Critical Care Concepts

Question 1

During resuscitation, what circumstances (9) mandate contact with clinical advice line within 15min of starting CPR?

Answer 1

Question 2

What is the general discontinuation criteria?

Answer 2

Question 3

What is the rapid discontinuation criteria?

Answer 3

Question 4

Verification of death exam parts?

Answer 4

Question 5

When deciding to commence or withhold resuscitation, what legal factors need to be considered?

Answer 5

Question 6

Describe the “Bundles of Care” for cardiac arrest management

Answer 6

Question 7

What are the expected pre-ductal SpO2 in the neonate?

Answer 7

Question 8

Describe the neonatal resuscitation algorithm

Answer 8

Question 9

Describe the paediatric cardiac arrest algorithm

Answer 9

Question 10

Describe post-ROSC management

Answer 10

Question 11

Describe the traumatic arrest management algorithm

Answer 11

Question 12

Describe strategies for managing cardiac arrest with suspected asthmatic/lung disease aetiology

Answer 12

Question 13

Discuss management of CPR-induced consciousness

Answer 13

Question 14

Describe management of hypothermic cardiac arrest

Answer 14

Consider prolonging resuscitation until warmed
# Consider transfer to ECMO-available hospital
# If < 30 deg and in PEA, assess for pulse over 1 minute and consider EtCO2 or USS if available to confirm cardiac output. CPR may precipitate VF in this cohort
# WITHHOLD drugs until warmed to > 30 deg
# >30 and <35 deg, double drug intervals ie adrenaline Q8min
# >35 deg revert to normal drug intervals
# If <30 deg & in VT/VF, give 3x DCCS then withhold until >30deg

Question 15

Discuss issues with ventilation in obese patients

Answer 15

Question 16

How should an arrest with a PPM/ICD in situ be managed?

Answer 16

Place defibrillator pads >8cm from device
# AP and AL positions both acceptable

Question 17

What accommodations should be made for a pregnant patient in cardiac arrest?

Answer 17

Tilt to L) lateral to avoid aortocaval compression
# Intubation to facilitate higher Paw and/or PIP
# Downsize tracheal tube by 0.5-1mm due to airway oedema
# Place compressions superiorly due to gravid uterus

Question 18

Describe approach to tracheostomy/laryngectomy management

Answer 18

Question 19

What are the (7) contraindications of CPAP?

Answer 19

Question 20

What is the FiO2 of each CPAP Paw?

Answer 20

Question 21

What does a this waveform represent?

Answer 21

Question 22

What does a Curare-cleft represent?

Answer 22

Question 23

What does a prominent phase IV represent?

Answer 23

Question 24

What does a dimorphic phase II represent?

Answer 24

Question 25

What does this waveform represent?

Answer 25

Question 26

What does this waveform represent?

Answer 26

Question 27

Discuss EtCO2 values in cardiac arrest

Answer 27

Question 28

Describe asthma pathophysiology

Answer 28

Bronchospasm

Question 29

Describe COPD pathophysiology

Answer 29

Question 30

Describe obstructive lung ventilation strategies

Answer 30

General Strategy # Aim for largest ETT that can be passed #Optimise IV & NEB bronchodilators (B2, steroids, Mg2+) # Smaller tV 6-8mL/kg # Lower frequency (~6-8/minute) --> Higher levels of sedation may be required --> Sustained paralysis may be required for desynchrony # ZEEP (or PEEP <3-5cmH2O if you absolutely insist) # Prolonged I:E ratios (1:4-6) # Short inspiratory times (to prolong I:E ratio) # Tolerate hypercapnoea # Monitor for tension pneumonthorax If on MV # Tolerate high PIP # Greater PIP - Pplat difference reflects degree of bronchospasm #Paw not necessarily indicative of alveolar pressure

Question 31

Describe restrictive ventilation strategies

Answer 31

General strategy # Smaller tV # Higher frequency (14 - 20) # Higher PEEP to maximise recruitment (>5cmH2O)

Question 32

What is a normal V/Q ratio?

Answer 32

0.8 (4L ventilation/5L cardiac output)

Question 33

Describe the concept of dead space

Answer 33

Adequately ventilated spaces of lung that have nil or poor perfusion

Question 34

Describe the VQ ratios in relationship to areas of lung

Answer 34

Question 35

Describe the differences between the right and left ventricle, especially in terms of pressure and volume relationships

Answer 35

"The right ventricle is volume-tolerant (preload) and pressure-intolerant (afterload)"

Question 36

Describe ECG changes in RV hypertrophy/strain

Answer 36

Question 37

What are the Well's criteria (7) for pulmonary embolism?

Answer 37

Question 38

Explain the pathophysiology of obesity hypoventilation syndrome?

Answer 38

Question 39

What does lung compliance refer to?

Answer 39

Question 40

What is base excess?

Answer 40

Question 41

What pulmonary pressure is considered hypertensive?

Answer 41

Question 42

What is the management of pulmonary hypertension?

Answer 42

Question 43

Describe the manifestations of serotonin syndrome?

Answer 43

Question 44

Describe the manifestations of neuroleptic malignant syndrome>

Answer 44

Question 45

What are the components of the modified Sgarbossa criteria?

Answer 45

Question 46

What does MOANS stand for (in reference to BVM)?

Answer 46

Question 47

What does RODS stand for (in reference to SGA)?

Answer 47

Question 48

What does LEMON stand for?

Answer 48

Question 49

What happens to alveoli during apnoea?

Answer 49

Question 50

What are risk factors for aspiration?

Answer 50

Question 51

What are the issues with obstetric airway management?

Answer 51

Question 52

Name three causes of intrathoracic airway obstruction?

Answer 52

Question 53

Explain the oxyhaemoglobin dissociation curve

Answer 53

Question 54

Explain a rightward shift on the oxyhaemoglobin dissociation curve

Answer 54

Question 55

Explain a leftward shift on the oxyhaemoglobin dissociation curve

Answer 55

Question 56

Explain the Haldane effect

Answer 56

Question 57

What are the risk factors for laryngospasm?

Answer 57