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Questions and Answers
What score is assigned for a patient who opens their eyes spontaneously according to the GCS scale?
What score is assigned for a patient who opens their eyes spontaneously according to the GCS scale?
- 4 (correct)
- 1
- 3
- 2
The SOFA score assesses the degree of organ dysfunction in patients over time.
The SOFA score assesses the degree of organ dysfunction in patients over time.
True (A)
What is the highest score a patient can receive for the best motor response on the GCS scale?
What is the highest score a patient can receive for the best motor response on the GCS scale?
6
The __________ score was developed in 1983 to predict outcomes in patients with traumatic injuries.
The __________ score was developed in 1983 to predict outcomes in patients with traumatic injuries.
Match the following GCS responses with their corresponding scores:
Match the following GCS responses with their corresponding scores:
Which of the following criteria indicates adequate recovery for discharging a patient from ICU?
Which of the following criteria indicates adequate recovery for discharging a patient from ICU?
The GCS scale includes a category for assessing verbal response.
The GCS scale includes a category for assessing verbal response.
What is considered adequate pain control for a patient in the ICU?
What is considered adequate pain control for a patient in the ICU?
Which of the following medical staff are included in the ICU team?
Which of the following medical staff are included in the ICU team?
Patients with a PaO2 of 80mmHg at 60% FIO2 are indicated for ICU admission.
Patients with a PaO2 of 80mmHg at 60% FIO2 are indicated for ICU admission.
Name one reason for a patient to be admitted to the ICU.
Name one reason for a patient to be admitted to the ICU.
Patients with a serum potassium level greater than ______ mEq/L may be indicated for ICU admission.
Patients with a serum potassium level greater than ______ mEq/L may be indicated for ICU admission.
Which of the following vital sign changes indicates potential ICU admission due to hemodynamic instability?
Which of the following vital sign changes indicates potential ICU admission due to hemodynamic instability?
Match the following medical conditions to their indications for ICU admission:
Match the following medical conditions to their indications for ICU admission:
What is one role of physiotherapy in the ICU?
What is one role of physiotherapy in the ICU?
A patient with a serum sodium level of 120 mEq/L requires ICU admission.
A patient with a serum sodium level of 120 mEq/L requires ICU admission.
Physiotherapy in the ICU always involves invasive procedures.
Physiotherapy in the ICU always involves invasive procedures.
What is one condition that can lead to a patient being ventilated in the ICU?
What is one condition that can lead to a patient being ventilated in the ICU?
Name two benefits of early mobility in the ICU.
Name two benefits of early mobility in the ICU.
The movement of air in and out of the lungs is known as __________.
The movement of air in and out of the lungs is known as __________.
Match the following gas laws with their main focus:
Match the following gas laws with their main focus:
Which of the following is NOT a technique used by physiotherapists in the ICU?
Which of the following is NOT a technique used by physiotherapists in the ICU?
Knowledge of anatomy and physiology is not necessary for safe physiotherapy in the ICU.
Knowledge of anatomy and physiology is not necessary for safe physiotherapy in the ICU.
What indicates decreased ventilation in the V/Q ratio?
What indicates decreased ventilation in the V/Q ratio?
What two components are essential for understanding the physiology of breathing?
What two components are essential for understanding the physiology of breathing?
An area with no perfusion is referred to as a shunt.
An area with no perfusion is referred to as a shunt.
What is the primary cause of hypoxaemia in a critical care setting?
What is the primary cause of hypoxaemia in a critical care setting?
An anatomical shunt is defined as __________ of the pulmonary arterial system.
An anatomical shunt is defined as __________ of the pulmonary arterial system.
Match the following conditions with their descriptions:
Match the following conditions with their descriptions:
What causes ventilation to be wasted in dead space ventilation?
What causes ventilation to be wasted in dead space ventilation?
Perfusion is greater at the apex of the lungs due to gravitational forces.
Perfusion is greater at the apex of the lungs due to gravitational forces.
What should be the position of a patient for effective oxygenation?
What should be the position of a patient for effective oxygenation?
What is an indicator of respiratory failure?
