CICM First Part case studies
CICM First Part · Put your knowledge to work in context.
The First Part Examination is one of the assessments administered within the training and education program of the College of Intensive Care Medicine (CICM), the body responsible for intensive care medicine specialist training and education in Australia and Aotearoa New Zealand. It sits within a broader assessment framework that CICM describes as including a mix of in-training evaluations, exams, Workplace Competency Assessments, Observed Clinical Encounters and Formal Projects. The CICM First Part case studies are 5 cases and about 3,271 words.
1Septic shock with conflicting resuscitation targets
A 68-year-old man with type 2 diabetes and chronic kidney disease (baseline creatinine 180 micromol/L) presents with a 3-day history of fever and right lower lobe pneumonia. On arrival: temperature 39.1 C, heart rate 124/min, blood pressure 82/48 mmHg, respiratory rate 30/min, SpO2 91% on 15 L non-rebreather.
681 words, about 3 min2A child with diabetic ketoacidosis and a headache
A 9-year-old girl (weight 30 kg) with newly diagnosed type 1 diabetes is admitted to a district hospital with vomiting and drowsiness. Glucose 32 mmol/L, pH 7.09, bicarbonate 8 mmol/L, ketones 5.8 mmol/L, sodium 131 mmol/L, urea 11 mmol/L.
647 words, about 3 min3Postoperative pain in a patient on buprenorphine
A 44-year-old woman on long-term buprenorphine/naloxone 16/4 mg daily for opioid use disorder undergoes an emergency laparotomy for a perforated sigmoid colon. She receives a standard general anaesthetic with fentanyl and morphine.
600 words, about 3 min4Hyponatraemia in an elderly patient after a fall
An 81-year-old woman is brought in after a mechanical fall at home. She takes hydrochlorothiazide and sertraline.
600 words, about 3 min5Ventilator weaning in a patient with a difficult airway
A 57-year-old man with obesity (BMI 41), obstructive sleep apnoea, and a previous difficult intubation (Cormack-Lehane grade 3, requiring a videolaryngoscope and a bougie) has been ventilated for 6 days after an emergency laparotomy for ischaemic bowel. He is now awake, obeying commands, with a cuff leak present, FiO2 0.35, PEEP 8 cmH2O, peak pressures 28 cmH2O, and a spontaneous breathing trial on pressure support 8/5 has been tolerated for 30 minutes with respiratory rate 24/min, tidal volume 380 mL, and no desaturation.
743 words, about 4 min