CICM First Part flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Sepsis-3 definition

Life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ dysfunction defined as an acute increase in SOFA score of at least 2 points.

Septic shock criteria

Sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.

ARDS Berlin definition

Acute onset within 1 week, bilateral opacities on imaging, respiratory failure not fully explained by cardiac failure or fluid overload, and PaO2/FiO2 ≤300 mmHg with PEEP ≥5 cmH2O.

Lung-protective ventilation

Use tidal volume 6 mL/kg predicted body weight and keep plateau pressure ≤30 cmH2O; permissive hypercapnia is acceptable to minimize ventilator-induced lung injury.

KDIGO AKI stage 1

Increase in serum creatinine ≥26.5 µmol/L within 48 hours, or increase to 1.5–1.9 times baseline known or presumed to have occurred within the prior 7 days.

First-line vasopressor

Norepinephrine is the first-line vasopressor in septic shock; add vasopressin (up to 0.03 U/min) to reduce norepinephrine dose or achieve MAP target.

Restrictive transfusion threshold

In critically ill patients, transfuse red cells when haemoglobin <70 g/L; consider a threshold of <80 g/L in patients with acute coronary syndrome.

Stress ulcer prophylaxis

Indicated in mechanically ventilated patients >48 hours or those with coagulopathy; use a proton pump inhibitor or H2 receptor antagonist.

Paediatric fluid bolus

For paediatric septic shock, give 10–20 mL/kg crystalloid boluses, reassessing after each; total up to 40–60 mL/kg in the first hour may be needed.

Paediatric hypotension threshold

Systolic blood pressure below 70 + (2 × age in years) mmHg for children aged 1–10 years; below 60 mmHg for neonates; below 90 mmHg for children over 10 years.

Holliday-Segar maintenance fluids

Calculate hourly maintenance fluid as 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kg above 20.

Paediatric ARDS definition

Onset within 7 days, new infiltrates on chest imaging, and oxygenation deficit with oxygen saturation index ≥5 or PaO2/FiO2 ≤300 on invasive ventilation.

Paediatric defibrillation energy

First shock 2 J/kg, second shock 4 J/kg, and subsequent shocks at least 4 J/kg (maximum 10 J/kg or adult dose).

Paediatric epinephrine arrest dose

For paediatric cardiac arrest, give epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO and repeat every 3–5 minutes.

Paediatric head injury targets

Avoid hypotension and hypoxia; maintain normocapnia (PaCO2 35–40 mmHg) unless herniation is suspected, when brief hyperventilation may be used.

Propofol infusion syndrome risk

Prolonged propofol infusion, especially at high doses in children, can cause metabolic acidosis, rhabdomyolysis, and cardiac failure; limit dose and duration.

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.

Succinylcholine contraindications

Avoid in hyperkalaemia, burns older than 24 hours, spinal cord injury beyond 48 hours, crush injury, malignant hyperthermia susceptibility, and pseudocholinesterase deficiency.

Malignant hyperthermia treatment

Dantrolene 2.5 mg/kg IV bolus, repeated until symptoms resolve; provide supportive cooling, treat acidosis with bicarbonate, and manage hyperkalaemia.

Lipid emulsion for LAST

For local anaesthetic systemic toxicity, give 20% lipid emulsion 1.5 mL/kg bolus followed by infusion at 0.25 mL/kg/min; continue resuscitation and benzodiazepines for seizures.

Maximum lidocaine dose

Lidocaine maximum dose is 3 mg/kg without adrenaline and 7 mg/kg with adrenaline; do not exceed these to avoid systemic toxicity.

Apfel PONV score

Predicts postoperative nausea and vomiting using female sex, non-smoking status, history of PONV or motion sickness, and postoperative opioids; use prophylaxis for score ≥2.

Opioid equianalgesic conversion

Approximate oral morphine 30 mg equals oral oxycodone 20 mg, IV morphine 10 mg, or IV fentanyl 100 µg; adjust for tolerance and incomplete cross-tolerance.

Spinal anaesthesia hypotension

Prevent or treat with crystalloid co-load 10–15 mL/kg, vasopressors (phenylephrine or ephedrine), and left uterine displacement in obstetric patients.

STEMI reperfusion timing

Primary PCI should be performed within 120 minutes of first medical contact; if not feasible, give fibrinolysis within 30 minutes of diagnosis unless contraindicated.

Heart failure quadruple therapy

For heart failure with reduced ejection fraction, combine ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor to improve survival.

DKA management principles

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.

CURB-65 score

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

Acute pancreatitis diagnosis

Requires two of three: characteristic abdominal pain, lipase >3 times upper limit of normal, and imaging findings; initial management includes aggressive lactated Ringer's and analgesia.

Stroke thrombolysis window

Alteplase or tenecteplase within 4.5 hours of symptom onset; contraindications include uncontrolled hypertension >185/110 mmHg and recent surgery.

Hyponatraemia correction limit

Correct serum sodium by no more than 8–10 mmol/L in 24 hours to avoid osmotic demyelination; use hypertonic saline boluses for severe symptomatic cases.

COPD exacerbation oxygen target

Titrate oxygen to target SpO2 88–92% in acute exacerbation of COPD; use non-invasive ventilation for respiratory acidosis and give systemic corticosteroids and antibiotics if indicated.