2015 multiple true false questions for the final FFICM

Multiple True False Questions for the Final FFICM Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:21 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:21 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Multiple True False Questions for the Final FFICM Emma Bellchambers BMedSci, BMBS, MRCP, FRCA Specialty Trainee in Anaesthesia and Intensive Care Medicine, Severn Deanery, Bristol, UK Keith Davies MA, MBBS, FRCA, FFICM Specialty Trainee in Anaesthesia and Intensive Care Medicine, Severn Deanery, Bristol, UK Abigail Ford BSc (Med Sci), MBChB, MRCP, FRCA Specialty Trainee in Anaesthesia and Intensive Care Medicine, Severn Deanery, Bristol, UK Benjamin Walton MBChB, MRCP, FRCA, FFICM Consultant in Critical Care and Anaesthesia, North Bristol NHS Trust, Bristol, UK Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:21 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 University Printing House, Cambridge CB2 8BS, United Kingdom Cambridge University Press is part of the University of Cambridge It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence www.cambridge.org Information on this title: www.cambridge.org/9781107655317 © Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton 2015 This publication is in copyright Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press First published 2015 Printed in the United Kingdom by Clays, St Ives plc A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication data Bellchambers, Emma, 1983– author Multiple true false questions for the final FFICM / Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton p ; cm Multiple true false questions for the final Faculty of Intensive Care Medicine Examination Includes bibliographical references and index ISBN 978-1-107-65531-7 (pbk : alk paper) I Davies, Keith (Specialty trainee in anaesthesia and intensive care medicine), author II Ford, Abigail, author III Walton, Benjamin, author IV Title V Title: Multiple true false questions for the final Faculty of Intensive Care Medicine Examination [DNLM: Intensive Care – Great Britain – Examination Questions WX 18.2] RC86.9 616.02′ 8076 – dc23 2014020935 ISBN 978-1-107-65531-7 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:21 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Contents Introduction page vi Exam A Questions Answers 21 Exam B 111 Questions 111 Answers 130 Exam C 217 Questions 217 Answers 238 Index 327 v Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:41 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Cambridge Books Online http://ebooks.cambridge.org/ Multiple True False Questions for the Final FFICM Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton Book DOI: http://dx.doi.org/10.1017/CBO9781107705623 Online ISBN: 9781107705623 Paperback ISBN: 9781107655317 Chapter Introduction pp vi-vi Chapter DOI: http://dx.doi.org/10.1017/CBO9781107705623.001 Cambridge University Press Introduction In the United Kingdom, successful completion of the examinations for both the Primary and Final Fellowship of the Faculty of Intensive Care Medicine (FFICM) is now an integral part of the assessment for a Certificate of Completion of Training (CCT) in Intensive Care Medicine (ICM) Currently, a pass in the Primary examination of one of the relevant UK medical colleges – MRCP (UK), MCEM or FRCA Primary – allows candidates to sit the Final FFICM exam Discussions are under way on the introduction of a FFICM Primary examination in its own right The Final FFICM exam comprises three sections: a multiple choice question examination (MCQ), an objective structured oral examination (OSCE) and a structured oral examination (SOE) From July 2014, the MCQ part of the exam has consisted of 90 questions, 60 of the multiple true false (MTF) type and 30 of the single best answer (SBA) type While this book will be useful for all three components of the exam, it is best placed as a revision aid for the MTF part of the MCQ exam The three 90-question papers contained in the book have been designed to encompass the 13 sections that make up the current syllabus for a CCT in ICM This syllabus is broadly similar to the CoBaTrICE syllabus developed under the auspices of the European Society of Intensive Care Medicine, so the questions will be of direct relevance to those candidates undertaking this exam as well Each question has an answer and then both short and long explanations The former will provide a quick revision refresher, while the long explanation gives the candidate further information on the question topic, along with one or more references for further reading All exams require a certain element of luck to pass, but we believe that detailed revision – including attempting a number of relevant MCQ questions – will improve a candidate’s chances of success