Critical Care and Emergency Resuscitation
Resuscitation is a team sport with reversible causes
Critical care anesthesia covers shock (hypovolemic, distributive, cardiogenic, obstructive), sepsis, respiratory failure, ARDS, acute kidney injury, and post-arrest care. Use a systematic ABCDE approach, early antibiotics and source control in sepsis, balanced fluids, and vasopressors when mean arterial pressure is inadequate. Lung-protective ventilation uses low tidal volume (6 mL/kg predicted body weight), plateau pressure limits, and appropriate PEEP. Understand ACLS rhythms, defibrillation, epinephrine timing, and reversible causes (Hs and Ts).
Traps: do not delay compressions for intubation or vascular access. ETCO2 may be low in shock even with good compressions. Fluid boluses can worsen ARDS or right heart failure. Post-arrest cooling and oxygenation targets should avoid hyperoxia and hypotension. Dead is not a diagnosis until reversible causes are addressed.
Worked example: witnessed ventricular fibrillation arrest. Start CPR, defibrillate at biphasic 120–200 J, resume compressions immediately, give epinephrine 1 mg every 3–5 minutes after the second shock, and treat reversible causes. Use waveform capnography to gauge compression quality.
Rule of thumb: high-quality compressions at 100–120/min, depth 5–6 cm, full recoil, and minimal interruptions.