on cell function
: Low = lung, airway or CVpathology
: Sign of metabolism. High = sepsis, drug reaction
What observations are performed in ICU, excluding general Obs? What is their significance?
: Hypovolaemia, renal disease, overhydration, drugs. Normal = adequate perfusion
: lactate, glucose, acid/base. Metabolic function and perfusion
: Associated with actual or potential tissue damage
Size of Patients flaccid member?
Presence of anal tage?
Outline the general observations used in the APACHE II score
Rectal Temp, MAP, HR, RR
: Sodium, Potassium, pH, Creatinine, PaO2
Your patient is ill with oxygen FAIL, how much O2 do you prescribe?
Give all the mmHg!!!!
Outline the full calculations of the APACHE II score
Age (45-54=2, 64=3, 74=5, >75=6)
Chronic health; liver, CV resp, renal, immune
Outline the SOFA scoring system
What does the APACHE 2 system predict?
The prognosis of a critically ill patient
What does the SOFA scoring system determine?
Used to determine the extent of a person's organ function, or failure (respiratory, renal, coagulation, CNS, CVS, liver)
What does MEWS predict?
"Modified Early Warning Score"
Guide used to quickly determine the degree of illness
: SBP, HR, RR, tem and GCS
The more the patient's diverse from the norm, the greater the score
Outline the pathological mechanisms leading to shock
Micro-organisms invade blood stream
Toxins (exo/endo) cause mediator release
Profound vasodilation = acute renal failure + hypoxia
Necessary mechanical ventilation can also cause infection, trauma and so ARDS
- What are the clinical manifestations of shock?
- What defines 'severe sepsis'?
SIRS criteria + presumed/confirmed infection
Sepsis, with at least one acute organ dysfunction
What is the definition of 'septic shock'?
Confirmed severe sepsis
Hypotension unaffected by IV fluid reconstitution
How is a septic patient resuscitated?
1. High flow O2 for <4 hours
2. Two blood cultures, at least one from each IV access
3. Other examinations (CSF, CXR, urine culture)
4. Antibiotics within 1st hour; 1+ in likely spectrum
5. Iv fluids; 250ml crystalloid and consider fluid challenge
6. Severe hypotension = vasopressors
7. Lactate, Hb and urine measured
What were the findings of the Rivers clinical trial?
Proved aggressive management of sepsis, including guidelines described, associated with better mortality
What is the significance of AKI in a clinical setting?
Around 10% of patients in ospital are in the risk stages
Directly related to mortality and other organ failures
Around 20% of CCU patients require RRT
What are the classical causes of AKI?
: hypovolaemia, stenosis
: Vasculitis, glomerulonephritis, drugs
: obstruction, e.g. prostate, kidney stone
What are the multifactorial causes of AKI?
No single cause contributes to renal ischaemia
Vast majority are related to sepsis. Also poor haemodynamic or low cardiac output
Cytokines, toxins and obstructionpart of the 'multifactorial' idea
How are RIFLE criteria measured?
Outlines the measurements 'RIF' and outomes 'LE' of kidney injury
: Risk area - creatinine x1.5, urine <5ml/kg/h for 6hr
: Injury area- creatinine x 2, urine <5ml/kg/h for 12hr
: Failure - creatinine x 3, urine <3ml/kg/h for 24hr
: Persistent acute renal failure = complete loss of function >4 weeks
: End stage renal disease
What are the problems with the measurements used in the RIFLE criteria?
Several conditions can cause a drop in urine production unrelated to renal failure
Creatinine can also be affected by other conditions (e.g. diabetes, muscle mass)
What are the indications for RRT?
Increased urea, decreased urine, hyperkalaemia, acidosis, fluid overload etc. related to renal function
Hypoxia/sepsis/obstruction ruled out as causes of the AKI
Perfusion/BP unaffected by IV fluids
The withdrawal of desirable ions using concentration gradients across a semi-permeable membrane via countercurrent mechanisms
The withdrawal of desirable ions using concentration gradients, aided by hydrostatic pressure allowing for large solute removal. The fluid composition is then changed and reinfused
What are the contraindications of RRT?
If the injury is not survivable
There is no opportunity to stop RRT in the future
The prognosis is poor (elderly, ESRD etc)