What is an indicator of respiratory failure?
An increased deadspace will result in a decrease in carbon dioxide levels.
An increased deadspace will result in a decrease in carbon dioxide levels.
What does hypoxaemia refer to in the context of respiratory failure?
What does hypoxaemia refer to in the context of respiratory failure?
The purpose of airway maintenance is to ensure adequate __________.
The purpose of airway maintenance is to ensure adequate __________.
Which of the following is NOT a clue to the presence of respiratory failure?
Which of the following is NOT a clue to the presence of respiratory failure?
Match the terms to their meanings:
Match the terms to their meanings:
Paradoxical breathing is a sign of increased work of breathing.
Paradoxical breathing is a sign of increased work of breathing.
What can necessitate airway maintenance?
What can necessitate airway maintenance?
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Study Notes
ICU Staffing
- Medical staff includes intensivists and various specialists.
- Nursing staff consists of critical care nurses.
- Pharmacists play a vital role in medication management.
- Physiotherapy staff include critical care trained physiotherapists and respiratory therapists.
- Other allied health professionals in ICU: dietitians, occupational therapists, speech therapists.
Indications for ICU Admission
- Patients with respiratory failure needing ventilator support: PaO2 < 60mmHg at 60% FIO2, severe respiratory distress, or PaCO2 > 45mmHg.
- Patients with acute severe medical/surgical illness and two or more organ failures requiring close monitoring.
- Hemodynamically unstable patients needing invasive monitoring: vital signs such as pulse < 40 or > 150 bpm, systolic BP < 80 mmHg.
- Abnormal lab test results indicating critical conditions: serum sodium < 110 or > 170 mEq/L, potassium < 2.0 or > 7.0 mEq/L, glucose > 800 mg/dL.
- Acute conditions requiring monitoring: acute myocardial infarction, pulmonary edema, severe eclampsia.
Glasgow Coma Scale (GCS)
- Eye opening responses: spontaneous (4), to speech (3), to pain (2), no response (1).
- Best motor responses: obeys commands (6), localizes pain (5), withdraws (4), flexion (3), extension (2), no response (1).
- Best verbal responses: oriented (5), confused speech (4), inappropriate words (3), incomprehensible sounds (2), no response (1).
Severity of Illness Scoring Systems
- Anatomic and physiological scores predict outcomes for trauma patients.
- TRISS (Trauma and Injury Severity Score) considers blunt versus penetrating injuries.
- SOFA (Sequential Organ Failure Assessment) developed to assess organ dysfunction over time; scores range from 0 to 4.
Discharge Criteria from ICU
- Patient must have a clear airway and strong cough reflex.
- Normal blood gas levels and respiratory effort required.
- Hemodynamically stable patients not on inotropes.
- Adequate neurological status and renal function must be confirmed.
Role of Physiotherapy in ICU
- Integral for patient management involving manual airway clearance, suctioning, positioning, and interference with ventilators.
- Focuses on cardiopulmonary management and early mobilization to prevent complications, improve oxygenation, and enhance lung function.
Benefits of Early Mobility
- Improves blood sugar control and cardiovascular function.
- Enhances endothelial function and hormone regulation.
- Preserves musculoskeletal integrity and reduces depression.
Respiratory Physiology
- Breathing consists of inspiration and expiration, allowing ventilation (air movement) and respiration (gas exchange).
- Key gas laws: Boyle’s law governs inspiration, Dalton’s law pertains to gas pressures, and Henry’s law involves gas transport.
Ventilation/Perfusion (V/Q) Relationships
- Normal V/Q ratio is 1; any deviation indicates ventilation/perfusion mismatch.
- Conditions like chronic bronchitis or pulmonary embolism impact efficiency significantly.
Respiratory Failure
- Defined by a PaO2 < 60mmHg on high FiO2 or PaCO2 > 50mmHg with acidosis.
- Symptoms include increased respiratory rate, decreased tidal volume, and increased work of breathing.
Airway Maintenance
- Involves ensuring adequate ventilation; artificial airways may be necessary for patency.
- Required during airway obstructions, edema, or when facilitating secretion removal.
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