What are the major complications associated with CVCs?
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Mechanical, infectious, and therapeutic complications.
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What are the major complications associated with CVCs?
Mechanical, infectious, and therapeutic complications.
Why is knowledge of CVC complications important?
It allows for prompt recognition and management of complications, which can reduce morbidity, mortality, length of hospitalization, and cost.
What are the three components of the TRIAD for diagnosing cardiac arrest?
What are the three methods to assess breathing?
Look for chest wall movement, listen to breath sounds, and feel air flow.
What is the recommended dose of epinephrine for vasopressor use?
0.01 – 0.02 mg/kg IV every 3-5 minutes.
What is the technique for mouth-to-nose breathing?
Seal the mouth shut and breathe steadily through the nose.
What type of surgery requires post-operative monitoring in ICU?
Neurosurgery.
What are some causes of restrictive lung disease leading to respiratory failure?
Pulmonary edema, neuromuscular disease, morbid obesity, and pulmonary embolism.
What are typical indications for central venous catheters (CVCs)?
Hemodynamic monitoring, large volume blood resuscitation, infusion of vasoactive drugs, total parenteral nutrition (TPN), renal replacement therapy, failure to achieve peripheral access, and transvenous pacing.
What are some examples of mechanical complications from CVC insertion?
Arterial puncture, pneumothorax, and hematoma.
What is the definition of respiratory failure?
Inability of the lung to provide adequate arterial oxygenation and CO2 elimination.
What base deficit value indicates the need for ICU admission?
What is the chest compression to ventilation ratio for a single rescuer?
30:2.
What is a sign of hemodynamic instability that necessitates ICU admission?
Ongoing shock.
What are the clinical manifestations due to hypoxia in respiratory failure?
Dyspnea, tachypnea, central cyanosis, tachycardia, arrhythmia, hypotension, drowsiness, coma, convulsion, and death.
What condition must be managed before a patient can be discharged?
Cardiac dysrhythmias must be controlled.
What should be checked after the 3S steps in a collapsed patient?
Check for carotid pulsation.
What does post-resuscitation care aim to achieve?
To restore quality of life and minimize neurological insult.
What is one of the golden rules for performing high-quality chest compressions?
Ensure proper rate, depth, and recoil.
What is the recommended likelihood of deterioration for long-stay patients before discharge?
Low likelihood of deterioration in the next 24 to 48 hours.
What type of care do patients need when treatment has been withdrawn?
Basic nursing care and drugs for comfort.
What often results in airway obstruction during loss of consciousness?
Loss of tone in the muscles of the airway and falling back of the tongue.
What does BLS stand for and what does it entail?
Basic Life Support; it is life support without the use of special equipment.
What condition requires mechanical ventilation for ICU admission?
Respiratory failure.
What condition is associated with sepsis and multi-organ failure?
Sepsis.
What characterizes Type II respiratory failure?
Decreased PaO2 with increased PaCO2, usually due to hypoventilation.
What is a critical condition mentioned that requires careful management?
Acute severe pancreatitis.
What must be started immediately for any patient with absent central pulsations?
Chest compression.
What should be true about the admission etiological factor for discharge?
It should be under control or not significant anymore.
How is the head tilt, chin lift technique performed?
One hand is placed on the forehead and the other on the chin, tilting the head upwards to displace the jaw anteriorly.
Where should the palm of one hand be placed during chest compression?
On the concavity of the lower half of the sternum, 2 fingers above the xiphoid process.
What are the arterial blood gas (ABG) measurements used to assess in respiratory failure?
PaO2, PaCO2, pH, HCO3.
What routine biochemistry tests are important in coma management?
Urea, electrolytes, glucose, calcium, and liver biochemistry.
What are some causes of obstructive lung disease leading to respiratory failure?
Acute or severe asthma.
What is one criterion for discharge from the intensive care unit?
Patients not on any support or intervention that cannot be provided in the ward.
What are some treatment options for respiratory failure?
O2 supplementation, mechanical ventilation, removal of secretions, control of infection, bronchodilator, nutritional support, and treatment of the underlying cause.
What is the definition of CPR?
An emergency medical procedure for a victim of cardiac arrest or respiratory arrest.
What method is used for resuscitation in infants and small children?
Mouth to mouth and nose.
What should you do while performing mouth-to-mouth breathing?
Seal your lips over the patient’s mouth and blow steadily into it, watching the chest rise.
What is a common post-operative complication that requires ICU admission?
Acute respiratory failure.
How long should chest compressions be continued before reassessing cardiac rhythm?
For 2 minutes, equivalent to 5 cycles of 30:2.
What imaging techniques are useful in coma assessment?
CT or MR brain imaging.
