Critical Care

Question 1

What is the management of status asmathicus?

Answer 1

1. Salbutamol (nebulisation) + O₂
2. IV hydrocortisone
3. Ipatroprium bromide (nebulisation)
4. Magnesium IV
5. Salbutamol IV
6. Aminophyline IV
7. Intubation and ventilation

Question 2

What is the management of COVID-19?

Answer 2

Mild symptoms without hypoxia
- Supportive management

If in need of O₂
- Add dexamethasone

If ↓SPO₂ or hypoxia in spite of adequate O₂ offering
- High flow (nasal) cannula

If on mechanical ventilation
- Lung protective ventilation
- Alveoli recruitment strategies:
◆ 1st optimise PEEP
◆ 2nd (if no response) prone position.

Question 3

Describe the features of thoracic aortic dissection.

Answer 3

• Chest pain that radiates to the back in between the shoulder blades;
• BP in upper extremities varies (≠ on each arm);
• Associated to uncontrolled BP.

Question 4

What are the investigations done in thoracic aortic dissection?

Answer 4

Most appropriate / Gold standard:
- CT angiography
- Only in stable patients

Haemodynamically unstable
- Trans-oesophageal echo

Question 5

What is the management of thoracic aortic dissection?

Answer 5

• IV Labetalol
• Aim for SBP 100 - 120 mmHg
• Surgery (if appropriate)

Question 6

What is refeeding syndrome?

Answer 6

Metabolic disturbances occuring after reinstitution of carbohydrates on a starved patient.

Question 7

What are the symptoms of refeeding syndrome?

Answer 7

• Hypophosphatemia
• Hypomagnesaemia
• Hypokalaemia

Question 8

What is the management of refeeding syndrome?

Answer 8

• Correction of electrolyte imbalance;
• IV fluids.

Prevention
- Feeds should be given slowly;
- Monitor electrolytes.

Question 9

What are the electrolyte imbalances seen after a massive blood transfusion?

Answer 9

• Hypocalcaemia
• Hypomagnesaemia
• Hypo or Hyperkalaemia
• Metabolic alkalosis