As prepared by Chris Nickson, here are the practice written questions from a recent CICM Second Part exam practice session at The Alfred ICU, with recommended reading from LITFL.com Critical Care Compendium and other FOAM sources:
Q1.
- Discuss the advantages and disadvantages of using pulse oximetry to target oxygen therapy (50%)
- What SpO2 targets do you use in ICU patients and why? (50%)
Q2.
Outline the initial assessment of severe burns injury, including how you will calculate fluid resuscitation requirements.
Q3.
Outline the key considerations for the early post-operative ICU care of a patient who had open surgery for Type A aortic dissection.
Relevant history?
- Extent of type A dissection – Branches involved? AR? Pericardial tamponade?
- Patient comorbidities, allergies, and premorbid function
- Timeliness of diagnosis and time to OT
- Cause? (atraumatic vs traumatic – other injuries?)
Operative course?
- Surgery
- AVR? CAGS? Aortic root replacement? Hemiarch repair? Stents? Grafts?
- CPB – partial (22-28C) / total circulatory arrest (18 – 22C)? Cross clamp time?
- Drains? (location, output), ?lumbar drain (if dissection extends distally to prevent spinal cord injury)
- Anaesthesia
- Airway and ventilation?
- Haemodynamics and monitoring? (e.g. cerebral ox, ECG, TOE, differential BPs)
- Bleeding? Blood products?
- Medications? (e.g. inotropes, ABX, steroids, haemostasis)
- Lines? (maybe multiple arterial lines) Epidural? Devices? (?pacing, PAC)
Post-operative management:
- Specific:
- BP management targets? (e.g. SBP <120, avoid hypotension = associated with paraplegia) Best site to measure? HR control? (shear stress on suture lines)
- Ongoing coagulopathy/ bleeding? (FBC, coags, +/- TEG/ROTEM)
- Extubate when no return to OT, warm, pain controlled, and protects own airway
- Seek and treat complications from hypoperfusion, branch occlusion, and surgery
- Chest – wounds, drain outputs, PTX, HTX, atelectasis
- Cardiac – valve dysfunction, ischemia, conduction defects (ECG, Echo)
- CPB Cx (e.g. vasoplegia, organ dysfunction, coagulaopathy)
- Vessels – vascular obs all limbs – consider doppler US/ CTA – may need stents
- Neuro – desedate early to assess, CTB/ MRI if indicated
- Renal – UO, Cr (?need RRT)
- Abdo pain, LFTs, lipase – GI branches/ perfusion
- Supportive care
- Temperature – rewarm? (avoid hyperthermia)
- Fluid (aim euvolaemia)
- Nutrition (often NBM; consider early PN if malnourished)
- Analgesia (medications, epidural)
- VTE prophylaxis (usually withhold first 24h)
You can access an extensive set of past practice questions dating back to 2014 here:
https://docs.google.com/document/d/1_Ta8IvVaVtc5Il7-kJwj6qKGu54OmifJGRUWCXud8dY/