What is the maximum supplemental inspired oxygen concentration for discharge?
Less than 50%.
What is one criterion for admission to intensive care for trauma patients?
Multisystem trauma.
What is a potential complication of catheter placement related to bleeding?
Hemothorax.
What are some potential causes for patient deterioration in anesthesiology?
Airway swelling, metabolic disorders, coagulopathies, hypoxemia, hypercarbia, hypovolemia, intracranial events.
What is the goal of early defibrillation?
To restart the heart.
When is NaHCO3 used in resuscitation?
Only if there is metabolic acidosis, given empirically at 1 mmol/kg.
What is the maximum time the human brain can survive without circulation?
3 minutes.
What is the percentage range for thrombotic complications associated with central venous catheters?
6.5% to 21.5%.
What are the most common sites for CVC insertion?
Internal jugular vein (IJV), subclavian vein (SV), femoral vein (FV), and upper extremity veins (basilic, cephalic, brachial) for peripherally inserted central catheter (PICC).
What is the jaw thrust technique used for?
To maintain airway patency.
What can occur due to catheter misplacement?
Arrhythmia.
What is the dosage of atropine for resuscitation?
0.1 mg/kg.
What is the range of infectious complications associated with central venous catheters?
1.5% to 25%.
What type of IV fluid therapy is indicated with intravascular depletion?
Colloid or crystalloid.
What is the role of EEG in coma diagnosis?
It is valuable in diagnosing metabolic coma and encephalitis.
What should be administered empirically if there's a suggestion of infection in coma patients?
Broad spectrum antibiotics and/or antivirals.
What GCS score indicates a severe traumatic brain injury for ICU admission?
GCS < 8.
What is the first step in mouth-to-mouth breathing?
Hold the airway open and pinch the nostrils closed.
What is a serious risk associated with wire embolism?
It can lead to vascular complications.
What intervention cannot be performed in a general ward?
Continuous veno-venous hemofiltration.
What does CRBSI stand for?
Catheter-Related Bloodstream Infection.
What should be minimized during CPR?
Interruption of chest compressions.
What serious condition can arise from vascular stenosis related to catheter use?
Pulmonary embolism.
What is the head tilt, chin lift technique used for?
To maintain airway patency.
Which type of injury is associated with a threatened airway and requires ICU admission?
Facial or neck trauma.
What is the recommended depth of sternum depression for adults during CPR?
4-5 cm.
What characterizes Type I respiratory failure?
Decreased PaO2 with normal PaCO2, usually due to lung pathology.
What metabolic and endocrine studies are relevant in coma management?
TSH and cortisol levels.
What is a common infectious complication of central venous catheters?
Catheter colonization.
What are the clinical manifestations due to hypercapnia in respiratory failure?
Tachycardia, sweating, dyspnea, tachypnea, drowsiness, coma, and death.
What does seesaw (paradoxical) movement of the chest wall indicate?
Airway obstruction.
What does ACLS stand for and what does it involve?
Advanced Life Support; it involves life support with the use of special equipment (e.g., airway, endotracheal tube, defibrillator).
What is the purpose of early CPR?
To buy time.
What is the dosage of calcium chloride for resuscitation?
2-4 mg/kg.
What does the 'A' in life support stand for?
Airway (cervical spine).
What procedures are included in resuscitation for cardiac issues?
Defibrillation and cardioversion.
What should be monitored frequently in coma patients?
Vital functions and high flow oxygen.
What surface should the patient be placed on for chest compression?
A hard surface, such as a wooden board.
What is the first cornerstone for optimizing outcomes after cardiac arrest?
Early recognition and call for help.
What is the recommended rate of chest compressions during CPR?
100 – 120 compressions per minute.
How is apnea confirmed in a patient?
By confirming cessation of respiration.
When should a lumbar puncture be performed in coma patients?
Only after careful risk assessment and not if an intracranial mass lesion is suspected.
What is a potential thrombotic complication of central venous catheters?
Deep vein thrombosis.
What type of diet is recommended for coma patients?
A liquid diet through a fine intragastric tube, providing 3000 kcal daily.
What are the 3S steps before initiating resuscitation for a collapsed patient?
What is an AV fistula?
A connection between an artery and a vein, which can be a complication of catheter use.
What is a key consideration for preoperative optimization in patients?
Hemodynamic instability and/or major fluid and electrolyte disturbance.
What condition may require inotropic support in the ICU?
Hemodynamic instability.
What are the essentials of long-term care for coma patients?
Skin care, oral hygiene, eye care, fluid management, calorie intake, and catheterization when necessary.
What should be done in case of difficult venous access during CPR?
Intraosseous drug and fluid administration.
How often should neuro-observations be conducted in coma patients?
Every half hour.