vi Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:14:51 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.001 Cambridge Books Online © Cambridge University Press, 2015 Cambridge Books Online http://ebooks.cambridge.org/ Multiple True False Questions for the Final FFICM Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton Book DOI: http://dx.doi.org/10.1017/CBO9781107705623 Online ISBN: 9781107705623 Paperback ISBN: 9781107655317 Chapter Exam A - Questions pp 1-20 Chapter DOI: http://dx.doi.org/10.1017/CBO9781107705623.002 Cambridge University Press Question C86: Surgical site infection Exam C: Answers Park G Molecular mechanisms of drug metabolism in the critically ill Br J Anaesth 1996; 77: 32–49 Vilay A, Churchwell M, Mueller B Clinical review: drug metabolism and nonrenal clearance in acute kidney injury Crit Care 2008; 12: 235 Regarding surgical site infection: A Colonisation with methicillin-sensitive Staphylococcus aureus (MSSA) increases the risk of postoperative wound infection B Blood sugar should be kept at 4–6 mmol/l to reduce surgical site infection C Blood transfusion is associated with a higher incidence of surgical site infection D Oxycodone should be used in preference to morphine to reduce postoperative infection E Povidone–iodine is as effective as 2% chlorhexidine in preventing infections Answer: TFTTF Short explanation While the ideal blood sugar range is 4–6 mmol/l to reduce surgical site infection, the risk of hypoglycaemia means that current recommendations are to keep blood sugar < 10 mmol/l Povidone–iodine solutions are not as effective as 2% chlorhexidine at preventing surgical site infections Long explanation Surgical site infection occurs in up to 16% of patients postoperatively Variables conferring susceptibility to postoperative infection (including surgical site, respiratory, urinary tract and line infection) may be classified into non-modifiable and modifiable factors Non-modifiable factors include patient age, comorbidities (e.g diabetes mellitus), smoking, malnutrition, surgical site and type of surgery Modifiable perioperative variables include antibiotic prophylaxis, hand hygiene, invasive lines, hypothermia, perioperative glycaemic control, volume status, blood transfusion and postoperative analgesia Antibiotic prophylaxis reduces the bacterial inoculum at the time of surgery provided the minimum inhibitory concentration of the antibiotic agent at tissue level is exceeded for the duration of the surgery from incision to wound closure The infection rate is lowest when antibiotics are administered within 30 minutes of incision, with the incidence of infection increasing with administration after incision or > 60 minutes before The ideal blood sugar range is 4–6 mmol/l, but the risk of hypoglycaemia means that current recommendations are to keep blood sugar < 10 mmol/l Patients should be actively warmed unless hypothermia is required for surgery, as even a °C drop in core temperature is associated with increased risk of perioperative infection Hand hygiene, aseptic technique and the use of 2% chlorhexidine where appropriate all reduce the risk of infection The mode of analgesia may be of importance in reducing postoperative infections Regional anaesthesia is thought to be beneficial, as it improves vasodilatation and tissue oxygenation, reduces the stress response with improved analgesia, and may modify the inflammatory response Morphine, fentanyl and remifentanil all have immunosuppressive properties, while oxycodone and buprenorphine have no effect on the immune system and tramadol may have immune-enhancing properties While the choice of analgesia has not been shown to be an independent risk factor to date, Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 321 Exam C: Answers it may be sensible to avoid certain agents in patients with a high risk of developing postoperative infections Goal-directed fluid therapy and the avoidance of blood transfusion where possible also reduce the risk of surgical site infection Gifford C, Christelis N, Cheng A Preventing postoperative infection: the anaesthetist’s role Contin Educ Anaesth Crit Care Pain 2001; 11: 151–6 National Institute for Health and Care Excellence CG74: Prevention and Treatment of Surgical Site Infection London: NICE, 2008 http://www.nice.org.uk/cg74 (accessed June 2014) National Institute for Health and Care Excellence QS49: Surgical Site Infection London: NICE, 2013 http://www.nice.org.uk/qs49 (accessed June 2014) Question C87: Selective decontamination of the digestive tract Regarding selective decontamination of the digestive tract (SDD): A It is associated with a reduction in mortality B It increases the likelihood of infection with resistant bacteria C Topical therapy alone (selective oral decontamination) reduces ventilator-associated pneumonia D