CICM First Part cheat sheet

Sepsis-3 definition: life-threatening organ dysfunction due to dysregulated host response to infection; organ dysfunction defined as an increase in SOFA score of ≥2 points.

Septic shock: sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate volume resuscitation.

ARDS Berlin definition: acute onset within 1 week, bilateral opacities not fully explained by effusion/collapse/nodule, respiratory failure not fully explained by cardiac failure/fluid overload, and PaO2/FiO2 ≤300 mmHg with PEEP ≥5 cmH2O.

Ventilator-induced lung injury prevention: use low tidal volume (6 mL/kg predicted body weight) and plateau pressure ≤30 cmH2O; permissive hypercapnia is acceptable.

Acute kidney injury KDIGO staging: Stage 1: creatinine rise ≥26.5 µmol/L in 48h or 1.5–1.9× baseline; Stage 2: 2.0–2.9×; Stage 3: ≥3.0× or creatinine ≥354 µmol/L or initiation of renal replacement therapy.

Vasopressor of choice in septic shock: norepinephrine first-line; add vasopressin (up to 0.03 U/min) to reduce norepinephrine dose or reach MAP target.

Transfusion threshold in critically ill: restrictive strategy (Hb <70 g/L) is non-inferior to liberal in most patients; consider <80 g/L in acute coronary syndrome.

Stress ulcer prophylaxis indication: mechanical ventilation >48h or coagulopathy; use proton pump inhibitor or H2 receptor antagonist.

Delirium screening: use CAM-ICU or ICDSC; non-pharmacological measures first; avoid benzodiazepines unless alcohol withdrawal or specific indication.

Paediatric septic shock: fluid boluses of 10–20 mL/kg crystalloid (up to 40–60 mL/kg in first hour) with reassessment; avoid fluid overload; start vasoactive if shock persists after 40–60 mL/kg.

Paediatric hypotension thresholds: systolic BP <70 + (2 × age in years) mmHg for ages 1–10; for neonates <60 mmHg; for children >10 years <90 mmHg.

Paediatric maintenance fluids: Holliday-Segar method: 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg above 20; use isotonic crystalloid with 5% dextrose to avoid hyponatraemia.

Paediatric ARDS (PARDS) definition: onset within 7 days, chest imaging showing new infiltrates, and oxygenation deficit with oxygen saturation index (OSI) ≥5 or PaO2/FiO2 ≤300 on invasive ventilation.

Paediatric ventilation: lung-protective tidal volumes 5–7 mL/kg predicted body weight; permissive hypercapnia; target SpO2 92–97%.

Paediatric head injury: avoid hypotension (systolic BP <5th percentile for age) and hypoxia (SpO2 <90%); maintain normocapnia (PaCO2 35–40 mmHg) unless herniation suspected.

Paediatric defibrillation energy: first shock 2 J/kg, second 4 J/kg, subsequent ≥4 J/kg (max 10 J/kg or adult dose).

Paediatric epinephrine dose for cardiac arrest: 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO; repeat every 3–5 minutes.

Paediatric sedation: dexmedetomidine increasingly used; caution with propofol for prolonged infusion (propofol infusion syndrome risk).

Mallampati classification: Class I: soft palate, uvula, fauces, pillars visible; Class II: soft palate, uvula, fauces; Class III: soft palate, base of uvula; Class IV: hard palate only.

Difficult mask ventilation predictors: age >55, BMI >26, edentulous, beard, Mallampati III/IV, limited jaw protrusion; use MOANS mnemonic.

Succinylcholine contraindications: hyperkalaemia, burns >24h old, spinal cord injury >48h, crush injury, malignant hyperthermia susceptibility, pseudocholinesterase deficiency.

Malignant hyperthermia: triggered by volatile anaesthetics and succinylcholine; treat with dantrolene 2.5 mg/kg IV bolus, repeat until symptoms resolve; supportive cooling and bicarbonate for acidosis.

Local anaesthetic systemic toxicity: stop injection, secure airway, benzodiazepines for seizures, 20% lipid emulsion 1.5 mL/kg bolus then 0.25 mL/kg/min infusion; maximum dose lidocaine 3 mg/kg without adrenaline, 7 mg/kg with adrenaline.

Spinal anaesthesia hypotension: preload with crystalloid 10–15 mL/kg or co-load; treat with vasopressors (phenylephrine or ephedrine) and left uterine displacement in obstetric patients.

Postoperative nausea and vomiting (PONV) prophylaxis: Apfel score (female, non-smoker, history of PONV/motion sickness, postoperative opioids); use 2 interventions for score ≥2 (e.g., ondansetron + dexamethasone).

Acute pain management: multimodal analgesia with paracetamol, NSAIDs, opioids; for neuropathic pain consider gabapentinoids or ketamine; opioid tolerance requires higher doses.

Opioid conversion: oral morphine 30 mg ≈ oral oxycodone 20 mg ≈ IV morphine 10 mg ≈ fentanyl 100 µg IV (approximate equianalgesic doses).

Acute coronary syndrome: STEMI requires immediate reperfusion (primary PCI within 120 min of first medical contact); give aspirin 300 mg, P2Y12 inhibitor, anticoagulation, and consider oxygen only if SpO2 <90%.

Heart failure with reduced ejection fraction: quadruple therapy with ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor improves survival.

Diabetic ketoacidosis management: isotonic saline resuscitation, insulin infusion 0.1 U/kg/h after initial bolus, potassium replacement if K+ <5.5 mmol/L, and add dextrose when glucose <14 mmol/L to continue insulin.

Hyperosmolar hyperglycaemic state: profound dehydration, high osmolality, minimal ketosis; fluid replacement is cornerstone; insulin only after adequate fluids; monitor for cerebral oedema.

Acute exacerbation of COPD: controlled oxygen to target SpO2 88–92%, nebulised bronchodilators, systemic corticosteroids (prednisolone 30–40 mg for 5–7 days), antibiotics if increased sputum purulence, and non-invasive ventilation for respiratory acidosis.

Community-acquired pneumonia severity: CURB-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30, Blood pressure systolic <90 or diastolic ≤60, Age ≥65); score ≥2 consider hospital admission, ≥3 consider ICU.

Acute pancreatitis: diagnose with 2 of 3 (typical pain, lipase >3× upper limit, imaging); initial management with aggressive fluid resuscitation (lactated Ringer's), analgesia, and early enteral nutrition when tolerated.

Stroke thrombolysis: alteplase or tenecteplase within 4.5 hours of symptom onset; contraindications include recent surgery, uncontrolled hypertension (>185/110 mmHg), and anticoagulation with INR >1.7.

Hyponatraemia correction: maximum 8–10 mmol/L in 24 hours to avoid osmotic demyelination; for severe symptomatic hyponatraemia, hypertonic saline boluses (100–150 mL 3%) and frequent sodium checks.