Critical Care and Postoperative Care
What the exam tests
Critical care and postoperative questions test recognition and rescue: respiratory failure, sepsis, delirium, pain, PONV, and ICU sedation.
Core rules
- Postoperative hypoxemia: think atelectasis, opioid-induced hypoventilation, aspiration, PE, and fluid overload. Use exam, ABG, imaging, and response to position and oxygen.
- Sepsis: fluids and antibiotics early; norepinephrine for MAP <65 after fluids.
- ARDS: low tidal volume 6 mL/kg predicted body weight, plateau <30 cmH2O, PEEP titration.
- Pain: multimodal-acetaminophen, NSAIDs when safe, regional, opioids. Avoid meperidine.
- PONV: Apfel factors-female, nonsmoker, history, postoperative opioids. Use prophylaxis in high risk.
- Delirium: nonpharmacologic first; antipsychotics are not routine.
Worked example
A 75-year-old on postoperative day 1 is confused, hypoxic, and has a respiratory rate of 8. Reasoning: opioid-induced hypoventilation is likely; stop further opioids, give oxygen, monitor capnography, and consider titrated naloxone. Also check glucose, electrolytes, and pain. Do not sedate with benzodiazepines.
Traps
Treating hypoxia with oxygen alone while ignoring ventilation; using meperidine in renal failure; giving NSAIDs in AKI; missing sepsis because of normal temperature; over-sedating delirium.