SDD does not affect fungal infections E SDD is a method of controlling exogenous infections in critical care patients Answer: TFTFF Short explanation SDD is an enteral and parenteral antibiotic and antifungal protocol that aims to reduce mortality from endogenous infections in critically ill patients Exogenous infections are those acquired without prior colonisation, and they should be prevented by good hygiene measures Treatment with topical prophylaxis alone reduces respiratory infections but not mortality Long explanation Selective decontamination of the digestive tract (SDD) is an enteral and parenteral antibiotic protocol that aims to reduce mortality from endogenous infections in critically ill patients Endogenous infections may be classed as primary or secondary Primary endogenous infections are those present on admission to critical care, while secondary endogenous infections are those acquired later as a result of prior colonisation Exogenous infections are those acquired without prior colonisation, and they may be prevented by good hygiene measures So far SDD has not been universally adopted, despite robust evidence, because of largely unfounded concerns regarding cost and the potential for an increase in antibiotic resistance The latest Cochrane review found that a combination of topical and systemic prophylactic antibiotics reduced respiratory tract infections and overall mortality in adult ICU patients Treatment with topical prophylaxis alone (selective oral decontamination) reduced respiratory infections but not mortality The risk of antibiotic resistance was only measurable in one trial, which did not show evidence of this 322 D’Amico R, Pifferi S, Torri V, et al Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care Cochrane Database Syst Rev 2009; (4): CD000022 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 Question C88: Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) in patients after intensive care: Exam C: Answers Zandstra DF, Van Saene HKF Selective decontamination of the digestive tract (SDD) In Waldmann C, Soni N, Rhodes A Oxford Desk Reference: Critical Care Oxford: Oxford University Press, 2008; pp 474–5 A Is reduced in incidence by a self-help recovery package given to patients on discharge B Is more common in patients with delusional memories C Occurs in up to in 10 ICU patients D Should be assessed using validated screening tools E Should prompt psychiatric referral in all patients at risk Answer: FTTTF Short explanation Studies have shown that PTSD is not reduced by a self-help recovery package given to patients on discharge Patients with severe symptoms require psychiatric referral, but those with moderate symptoms may be managed expectantly Long explanation Post-traumatic stress disorder (PTSD) is a psychological disorder precipitated by a traumatic event with a wide variety of symptoms specific to the individual It occurs in up to in 10 ICU patients Severe PTSD will impair a patient’s ability to lead a normal life Symptoms generally occur within month of the event, but may be delayed by months or years Patients experience flashbacks and nightmares, and feel isolated, irritable and guilty They will try to avoid anything that reminds them of the traumatic event Patients recalling delusional memories from their critical care admission are at much higher risk of PTSD and anxiety than patients whose memories are real Patients with PTSD are generally unwilling to talk about what has happened to them Insomnia is common, and concentration spans are often reduced, with a state of hyperarousal and continuous anxiety Emotional numbing describes a state where the patient tries not to remember or feel anything at all They may withdraw from their usual activities The course of the illness varies, from relapsing and remitting to constant ICU patients should be screened for PTSD with validated tools such as the Impact of Event Scale, PTSS-10 or PTSS-14 Staff should be trained in assessing patients, and should be aware of warning signs NICE guidelines suggest that patients with PTSD should be given literature on the symptoms of PTSD, but a study of using a self-help recovery package on discharge showed no impact on psychological symptoms, although physical rehabilitation improved The role of ICU diaries has yet to be fully investigated, but they may improve the patient’s understanding of what happened, ameliorate amnesia and refute delusional memories Patients with moderate symptoms may be managed with regular follow-up, but severe symptoms require psychiatric evaluation Jones C, Griffiths RD Critical care follow up In Waldmann C, Soni N, Rhodes A Oxford Desk Reference: Critical Care Oxford: Oxford University Press, 2008; pp 586–7 Wake S, Kitchiner D Post-traumatic stress disorder after intensive care BMJ 2013; 346: f3232 