Outline the physiological consequences of therapeutic hypothermia at 32 degrees Celsius
It is well documented and often stressed that the Primary Exam is focused upon the basic sciences that underpin clinical Intensive Care. It will examine a candidates understanding of, for example, the physiology associated with a clinical circumstance. Many candidates discussed why we use therapeutic hypothermia after cardiac arrest rather than outline the physiological consequences of hypothermia at 32 degrees Celsius, for which they would not have scored any marks. A good answer was expected to outline changes in metabolism as well as specific organ responses such as cardiovascular (e.g. bradycardia; vasoconstriction; decreased cardiac output, etc), respiratory (decreased minute volume; haemoglobin-oxygen dissociation curve moves left; increased anatomical dead space; diminished HPV; increased pulmonary vascular resistance, etc), renal (e.g. diuresis, changes to GFR, etc) as well as other organs. Again candidates failed to synthesize a coherent and detailed answer.
It is impossible to retort directly to the examiners without knowing the content of the candidate's answers here, but one must counter their last comment by reminding them of all the times the college failed to synthesize a coherent question.
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Endocrine and metabolic consequences
Haematological consequences
Respiratory consequences
Acid-base changes: alkalosis and hypocapnea
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Pharmacological consequences
Cardiovascular consequences
Renal consequences
Central nervous system effects
Immunological consequences
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Wong, K. C. "Physiology and pharmacology of hypothermia." Western Journal of Medicine 138.2 (1983): 227.
Polderman, Kees H. "Application of therapeutic hypothermia in the intensive care unit." Intensive care medicine 30.5 (2004): 757-769.
Polderman, Kees H. "Mechanisms of action, physiological effects, and complications of hypothermia." Critical care medicine 37.7 (2009): S186-S202.