Critical Care and Emergency Anesthesia
Core Concepts
Understand the management of shock (hypovolemic, cardiogenic, distributive, obstructive), the principles of sepsis resuscitation, and the use of vasopressors and inotropes. Know the criteria for acute respiratory distress syndrome and the principles of lung-protective ventilation (tidal volume 6 mL/kg predicted body weight, plateau pressure <30 cmH2O).
Emergency Anesthesia
Know the management of the trauma patient: primary survey, damage control resuscitation, and the timing of surgery. Understand the management of the patient with a full stomach, the patient with a difficult airway, and the patient in extremis. Know the principles of rapid sequence induction and the choice of induction agent in shock (ketamine or etomidate, with awareness of adrenal suppression with etomidate).
Specific Emergencies
Understand the management of status asthmaticus, pulmonary embolism, and cardiac tamponade. Know the physiology of increased intra-abdominal pressure and abdominal compartment syndrome.
Traps
Questions often test the choice of induction agent in the shocked patient, the fluid strategy in sepsis, and the recognition of tension pneumothorax. Another trap is the belief that etomidate is always safe; it can cause adrenal suppression. Also know that permissive hypotension is appropriate in penetrating trauma before hemorrhage control.
Worked Example
A trauma patient with a systolic BP of 80 mmHg and a distended abdomen. After initial fluids, the patient remains hypotensive. The priority is hemorrhage control, not further crystalloid; use blood products in a balanced ratio and proceed to the operating room.