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 323 Exam C: Answers Question C89: Organ donation Concerning organ donation and transplantation: A Organ donation should be considered in every patient expected to die in ICU B Family members have no right to refuse to authorise donation if the patient is on the organ donor register (ODR) C Family members may authorise donation if there is no indication of the prior views of the patient D Donation after circulatory death (DCD) can be classified as controlled or uncontrolled E Organ donation coordinators may only be approached after authorisation for donation has been received Answer: TFTTF Short explanation All ICU deaths should be considered for organ donation, and donation coordinators should be involved early Consent is implied by the presence of a patient on the ODR, but familial assent must also be obtained Patients not on the ODR may still donate with the consent of the family DCD may be controlled (following withdrawal of life-sustaining treatment) or uncontrolled (organised after the unexpected death of a suitable patient) Long explanation All patients who are expected to die in ICU should have the possibility of organ donation considered There are few contraindications to organ donation: Absolute contraindications Infective neurodegenerative disease (e.g variant Creutzfeldt–Jakob disease) AIDS/HIV disease (HIV infection alone is not a contraindication) Relative contraindications Age over 90 years Cancer Disseminated cancer Treated cancer within years (except skin and cervical cancer) Melanoma (unless locally excised > years prior to donation) 324 Organ donation coordinators should be contacted once a patient has been recognised as a possible candidate for organ donation The process of checking the organ donor register (ODR), discussing with the family and consent are greatly facilitated by the presence of donation coordinators Consent to organ donation is complex If a patient is on the ODR, then this is taken as an indication of the wishes of the patient, but the family should still be approached for consent to proceed to organ donation If the family objects despite the presence of the patient on the ODR, then organ retrieval cannot occur For patients not on the ODR, then consent needs to be obtained from the patient’s family Patients with maintained capacity are able to consent to organ donation themselves, but this is very rare, owing to the nature of conditions leading to consideration of organ donation Donation after brain death (DBD) is becoming less common as road safety and care of traumatic brain injury improves Live organ donation (kidney, partial liver) and donation after circulatory death (DCD) are becoming increasingly common to compensate DCD may be controlled or uncontrolled Controlled DCD occurs following Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 National Institute for Health and Care Excellence CG135: Organ Donation for Transplantation London: NICE, 2011 http://www.nice.org.uk/cg135 (accessed June 2014) Exam C: Answers withdrawal of life-sustaining treatment in critical care Therapy is withdrawn once organ retrieval teams are available Retrieval can only occur if the patient dies within a certain, organ-specific time following withdrawal Uncontrolled DCD is uncommon, as it requires the summoning of retrieval teams after the patient has died unexpectedly Question C90: Central pontine myelinolysis With regards to central pontine myelinolysis (CPM), which of the following are correct? A B C D It is more commonly seen in patients with alcohol dependence Rapid correction of acute hyponatraemia is the main cause MRI is the imaging modality of choice for diagnosis Microscopically there is degeneration of axons in the pons with preservation of oligodendrocytes E Parkinsonism, catatonia and movement disorders suggest extrapontine myelinolysis Answer: TFTFT Short explanation Rapid correction of chronic hyponatraemia is believed to be the main cause of CPM Correction of acute hyponatraemia has only been reported as a cause in a few patients Oligodendrocytes appear to be more prone to apoptosis, and this may be due to osmotic stress triggering the apoptosis cascade Long explanation Central pontine myelinolysis (CPM) is a condition which many clinicians fear when correcting hyponatraemia Rapid correction of chronic hyponatraemia is believed to be the main cause of CPM Correction of acute hyponatraemia has only been reported as a cause in a few patients Unfortunately, despite close monitoring and avoidance of hypertonic saline, the sodium often rises faster than clinicians would like, particularly in severe hyponatraemia CPM was first described in the 1950s as a post-mortem diagnosis A link between the syndrome and rapid correction of hyponatraemia was established in the 1980s The usual clinical