Untitled

KAIM Logo and Vital Signs

• KAIM logo represents vital signs like breathing, circulation and consciousness

Professor William Ganz

• Professor William Ganz was born on July 1, 1919, in Kosice and died on November 10, 2009, in Los Angeles
• He co-invented the pulmonary artery catheter and introduced it into medical practice
• The pulmonary artery catheter measures pulmonary capillary wedge pressure (PCWP), indicating left ventricular preload

ICU Admission

• ICU admission is indicated in case of vital organs failure
• Intensive care supports patients with potentially recoverable conditions needing more observation and invasive treatment
• ICU is reserved for patients with potential or established organ failure, most commonly the lung
• Evaluation factors include diagnosis, severity, outcome, illness, life expectancy, quality of life, and wishes

ICU Admission Criteria

• Four general groups indicate ICU admission: respiratory/ventilatory failure, low consciousness, post-resuscitation care, and post-theatre for emergency surgeries or severe elective case complications

Airway Maneuvers

• The basic airway maneuver is the head tilt (back) and chin lift
• Head tilt/chin lift prevents tongue obstruction in unconscious patients
• The head tilt/chin lift method involves placing one hand on the forehead to tilt the head back and then lifting the chin with the other hand
• The head tilt/chin lift maneuver is used in any patient without concerns about cervical spine injury
• Esmarch manoeuvre is for opening of airway

Jaw-Thrust (Esmarch Maneuver)

• Jaw-thrust prevents tongue obstruction in unconscious patients
• To perform the jaw-thrust Place thenar eminences on zygomatic arch, index and middle fingers under the mandible's angle, and lift the jaw forward
• The jaw-thrust maneuver is used in patients with cervical neck problems or suspected spine injury

Oropharyngeal Airway

• Appropriate sized oropharyngeal airway distance measured from earlobe to labial angle
• During insertion the oropharyngeal airway must be rotated by 90 degrees

Laryngeal Mask

• Laryngeal mask insertion does not require muscle relaxants

Tracheostomy Advantages

• Tracheostomy reduces dead space by 1/3
• Tracheostomy creates a permanent or temporary opening (stoma) in the cervical trachea with surgical incision
• Per lecture trachea incision occurs between the 1st and 2nd tracheal cartilage ring
• Indications: long-term ventilation (>3 weeks), upper airway obstructions, infections, malignancy, hemorrhage, foreign body, or oropharyngeal edema

Capnography

• Capnography is CO2 monitoring in airway gases for the purpose of ventilation, circulation, and metabolism monitoring of CO2 content near the endotracheal tube mouth

Preload of the Right Heart Ventricle

• Preload of the right heart ventricle is determined by the pressure in vena cava superior, also known as central venous pressure (CVP)
• Preload is the force stretching the ventricle during diastole, also described as end-diastolic ventricular volume
• CVP is an indicator of right ventricular preload, while PCWP indicates left ventricular preload

Atypical Morphine Effects

• Artery hypertension, cough, and mydriasis do not belong among typical morphine effects
• Morphine properties include analgesia, sedation, respiratory depression, antitussive effects, vasodilation, histamine release, constipation, nausea/vomiting, miosis, Oddi sphincter spasms, urinary retention, tolerability, and addiction

Visual Analog Scale (VAS)

• The recommended VAS (1-10) value for controlling pain is less than 3 in acute pain
• Visual analog scale (VAS) Subjective pain score: 0 – 10, Acute pain <3, Chronic pain < 2

Definitions

• Withholding is refusing or not initiating treatment, not escalating it
• Withdrawing is stopping/removing an existing treatment
• Euthanasia is administering medication to intentionally end a patient's life
• Assisted suicide is when the patient self-administers a lethal agent with healthcare assistance
• Double effect is when medication for pain relief speeds up dying

Colloids

• Starches, gelatin, and dextran agents belong to artificial colloids, while plasma, albumin, and red blood cells belong to nature colloids
• Distributional space for glucose infusion is intravascular only

Energy values

• 38 ATP molecules from 1 glucose molecule in aerobic condition, 2 ATP in anaerobic condition
• 1 gr carbohydrate= 4 kcal, 1 gr proteins= 4 kcal, and 1 gr fats= 9 kcal of energy

Hypoglycaemia

• Hyperglycaemia is one of the early signs of liver failure

IgA

• 80% of IgA is produced by Gastrointestinal Associated Lymphoid Tissue (GALT)

Hypophosphatemia

• Hypophosphatemia is a typical sign of refeeding syndrome

Nutrition

• Solution containing 20% lipids cannot be administered to the peripheral vein
• Recommended minimal duration of artificial nutrition support in severe malnourition is 7 days

