SC02 - Anesthesiology - ICU

Question 1

ICU
- Functions
- Staffing

Answer 1

Intensive Care Unit (ICU) function:

• Therapy for life-threatening illnesses, injuries and complications
• monitoring of potentially life-threatening conditions and organ function
• provides special expertise and facilities for vital organ support
• Salvage reversible end-organ damage for eventual recovery

Staffing:
- Nurse: patient ratio of 1:1 for ventilated patient, 1:2 for lower acuity
- Qualifications in Intensive Care, ALS
- Doctors: Physicians, Anesthesiologists
- Support: Surgeons, Physiotherapists, Pharmacists, Dieticians, Microbiologists

Question 2

Types of intensive monitoring in ICU

Answer 2

Cardiovascular:
- ECG, CVP, invasive arterial bloodpressure monitoring, temperature

Renal:
- RFT, UO (foley)

Respiratory:
- RR, Waveform capnograph (intubated)

Neurological:
- EEG

Question 3

Modalities of life support in ICU

Answer 3

Respiratory:
- Invasive/ non-invasive ventilators, High flow O2

Renal:
- Plasmapheresis, Hemofiltration, Hemodialysis, Peritoneal dialysis, Cytokine adsorption

Cardiocirculatory:
- Extracorporeal circulation, temperature regulator, CPR

Hepatic:
- Hepatic coma care, Liver dialysis (Molecular Adsorbent Recycling System (MARS) (outdated))

Neurological:
- Acute coma care, acute post-infectious polyneuropathy care

Drug:
- Overdose/ desensitization care

Others:
- Metabolic: thyroid storms, DKA, electrolytes
- Obstetric emergencies
- Burns/ wound complications

Question 4

Triage logic for ICU admission

Answer 4

• Patient consent/ preference
• Disease severity/ prognosis
• Reversibility of condition or organ damage
• Quality of Life: co-morbidities, disease progression and expected sequalae after admisssion

Question 5

Pros and Cons of ICU admission

Answer 5

Pro:
- Life-saving
- Intensive therapy and monitoring to salvage important organ function

Cons:
- Invasive procedures
- Infection risks/ nosocomial infections
- Loss of self-esteem/ psychosocial co-morbidities
- Delirium development and long-term cognitive impairmen
- Long-term performance status impairment

Question 6

Life-sustaining processes that can be withdrawn under patient consent

Answer 6

DNR/ DNACPR
Withdrawal of circulatory support: Inotropes, Vasopressors, blood products…
Withdrawal of ventilator/ limitation of ventilator settings
Withdrawal of Renal replacement therapy

Question 7

End-points to measure ICU outcome

Answer 7

• Absolute mortality rate
• Standardized Mortality Ratio (SMR): mortality of one ICU unit compared to reference data base,
   APACHE Score (Acute Physiology and Chronic Health Evaluation)
   SAPS Score (Simplified Acute Physiology Score)
   MPM (Mortality Prediction Model)
• Quality of life during stay and after discharge
• Subjective opinion of patient comfort

Question 8

Outlin APACHE score for ICU outcomeS

Answer 8

Question 9

Definition of ARDS

Answer 9