picture is of encephalopathy or seizures due to severe hyponatraemia followed by a period of recovery following correction After a few days, the patient may deteriorate with neurological signs such as dysarthria, dysphagia, oculomotor abnormalities and flaccid quadriparesis which later becomes spastic The ‘locked in’ syndrome can also occur with large lesions CPM can also be accompanied by extrapontine myelinolysis (EPM), with features including catatonia, mutism, parkinsonism and dystonia CPM is unusual in patients who have no other comorbidities; usually patients are alcoholics or malnourished It is rare in diabetic or renal dialysis patients, probably because there is a protective mechanism from the high levels of glucose or urea Pathologically, there is axon fibre preservation with loss of oligodendrocytes in the basis pontis of the pons Rarely the lesion spreads to the medulla or the midbrain The cause of the demyelination may be due to the triggering of apoptosis of oligodendrocytes brought about by over-activation of ion channels during the osmotic Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 325 Exam C: Answers changes that occur when hyponatraemia is corrected Slower correction of sodium levels can prevent the syndrome occurring, although the mortality of uncorrected severe hyponatraemia is also very high Expert advice regarding correction of severe hyponatraemia should be sought, particularly in high-risk patients such as alcoholics Martin RJ Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes J Neurol Neurosurg Psychiatry 2004; 75: iii22–8 326 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:09 GMT 2015 http://dx.doi.org/10.1017/CBO9781107705623.007 Cambridge Books Online © Cambridge University Press, 2015 Index Abbreviated Injury Scale (AIS), 273 abdomen, open, 19, 102–3 abdominal compartment syndrome, 102, 270 abdominal trauma, 231, 301–2 ABO incompatibility, 147 ACE inhibitors, heart failure, 82 acetaminophen See paracetamol acetazolamide, 200 aciclovir, 289 acid ingestion, 227, 284–5 acute coronary syndromes (ACS), 2, 26–7 acute kidney injury (AKI) definitions and staging, 120, 171–2 drug metabolism, 320 pharmacological risk reduction, 222, 261–2 RIFLE criteria, 112, 137 acute liver failure (ALF) diagnosis and causes, 15, 85 management, 124, 193–4 paracetamol-induced, 232, 304–5 acute respiratory distress syndrome (ARDS) Berlin definition, 1, 21–2 direct causes, 119, 167 treatment, 115, 148–9 adder bites, 129, 215 adrenal insufficiency, causes, 16, 90 adrenaline (epinephrine), 139, 145, 238–9 adrenergic receptors, 238–9 advance decisions/directives, 157–8, 233, 308–9 advanced life support 124, 190–1 See also cardiopulmonary resuscitation advanced trauma life support (ATLS), 222, 263–4 airway management See also tracheal intubation adult epiglottitis, 280 multiple trauma, 263 smoke inhalation, 54–5 airway obstruction, treatment, 219, 245–6 airway pressure release ventilation (APRV), 47, 122, 154, 182–3 alcohol (ethanol) intoxication, 12–13, 74–5 therapy, ethylene glycol poisoning, 311 alcohol-based hand gels, 223–65, 266 alcoholic ketoacidosis, 75 alkali ingestion, 227, 284–5 amantadine, 283–4 aminoglycoside antibiotics, 271–2 aminophylline, 37, 142 amiodarone, 145 amniotic fluid embolism, 228, 286–7 amphotericin B, 63 anaemia cyanosis, 251 pathophysiology, 122, 181 transfusion guidelines, 235, 318–19 analgesia, postoperative, 321–2 anaphylaxis, 113, 138–9 mast-cell tryptase, 8, 56–7 pathophysiology, 38 transfusion-induced, 147 aneurysms, bleeding intracranial, 171 angiotensin II receptor antagonists, heart failure, 82 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 327 Index 328 angiotensin-converting enzyme (ACE) inhibitors, heart failure, 82 anidulafungin, 64 anion gap, 79–199 anion gap acidosis, high, 125–6, 199 antecubital fossa, 218, 243–4 anterior triangle, neck, 5, 41–2 antibiotics acute liver failure, 194 aminoglycoside, 271–2 burns, 294 mechanisms of action, 115, 150–1 MRSA infections, 230–1, 299 neutropenic sepsis, 87 resistance, 9, 58–9 surgical patients, 321 antidiuretic hormone (ADH; vasopressin), 117–18, 162 antiepileptic agents, status epilepticus, 251 antifungal agents, 10, 63–4 antioxidants, 314 antivenom, snake bites, 215 APACHE II scoring system, 2, 25–6, 138 apnoea testing, diagnosis of death, 245 arrhythmias hypothermia, 150 management, 18, 100–1 tricyclic antidepressant toxicity, 24 arterial blood gases (ABG), 116, 155–6 arterial pressure invasive monitoring, 274–5 waveform, derived measures, 112, 134 ASCOT (A Severity Characterisation of Trauma) score, 273 aspirin acute coronary syndromes, 27 acute stroke, 285 overdose, 19, 103–4 thromboprophylaxis, 298 asthma, acute/life-threatening drug treatment, 113, 141–2 management, 4, 37–8 ventilator modes, 116, 154–5 atrial fibrillation drug treatment, 