A free online resource for Intensive Care Medicine
Table of Contents
CICM First Part Exam Revision Notes and Questions
CICM Second Part Exam Revision Notes and Questions
New Chapters
Pulmonary complications of liver disease
Sunday, April 23 (2023); Gastroenterology and Hepatology
Hepatopulmonary syndrome is a consequence of excessive vasodilatation due to liver disease, and porto-pulmonary hypertension is a consequence of excessive vasoconstriction. It appears liver disease has the capacity to both increase pulmonary vascular resistance by failing to degrade vasoconstrict substances, and to decrease pulmonary vascular resistance by enhancing the synthesis of vasodilatory mediators.
Unfractionated and low molecular weight heparin
Tuesday, April 18 (2023); Haematological system
Heparin is a heterogenous mixture of mucopolysaccharides, termed glycosaminoglycans. It is essentially a polymerised disaccharide, a starch. This drug is a staple of ICU anticoagulation, and one would do well to become very familiar with its properties.
Graft versus host disease
Saturday, April 22 (2023); Haematology and Oncology
Graft vs host disease (GVHD) is usually a complication of haematopoietic stem cell transplantation (HSCT) but can also result from blood transfusion, granulocyte transfusion, CAR-T cell therapy and rarely from solid organ transplantation.
Palliative medicine in the ICU
Saturday, April 8 (2023); Communication and Ethics
End of life care in the ICU is more challenging than in other environments. A collaborative model where palliative medicine specialists and intensivists join forces is the most conducive to good patient care. Open ICU models may benefit more from early specialist palliative medicine consultation (mainly to bring about better governance over end-of-life matters), whereas in closed intensive care units there are strong arguments for an intensivist-led approach to palliative care and decisionmaking.
Complaint resolution
Thursday, April 6 (2023); Administration and Data Management
Complaints are a routine part of life for directors of Intensive Care units, a surprise and inconvenience for early-career ICU specialists, and a mysterious and fearsome natural occurrence for junior ICU staff, like a solar flare or a locust plague. Judging by the appearance of this topic in Question 22 from the second paper of 2022, it seems the college wants trainees to develop a familiarity with this process long before they are expected to manage it independently.
Radiological findings in hypoxic ischaemic encephalopathy
Tuesday, April 4 (2023); Cardiac Arrest and Resuscitation
CT and MRI have good positive and negative predictive value in hypoxic ischaemic encephalopathy when combined with clinical predictors. Loss of grey-white differentiation on CT and restricted diffusion on DWI are strongly predictive of poor neurological outcome.
Donation after circulatory determination of death
Tuesday, March 7 (2023); Cardiac Arrest and Resuscitation
Circulatory determination of death basically requires no arterial pulse for five minutes, as well as other findings associated with death (i.e. unresponsiveness and apnoea). "Donation after circulatory determination of death" is the name we have currently settled on after "donation after cardiac death", "donation after circulatory death" and "non-heartbeating organ donation" have receded into history.
Myasthenic crisis
Wednesday, March 29 (2023); Neurology and Neurosurgery
Myasthenia gravis has appeared in the exam mainly as a foil for Guillain-Barre syndrome, but has more recently graduated to become an SAQ topic all of its own, in the form of myasthenic crisis - the acute exacerbation of myasthenia gravis which requires mechanical ventilation.
Trials and guidelines for endocrinology, metabolism and nutrition
Tuesday, February 14 (2023); Endocrinology Metabolism and Nutrition
This is a summary of trials and guidelines related to metabolism nutrition and endocrinology, aimed at the CICM Part 2 exam candidate. The objective was to list the important studies, link to an authoritative analysis, and produce a pithy one-liner to help remember the main points.
Empyema
Wednesday, February 15 (2023); Infectious Disease Antibiotics and Sepsis
Empyema is a purulent collection of pleural fluid that usually originates from a parapneumonic pleural effusion. The mainstay of therapy is drainage by thoracostomy or decortication, as well as long-term antibiotics. All drainage options have their advantages and disadvantages, mostly related to the difficulty in extracting the viscous infected fluid from a cavity that is potentially multiloculated and full of fibrin.
Trials and guidelines for neurology and neurosurgery
Tuesday, April 25 (2023); Neurology and Neurosurgery
This is a summary of trials and guidelines related to neurology and neurosurgery, aimed at the CICM Part 2 exam candidate. The objective was to list the important studies, link to an authoritative analysis, and produce a pithy one-liner to help remember the main points.
Trials and guidelines for sepsis and infectious disease
Sunday, February 12 (2023); Infectious Disease Antibiotics and Sepsis
This is a summary of sepsis and infectious diseases trials and guidelines, aimed at the CICM Part 2 exam candidate. The objective was to list the important studies, link to an authoritative analysis, and produce a pithy one-liner to help remember the main points.
Relationship between muscle length and tension
Friday, January 13 (2023); Musculoskeletal system
The tension generated by a sarcomere depends on the length of the sarcomere, and there is an optimal length at which tension is maximal, which in humans is ~2.7 µm. This is because of filament interactions: the greater the overlap between actin and myosin, the greater the force of contraction. As the filaments are pulled apart further, fewer of them are in contact, and less force can be generated. When the filaments lose contact altogether, the tension generated by the muscle is zero.
The mechanism of excitation-contraction coupling
Friday, December 30 (2022); Musculoskeletal system
Excitation-contraction coupling is the series of events that link the sarcolemma action potential to muscle contraction and relaxation. It consists of several steps: action potential arrival, opening of voltage-gated calcium channels, release of calcium from the sarcoplasmic reticulum in response to this, and calcium-mediated disinhibition of regulatory proteins that control the mechanical act of myosin-actin crossbridge cycling. To relax, all the calcium must be returned to its stores in the sarcoplasmic reticulum.