Surgical Critical Care
Core concepts
Critical care questions test shock recognition and resuscitation, sepsis management, ventilator basics, and acid-base interpretation. Understand the categories of shock (hypovolemic, distributive, cardiogenic, obstructive) and the early priorities: airway, oxygenation, and perfusion. Sepsis bundles emphasize early antibiotics, source control, and fluid resuscitation. Know the difference between respiratory and metabolic acidosis/alkalosis and how to calculate an anion gap.
Traps
- Shock type confusion: hypotension with warm extremities and low systemic vascular resistance suggests distributive (septic) shock; cool extremities and elevated resistance suggest cardiogenic or hypovolemic.
- Source control: antibiotics alone don't fix an undrained abscess or perforation; questions reward identifying the need for source control.
- Acid-base: always check the anion gap in metabolic acidosis; a normal gap suggests bicarbonate loss (diarrhea, renal tubular acidosis) rather than ketoacidosis or lactic acidosis.
- Fluid responsiveness: not every hypotensive patient needs more fluid; assess response and consider vasopressors in septic shock.
Rule of thumb
In undifferentiated shock, start with ABCs, obtain lactate and blood cultures, give broad-spectrum antibiotics early in suspected sepsis, and pursue source control. Reassess perfusion with urine output, mentation, and lactate clearance.
Worked example
A postoperative patient with fever, hypotension, and warm extremities: suspect septic shock. Draw cultures, give antibiotics promptly, resuscitate with fluids, add vasopressors if needed, and search for a surgical source requiring drainage.