Surgical Critical Care
Core concepts
Focus on shock recognition and resuscitation, sepsis management, ventilator strategy, and post-operative complications. Know the Surviving Sepsis bundles: early antibiotics, fluid resuscitation, lactate clearance, and vasopressors when mean arterial pressure is inadequate. Understand ARDS with low tidal volume ventilation and permissive hypercapnia.
Organ support
- Hemodynamics: distinguish hypovolemic, cardiogenic, distributive, and obstructive shock by filling pressures, cardiac output, and response to fluids.
- Renal replacement indications: refractory acidosis, hyperkalemia, volume overload, uremia.
- Nutrition: early enteral feeding when feasible.
- Sedation and delirium: minimize sedation, assess daily.
Traps
- Giving large fluid boluses in cardiogenic shock.
- Missing abdominal compartment syndrome in a distended, oliguric patient.
- Ignoring lactate trends.
- Confusing ARDS with cardiogenic pulmonary edema.
Worked example
A post-op patient with fever, hypotension, and rising lactate: start broad-spectrum antibiotics within an hour, give balanced crystalloid, reassess perfusion, and add norepinephrine if MAP remains below target. Rule of thumb: in septic shock, antibiotics and source control outrank any single fluid number.
Study strategy
Practice interpreting hemodynamic profiles and ventilator settings. Link each shock type to its expected filling pressure and cardiac output.