Speech and Language Therapy Pillar

Respiratory Support Units

A respiratory support unit is an enhanced care area, more than a ward, but less than critical care.

The classic example would be folk needing NIV

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As a place in a hospital, what is a Respiratory Support Unit?	Its an area with more monitoring for resp illness than a ward, but less than a critical care environment
What would be the classic example of a respiratory support unit?	A NIV capable ward
What particular investigations and interventions should patients in a respiratory support unit have access to?	Chest Ultrasound and Bronchoscopy

Fire Evacuation Guidance

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Recommendations

There should be at least 10 air changes an hour in areas where CPAP or HFNO2 are used, to stop oxygen build up
There is no absolute requirement for staff to protect patients over themselves
ICUs should sim evacuation every two years at minimum
There should be an evacuation box per bed space including everything needed
Don't put oxygen cylinders on bed, for risk of setting bed on fire!

The order recommended for evacuation is:

Closest to Fire First
Least Unwell Patients Next
Most Unwell
Then Side Rooms Last

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To minimise fire risk, how many air changes does the ICS recommend each hour in a unit?	At least ten
In triaging who to evacuate from a fire, which patients evacuated first?	Those closest to fire
In triaging who to evacuate from a fire, which patients evacuated after those closest to fire?	Those most well
In triaging who to evacuate from a fire, which patients evacuated after those closest to fire and those most well?	Those most unwell
In triaging who to evacuate from a fire, which patients evacuated after those closest to fire and those most well and those most unwell?	Those in side rooms

Vaccine Associated Thrombocytopenia and Thrombosis

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In those you are worried about COVID Vaccine Associated Thrombocytopenia, what is the main imaging you need to do?	CT Cerebral Venogram
In those you are worried about COVID Vaccine Associated Thrombocytopenia, what is the diagnostic blood test you need to do?	PF4 Antibody Assay
In those you are worried about COVID Vaccine Associated Thrombocytopenia, what happens to your fibrinogen?	Goes down
In those you are worried about COVID Vaccine Associated Thrombocytopenia, what happens to your d-dimer?	Goes Up (More than 4000)
In those you are worried about COVID Vaccine Associated Thrombocytopenia, what is the main treatment?	IVIG, Plasma Exchange, and anticoagulation

ICS Levels of Care

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In the 2021 ICS Guidance on Levels of Care, what number is Enhanced Care?	1
In the 2021 ICS Guidance on Levels of Care, what number is Critical Care?	2 and 3
In the 2021 ICS Guidance on Levels of Care, what does Level 1 Care Mean?	"Enhanced Care", more than ward less than critical care
In the 2021 ICS Guidance on Levels of Care, what number is Ward Care?	It doesn't have one!

Physical Restraints

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Do "boxing gloves" count as a form of physical restraints?	Yes
What is the commonly used form of physical restraint used in UK Adult ICUs?	Boxing glove mitts
Are physical restraints illegal to use in ICUs in the UK?	No

Prone Ventilation and COVID

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If you can't ventilate a COVID patient due to high pressures etc, what is the one equipment thing you must think of?	Waterlogged HME

Standard Medication Concentration

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How do ICS recommend you make up a clonidine infusion?	750 micro in a 50ml syringe
How do ICS recommend you make up a dexmedatomidine infusion?	200 micro in a 50ml syringe
How do ICS recommend you make up a vasopresin infusion?	20 units in a 50ml syringe
How do ICS recommend you make up a atracurium infusion?	500 mg in a 50ml syringe
How do ICS recommend you make up a heparin infusion?	20,000 units in a 20ml syringe

Peripheral Vasopressors

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What is the smallest venflon that ICS recommend giving peripheral vasopressors in?	20G
What concentration of adrenaline does ICS recommend using if given peripherally?	80 micro/ml (1 4mg vial into a 50ml syringe)
What concentration of noradrenaline does ICS recommend using if given peripherally?	16 micro/ml (1 4mg vial into a 250ml bag)

Animal Assisted Intervention

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Plexopathy During Prone Positioning

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When proning patients in the "swimmers position", how far should you abduct the arm going up?	No more than 70 degrees
When proning patients in the "swimmers position", which way should the head face?	Towards the abducted arm
When proning patients in the "swimmers position", should they have shrugged shoulders?	A little bit yes!

Tracheostomy Care

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The ICS recommend that all patients with a tracheostomy are seen by a tracheostomy MDT
About 10% of ventilated covid patients were needing a tracheostomy

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What must you always always always remember when trying a speaking valve on a tracheostomy?	Deflate the cuff first!
Can you put a speaking valve on a tracheostomy with the cuff up?	No you'll cause aspyhxiation
Can you put a speaking valve on a tracheostomy with the cuff down?	It's the only way to do it

Guidance for Removal of Femoral Dialysis Line

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How long do ICS say you should stay lying down in bed following femoral dialysis line removal?	2 Hours
How long do ICS say you should apply pressure after removing a femoral dialysis line?	5 mins

Gas Embolism Guidance

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Does a venous gas embolism cause left sided or right sided cardiac failure?	Usually right
What should be the immediate management of Venous Gas Embolism?	100% O2, Keep Flat/Head Down
What potential additional procedure could you do in management of Venous Air Embolism?	If there is a neck line, try aspirating the air out of it.
What more complicated management should you consider for patients with gas embolism?	Hyperbaric Unit

ARDS

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What is the other name for the Murray Score in ARDS?	The Lung Injury Score
What is the other name for the Lung Injury Score in ARDS?	The Murray Score
When does the ICS recommend that you use neuromuscular blocking drugs in ARDS?	When PF ratio less than 20
When does the ICS recommend that you prone in ARDS?	When PF ratio less than 20

Eye Care In ICU

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Which patients does the ICS recommend get eye lubricants?	If theres any part of eye open
Which patients does the ICS recommend get eye lubricants and taping of lids?	If theres any part of cornea exposed
In conjunctivitis in patients in ICU, do you give ointment or drops?	Ointment (more moisturising)
If someone in ICU is septic and has a red eye, what should you think?	Worry about endophthalmitis (eye sepsis)

Analgesia and Sedation

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What do ICS recommend you start your propofol sedation dosing at?	0.3mg/kg/hr (70kg = 2ml/hr 1%)
What do ICS recommend you start your midazolam sedation dosing at?	0.15mg/kg/hr (70kg = 10mg/hr)
What do ICS recommend as an upper range for your propofol sedation dosing?	3mg/kg/hr (70kg = 20ml/hr 1%)
What do ICS recommend as an upper range for your midazolam sedation dosing?	0.6mg/kg/hr (70kg = 40mg/hr)
What was the trial that compared Dexmedatomidine to Propofol?	PRODEX
What was the trial that compared Dexmedatomidine to Midazolam?	MIDEX
Did the PRODEX trial show any differences between using propofol or dexmedatomidine for sedation?	No
Did the MIDEX trial show any differences between using midazolam or dexmedatomidine for sedation?	Dexmed had shorter times on ventilator
What do ICS recommend as a loading dose for dexmedatomidine?	1micro/kg over 10 mins
What do ICS recommend as a starting maintenance dose for dexmedatomidine?	0.2micro/kg/hr
What do ICS recommend as a starting maintenance dose for clonidine?	0.5micro/kg/hr
What do ICS recommend as an upper maintenance dose for dexmedatomidine?	0.7micro/kg/hr
What do ICS recommend as an upper maintenance dose for clonidine?	4micro/kg/hr
What do ICS recommend as a bolus dose of haloperidol?	2-10mg IV