Outline the important management principles in treating a patient who has been admitted to your ICU intubated and ventilated immediately following successful resuscitation from an out of hospital cardiac arrest.
Post-resuscitation care has an impact on overall outcome and consists of ongoing resuscitation and organ support, neuroprotection, treatment of the cause of the cardiac arrest and management of underlying co-morbidities.
Let us deconstruct this answer. This question interrogates the candidate's ability to approach a post-arrest patient in a systematic manner. Of course, the natural tendency of any ICU trainee would be to immediately start ranting about therapeutic hypothermia (hard to blame them, of course - it is indeed an exciting topic). And then to strat ranting about family discussions. The savvy candidate will note that there is no mention of family discussions in the model answer.
The answer is organised in a familiar A-B-C-D of resuscitation. I have both a brief summary of post-resuscitation care, and a prolonged elaboration of this topic. In brief, a structured answer would resemble the following:
First, the college wants you to acknowledge that the patient is intubated, and that you are concerned about their ETT position. This, as a matter of general principle, is never wrong.
Secondly, the college wants you to acknowledge that you would pursue normoxia and normocapnea.
TTE, angiography, fluids and vasopressors are mentioned - again, this is consistent with the AHA guidelines.
Therapeutic hypothermia is mentioned, and it would be amiss to write an answer to this question without discussing this.
Overall, the model answer expects nothing suprising or inventive from the candidate. The only unusual feature is the mention of ECMO, which (unlike the rest of the answer) does not have strong evidence behind it in post-resuscitation care.
Kilgannon, J. Hope, et al. "Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality." JAMA: The Journal of the American Medical Association 303.21 (2010): 2165-2171.
Peberdy, Mary Ann, et al. "Part 9: Post–Cardiac Arrest Care 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation 122.18 suppl 3 (2010): S768-S786.
Stub, Dion, et al. "Post Cardiac Arrest Syndrome A Review of Therapeutic Strategies." Circulation 123.13 (2011): 1428-1435.