Critical Care and Intensive Care Medicine
Core concepts
Understand the physiology and management of shock: hypovolemic, cardiogenic, distributive, and obstructive. Know the principles of sepsis management, including early antibiotics, fluid resuscitation, and vasopressor support. Master the interpretation of arterial blood gases, including compensation for metabolic and respiratory disorders. Understand ventilator modes and the lung-protective strategy (low tidal volume, appropriate PEEP, plateau pressure limits). Know the management of acute respiratory distress syndrome, acute kidney injury, and delirium. Recognize the presentation and management of common ICU emergencies: tension pneumothorax, cardiac tamponade, and airway obstruction.
Traps in questions
- Misinterpreting a mixed acid-base disorder by assuming a single primary process.
- Forgetting that permissive hypercapnia is acceptable in lung-protective ventilation but not in raised ICP.
- Treating hypotension with fluids alone in cardiogenic shock; inotropes may be needed.
- Overlooking that sepsis can present with normal blood pressure but elevated lactate.
- Assuming a normal chest radiograph excludes ARDS early in its course.
Worked example / rule of thumb
A patient with sepsis and lactate of 4 mmol/L but normal blood pressure still has tissue hypoperfusion; start antibiotics and fluids promptly. Rule of thumb: in a mixed acid-base picture, calculate the expected compensation and compare with the measured values to identify a second disorder.
Exam framing
Questions often ask the first intervention in shock. Prioritize airway, breathing, and circulation, then source control and antibiotics in sepsis, and choose vasopressors when fluids are insufficient.