"Factors which influence blood pressure" seems like a really basic fundamental topic, and so it was surprising to discover a vast conspiracy among academic authors to teach it in a way which makes it totally incomprehensible. In short, blood pressure is determined by flow, resistance, and the total energy of the flowing blood. Each of these factors have their own dependent components, and the contribution of each component varies during the cardiac cycle.
The autonomic nervous system is a peripheral nervous system that regulates involuntary physiologic processes, and that has a distinct organisation from the somatic and sensory nervous systems. It is divided anatomically and functionally into sympathetic parasympathetic and enteric divisions.
As the main substrate of the respiratory system are gases and vapours, it makes sense to start the discussion of respiratory physiology with this as a foundation. Humidification is discussed in greater detail in the chapters dealing with the normal physiological mechanisms of humidification and with the technological solutions used to replicate it for mechanical ventilation. For the purpose of this chapter, it will suffice to discuss the colligative properties of liquids which are relevant to the evaporation of water and anaesthetic gases.
The ideal anaesthetic drug should be chemically stable, presented without excipients, and available by a variety of routes. It should distribute to molecular targets which only produce sedation, with a rapid onset and offset time, and it should not accumulate with prolonged use. There should be no effects other than anaesthetic effects, and it should not rely on any specific organ system for elimination. There should be no withdrawal or rebound effects, and it should not have active metabolites.
These are the equations which are used to calculate the derived parameters (i.e. derived from the measurements produced by the PA catheter in the course of a thermodilution). Anything that called an index is a variable which is corrected for body surface area.
Calcium channel blockers can be divided into dihydropyridines (which selectively affect smooth muscle) and the others (verapamil and diltiazem) which are non-selective and which also affect the heart. They are all highly lipophilic highly protein-bound drugs with a large volume of distribution and mainly hepatic clearance (the only exception is clevidipine which is hydrolysed by plasma esterases over mere seconds). Their mechanism of action involves preventing voltage-gated calcium channel opening, thereby decreasing cardiac and vascular smooth muscle contractility as well as pacemaker automaticity.
This collection of trauma trials and guidelines should serve as a sort of suggested reading material for the CICM Second Part exam candidate preparing for the increasingly unpredictable Fellowship exam, to supplement the increasingly inadequate practice of revising by doing past papers.
The CICM Second Part Exam inevitably contains a 10-mark statistics/EBM question, and these have historically consisted mostly of definitions or interpretations of concepts in clinical trial design or reporting. The possible range of questions is vast but finite, and one can imagine that in a fair world the questions would be picked from among common or essential subjects, of the sort that might enjoy a lot of attention in the scientific press. It is therefore conceivable that all the possible answers to all the possible statistics/EBM SAQs are available somewhere in published literature. The purpose of this section is therefore to bring this literature together and to arm the candidates against the unexpected.
This section mainly represents a place to store all those "balanced crystalloid vs saline" trials, which there would be no other place for. Otherwise, there are few critically important ICU-relevant trials, and surprisingly few widely accepted guidelines for fluid management, electrolyte replacement or investigations.
This collection of trials and guidelines about gastroenterology and hepatology has also ended up with all of general surgery in it, because there was nowhere else to put it. It is separated into "liver stuff", "gut stuff" and "general abdominal surgical stuff"as these are the broad categories into which the material has seemingly organised itself. The CICM Second Part exam candidate will always be at risk of being expected to know about these common problems.
Thyroid hormones are a major regulator of metabolism and thermogenesis, besides being essential for development. Their actions are exerted by binding to nuclear receptors which regulate gene transcription, and are therefore slow to manifest.
Of the historical cardiology questions from the CICM Second Part Exam, those that have not been straightforward ECG interpretation exercises have focused mainly on the management of heart failure, arrhythmias, and acute cardiac ischaemia. To guide the end-stage exam candidates this compilation of trials and guidelines hopes to fill a space in the exam revision process that had previously been occupied by doing the past papers, but which has become more vacant in the recently changing exam process.
This collection of trials and guidelines about critical care nephrology and dialysis techniques is intended to act as a quick review resource for the end-stage exam candidate, as the preparation for the CICM Second Part exam should involve some reading beyond the past paper questions, to be ready for the possibility that something interesting and original might be asked.