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.
The college have never paid much attention to this topic. It merited a little sub-question (d) in Question 15 from the second paper of 2010. In this question, the candidates were only expected to list the benefits.
Question 12 from the first paper of 2000 asks: "Outline your postoperative management plan for a patient who has just -returned from the operating theatre after undergoing bilateral thoracoscopic lung reduction for emphysema".
This question can be generalised to any patient with a bilateral thoracoscopic lung resection.
This came up in Question 25 from the second paper of 2005.
Generally speaking - on the basis of statistics - the cause of obstruction is almost invariably malignant. The mean life expectancy in these people is about 6 months even with treatment, but it can be variable depending on precisely which malignancy is involved.
Question 18 from the second paper of 2006 asked about the causes of post-bypass hypoxia. Prior to this, and subsequently, there have been no questions directly addressing this topic. However, it is an interesting and important topic.
Question 13.1 from the first paper of 2009 asks the candidate to come up with reasons for why their post-op CABG patient is bleeding to death, and to come up with a management strategy. Something similar occurs in Question 13 from the first paper of 2012.
This is relevant for Question 9.1from the second paper of 2008, where the college asked about the mechanics of measuring pH, pO2 and pCO2. The candidates were expected to submerge deeply into the physics and chemistry of ion-selective electrodes.
A Wheatstone bridge is an electrical circuit used to measure an unknown electrical resistance. The electrical resistance in most medically relevant case is of a strain gauge, which is coupled to a measured parameter (eg. arterial or venous blood pressure). The coupling is usually via some sort of incompressible fluid-filled tubing. Typically, the circuit takes the shape of a cicular arrangement of resistors where the resistance of all but one is known. The remaining "unknown" resistor acts as the strain gauge. As pressure on the gauge changes, so does its resistance, and this causes a change in the current which flows though the Wheatstone bridge. The magnitude of this pressure can be inferred from the magnitude of the changes in current.
In summary, MAP = (Systemic vascular resistance) × (Cardiac output). We are interested in this variable because it is the pressure which seems to have the greatest influence on bloodflow autoregulation within organs, and on whole-body haemodynamic homeostatic mechanisms (such as the baroreceptors). It is resistant to confounding measurement factors, and is attractively easy to calculate. However, it has a series of drawbacks, not the least of which being the lack of agreement regarding what an appropriate MAP is in any given situation. The golden "MAP of 65" rule is another one of those things which has widespread support and absolutely no evidence.