A free online resource for Intensive Care Medicine.
An unofficial Fellowship Exam (CICM Part 2) preparation resource.
Deranged Physiologyis a slowly growing archive of discussions and study notes relevant (or if not relevant, then at least interesting) to the practice of intensive care medicine. The content provides an introduction to the fundamental themes in intensive care: mechanical ventilation, vasopressors, electrolyte management, hemodynamic monitoring, dialysis, and so forth. Attention is directed at equipment in intensive care, and there are attempts to revisit interesting pharmacology and physiology. The aim of this resource is to supplement the bedside teaching of senior staff, and to consolidate resources for intensive care trainees in the initial stages of their training.
Tuberculosis is the second topic of Sivakumar and Pelly's chapter on tropical diseases in Oh's Manual. It has not been interrogated in the SAQs directly, but it comes up as a differential fairly often. A good alternative resource is this clinical review article from Critical Care (2013).
This virus was asked about in Question 29.1 from the first paper of 2009. In that specific instance, the college had asked the candidates to recognise the rash of chicken pox from a photograph. In Oh's Manual, Varicella doesn't even appear in the index. Though it appears around the book as a differential for various things (eg. viral encephalitis), it receives no attention beyond that. For the CICM felloship candidates, this brief summary of what a CICM trainee is expected to know about VZV has been cobbled together from semi-reputable sources.
The presence of Candida glabrata in the blood cultures is explored in Question 18 from the second paper of 2011. A good article on this exact subject is available. It had found that non-albicans candidaemia is associated with CVCs and multiple antibiotic therapy. TPN also seems to all but triple the risk of non-albicanscandidaemia. There is also an association with malignancy, which is biased by the fact that most studies of candidaemia have been performed in solid or hematological cancer patients. Renal failure is another significant risk factor.
For a fungus, this thing attracts a lot of attention from the college. Question 9 from the second paper of 2014 asked for a substantial amount of detail regarding the diagnosis of aspergillosis. As with many of these, Oh's Manual offers little help. Instead, one should turn to LITFL's CCC entry on this subject, which is precise and brief. However if one is not into brevity and precision, one can enjoy several hours submerged in the reference swamp listed below.
Or is "acronymic" the correct adjective? In any case, the college loves to repeat this question. Recent iterations have included Question 3.3 from the first paper of 2014, Question 25.2 from the first paper of 2009 and Question 25.2 from the second paper of 2008.
Question 15 from the second paper of 2002 asked to compare PCA and thoracic epidural in the setting of rib fractures. Question 20 from the second paper of 2005 asked more broadly about the role of regional anaesthesia in the critically ill.
A brief perusal of LITFL has yielded a nice summary of this topic, most relevant to inteference with the function of pacemakers and AICDs. 1990s cell phones were the first to cause observed interference with medical devices. The range for interaction was about 2m; early analog devices were to blame; ventilator and neonatal incubator failures were observed.
Question 16from the first paper of 2012 asks about the advantages and disadvantages of various cooling methods. I have assembled these advantages and disadvantages into a massive table. This table is based on an even better table from a 2009 article by Kees Polderman and Herold Ingeborg, which is almost identical to the college answer for Question 16.
The table can be summarised in a single statement: that the method affording the best balance between invasiveness and effectiveness is the water-cooled jacket. It may even be faster than cooling by extracorporeal circuit. Antipyretic drugs, various electric fans and air-filled blankets, cold saline infusions, and intravascular cooling catheters are all available as options, but all suffer from crippling disadvantages.
This was one of the older SAQs, Question 9 from the first paper of 2000. Co-oximetry was also asked about in Question 17.2 from the first paper of 2010. Generally, the trainees have been expected to know how the pulse oximeter and co-oximeters differ in their function, and what may give rise to false pulse oximeter readings.
This device has not come up in the written exam, but frequently examiners (or just evil-minded intensivsts) like to offer the trainees a Laerdal bag, and ask them to reassemble it from scratch, or discuss the volume it contains, or something similar.
This has appeared in Question 15.3 from the first paper of 2012, and in Question 22.1 from the first paper of 2010. In brief, it is a plastic mask with a bag acting as an oxygen reservoir, which is held affixed to the patient's face with elastic. The defining feature of this device is the presence of unidirectional valves. When the patient inhales, the valves prevent the inspiration of room air - the patient will only breathe from the oxygen reservoir. When the patient exhales these valves prevent the movement of expired gas back into the reservoir, so as to prevent the re-breathing of expired gas (hence "non-rebreather").
This has come up once, in Question 28.3 from the first paper of 2011. The marvels and wonder of nitric oxide are discussed elsewhere. This question refers specifically to the the nitric oxide cylinder, which is the form this gas is usually found in. The gas comes in a pressurised cylinder, under a brand name "INOmax". It contains 99.92% nitrogen and only 0.08% nitric oxide, or 800 parts per million (ppm). It needs to be dilute, for convenience of administration. The highest concentration you would ever use is about 80ppm, which corresponds to a gas mixture of 90% whatever, and 10% Inomax. In general, the INOmax delivery system procedure guide is an excellent source of detailed gas-cylinder-related information.
This was the subject of the nightmarish Question 2 from the second paper of 2005; it interrogated the candidate's intimate knowledge of Australian Standard 2896 1998 – "Medical gas systems – installation and testing of non-flammable medical gas pipeline systems".