ICU

Question 1

Oral Potassium replacement

Answer 1

Sando K 1-2 tabs BD/TDS

Question 2

NG potassium replacement

Answer 2

Kay-Cee-L (20-40mmol)

Question 3

IV potassium replacement

Answer 3

Peripheral: Max 40mmol/500ml

Central: max 60mmol/60ml

Rate 10-20mmol/hr

Question 4

IV Magnesium replacement

Answer 4

10-20mmol over 12-24hr

To avoid exceeding renal threshold

Question 5

Oral/NG phosphate replacement

Answer 5

Phosphate sandoz 1-2 tabs TDS

Question 6

IV phosphate replacement

Answer 6

Phosphate polytusor 100-200ml over 12h

Question 7

TBI

CPP aim

Answer 7

60-70mmHg

Adjust with fluid/vasopressors

Question 8

TBI
Physiological aims
(If CPP 60-70)

Answer 8

PaO2>13
PaCO2<4.5-5
BG=6-10
Na = 140-155
Temp = 35-37.9
Head tilt = 20•
Keppra 7 days
Hb>80
Enteral feeding
Sedation

Question 9

Management ICP>20

Irrespective of CPP

Answer 9

1) Adequate sedation, unobstructed venous drainage and appropriate ventilation?
2) CT head to exclude surgical reason
3) 5% saline 100ml boluses (CVC), and furosemide 10-20mg - aim Na and negative fluid balance ~0-500ml/day
4) Cool 34C, vecuronium, check amylase and clotting daily
5) PaCO2 to 4kPa
6) decompressive craniotomy?
7) thiopentone infusion

Question 10

TBI
ICP>30
(Emergency)

Answer 10

1) Propofol bolus
2) vecuronium
3) 5% saline 100ml +- furosemide 10-20mg
4) increase ventilation until ICP stabilised

Question 11

SUP
(Stress ulcer prophylaxis)
For patients on mechanical vent
Tx

Answer 11

Feeding or
IV ranitidine 50mg TDS
PO/NG ranitidine 150mg BD
If coagulopathy: 
IV omeprazole 40mg OD
PO/NG lansoprazole fastab 30mg OD

Question 12

Reduced ranitidine dose

Renal replacement or eGFR<50

Answer 12

IV ranitidine 50mg BD

PO/NG ranitidine 100mg OD

Question 13

Pneumonia Ix

Answer 13

Atypical serology
Blood culture 
HIV test
Urine legionella and pneumococcal antigen 
Sputum MC+S
\+\- virology PCR
\+\- pleural fluid

Question 14

Fluid bolus for septic shock

Answer 14

30ml/kg

Question 15

CVC for sepsis

Answer 15

1) refractory hypotension
2) lactate >4 after fluid
3) norad as 1st line 8/50
4) MAP>65
5) consider echo, piCCO, dobutamine, vasopressin, hydrocortisone