Hypovolemia Assessment

• Measurement of changes in blood pressure during passive leg raising test (PLRT) is the simplest assessment for hypovolemia
• In acute circulatory failure, passive leg raising (PLR) predicts increased cardiac output with volume expansion by transferring ~300 mL of venous blood from the lower body to the right heart

Hypovolemic Shock

• Hypovolemic shock from loss of greater than 20% of intravascular fluid volume

Sepsis

• Sepsis is life-threatening organ dysfunction caused by inappropriate organism response to infection

Septic Shock

• Septic shock is a stage of sepsis with perfusion abnormalities requiring vasopressors support or metabolic derangement like hyperlactemia

Rescuing a Collapsed Person

• The first step when finding a collapsed person is to confirm safety of the scene

Adrenaline Contraindications

• Adrenaline (Epinephrine) is not indicated in Atrial fibrillation
• If epinephrine is given in Atrial fibrillation we will kill the patient. In ANY other case of cardiac arrest, Epinephrine is indicated

Defibrillation Indications

• Defibrillation is indicated in Ventricle fibrillation

Chest Compressions and Ventilation Ratio

• The compression-to-ventilation ratio for one rescuer is 30:2

Cardiac Arrest Survival Factor

• Chest compression + defibrillation is the most important factorS for surviving a cardiac arrest

Hs and Ts not belonging together

• Haemolysis, tachycardia, trismus, tetany do not belong among 4H and 4T

Lethal Triad

• Acidosis, coagulopathy, hypothermia are the constituents of the lethal triad in haemorrhagic shock

Hemorrhagic Shock

• Haemorrhagic shock results in inadequate oxygen and nutrients delivery
• Trauma triad of death (hypothermia, acidosis, coagulopathy) results in a significant increase in mortality rates
• The trauma triad of death is the combination of hypothermia, acidosis, and coagulopathy.

Surgical Incisions

• Thoracotomy - surgery incision into the chest wall

ABCDE Approach

• ABCDE approach is used by staff in HDU, ICU, ambulances & EDs, and physicians/nurses on the wards

Advanced Life Support

• Adrenaline is not adrenaline in pulseless electrical activity

Electric Currents

• Attachment electrodes should be sticky ones

IV Access

• Intraosseous approach is the second recommended iv access route

Child life support

• Child life support starts with 5 initial breaths

Blood Loss

• Clinical features of hemorrhagic shock include a weak pulse, tachycardia, and tachypnea
• Pathophysiology of hemorrhagic shock leads blood pooling and pressure increases
• Vasopressin, renin and aldosterone are all hormonally released in response to hemorrhage

Loss of Consciousness

• Quantitative loss of consciousness includes somnolence and stupor
• Qualitative loss of consciousness includes amentia, delirium and obnubilation

Colloid Examples

• Natural colloids: albumin, fresh frozen plasma (FFP), blood
• Artificial colloids: Gelatins, dextrans and hydroxyethyl starches

Crystalloids Example

• Crystalloid Aqeous solutions with varying concentrations of electrolytes

Shock Compression

• External chest compression frequency is 100/120 minute rate with depth of 5-6 cm

Electromechanical Dissociation

• Electromechanical Dissociation can be caused by Hypovolaemia

Energy Loads

• The Energy load of biphasic defibrillation is First shock: 120-200 J and then additional shocks: 200-360 J

Defibrillation

• Treat shockable rhythm Patient apnoeic and pulseless with CPE and adrenaline 1mg, amiodarone 300mg

Adrenaline During CPR

• Epinephrine- The typical initial dose is 1,0mg
• Epinephrine given IV (1mg) as soon as possible without delaying CPR repeat every 3-5min

Anaphylactic Reaction

• In severe anaphylactic reaction administer 0.5mg I.M (slowly) adrenaline

Reversible Cardiac Causes

• Reversible cardiac arrest causes → 5H & 5T

Defibrillation Positions

• Standard electrodes defibrillation position → Below right clavicle and left mid axillary line

Shock depth

• The depth of chest compression should be? 5-6cm with a rate of 100-120 per minute

Shock rhythms

• Shockable includes Ventricular fibrillation and pulseless Ventricular tachycardia

Assesing Rhythms

• With a patient In VT WITH pulse, and low BP, so patient is UNSTABLE and needs synchronized CARDIOVERTION (shock to reset the rhythm)

Adrenalins

• Give amiodarone in a drip, and crystalloids to correct the low BP

Defibrillation

• Shockable is when the patient is apnoeic and pulseless

Opiod

• Intravenous must be Given in if you can't give opiods

Oxygen

• To increase the level of oxygen concentration given during artificial ventilation use Increase in inspiratory oxygen concentration (FiO2) and pressure in airway in the end of the expiration(PEEP)

Ananesthesia steps

• Three main steps: hypnosis, analgesia and muscle relaxants

Side effects

• When giving Atropine be aware for acute asthma and respiratory distress