114, 142–3 treatment options, 100 atropine, 145, 146 azole antifungals, 63 bacilli, Gram-positive, 113, 139–40 Bacillus anthracis, 140 Bacillus cereus, 140 bactericidal antibiotics, 150–1 bacteriostatic antibiotics, 151 base excess (or deficit), 155, 220–1, 256 Beck’s triad, 180 benzodiazepines acute confusion, 249 status epilepticus, 141, 250–1 ␤-adrenoceptor agonists, asthma, 142 ␤-blockers, heart failure, 82 bicarbonate therapy base excess for guiding, 256 lactic acidosis, 145 metabolic acidosis, 128–9, 214 severe sepsis, 29 tricyclic antidepressant overdose, 24 bicarbonate, arterial blood, 156 BIG intraosseous device, 252–3 bilevel ventilation (BIPAP), 154–5 blood cultures, 173 blood pressure invasive monitoring, 274–5 management, subarachnoid haemorrhage, 171 blood products, 123–4, 190 blood transfusion acute lung injury after See transfusion-related acute lung injury coagulopathy after, 222, 260–1 complications, 114, 146–7 massive, 231, 299–300 multiple trauma, 212 platelets, 16, 92–3 red cells, guidelines, 235, 318–19 Bogota bag, 102, 103 botulism, 140, 232, 303–4 brachial artery, 244 brain death (neurological death) brainstem reflex tests, 123, 187–8 diagnosis, 218, 244–5 physiological effects, 12, 74 brain tissue oxygen tension (PbrO2 ), measurement, 91 bronchoscopy, flexible, 117, 158–9 burns fluid management, 115–16, 152–3, 294 inhalational injuries, 8, 54–5 management, 229, 294–5 partial and full thickness, 10, 66 pathophysiology, 121–2, 179 surface area calculation, 272–3 candidiasis, invasive, risk factors, 120, 174–5 capillary refill time (CRT), 267 capnography, 115, 151–2 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 unconscious trauma patients, 226, 277–8 chest compressions, 6, 44–5 chest drains, intercostal (ICDs), 126, 201–2 chest radiographs acute cardiogenic pulmonary oedema, 111–12, 132–3 multiple trauma, 212 spontaneous pneumothorax, 31 chlorhexidine, 50, 51 chronic kidney disease (CKD), 235, 319–20 chronic obstructive pulmonary disease (COPD), 10, 65 citrate toxicity, transfusion-related, 146–7 cleaning, medical equipment, 5, 40–1, 168 clopidogrel, 27 clostridia, 140 Clostridium botulinum, 140, 303 Clostridium difficile-associated diarrhoea, 121, 178–9 Clostridium tetani, 140, 192 coagulopathy acute liver failure, 193 disseminated intravascular coagulation (DIC), 229, 291–2 multiple trauma, 212 transfusion-related, 222, 260–1 colonic pseudo-obstruction, acute, 124, 191–2 community-acquired pneumonia (CAP) causative organisms, 226–7, 281–2 severity of illness scoring, 119, 169–70 computed tomography (CT) acute colonic pseudo-obstruction, 191–2 acute stroke, 285 spontaneous pneumothorax, 282 subarachnoid haemorrhage, 171 unconscious/obtunded trauma patients, 277, 306 Confusion Assessment Method for ICU (CAM-ICU), 70, 71 confusion, acute, 219, 248–9 Conn’s syndrome, 163, 164, 266 consent to treatment, 233, 308–9 continuous positive airway pressure (CPAP), 154 core temperature measurement, 10, 64 coronary arteries, localisation of occlusion, 111–30, 131 corticosteroids, adrenal suppression, 90 Corynebacterium diphtheriae, 140 creatinine, serum, 171–2 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Index carbon monoxide poisoning, 204, 230, 295–6 carboxyhaemoglobin, 39, 295 cardiac arrest See also cardiopulmonary resuscitation advanced life support, 124, 190–1 EEG evaluation after, 156 emergency pacing, 114–15, 147–8 precordial thump, 227, 282 prognostication after, 9, 60–1 therapeutic hypothermia, 221, 259–60 cardiac output (CO) monitoring Fick method, 119, 169 methods, 8, 55–6 oesophageal Doppler monitoring (ODM), 221, 257–8 pulmonary artery catheter, 159 pulse contour analysis, 3, 29–30 cardiac tamponade, 122, 180 cardiogenic pulmonary oedema, acute See pulmonary oedema, acute cardiogenic cardiogenic shock, 38, 246 levosimendan, 98 cardiomegaly, 132 cardiopulmonary resuscitation (CPR) advanced life support, 124, 190–1 chest compressions, 6, 44–5 defibrillation threshold, 221, 256–7 drowning victims, 50 drug dosages and regimens, 114, 145–6 indications for not starting/discontinuing, 116–17, 157–8 precordial thump, 227, 282 timing of defibrillation, 1, 22–3 carotid sheath, 42 caspofungin, 64 catecholamines, 217, 238–9 catheter-related blood stream infection (CRBSI) central venous, 121, 176–7 skin disinfection for preventing, 51 catheterisation, urinary, 118, 163 caustic ingestion, 227, 284–5 central pontine myelinolysis (CPM), 237, 325–6 central venous catheter-related blood stream infection (CRBSI), 121, 176–7 cerebral blood flow, measurement, 16, 91 cerebral oxygenation, measurement, 91, 293–4 cervical spine injuries obtunded trauma patients, 232, 305 329 Index cricothyroidotomy, 275 critical care scoring systems, 118, 164–5 critical illness neuromyopathy (CINM), 123, 186–7 cryoprecipitate, 261, 291–2 cubital fossa, 218, 243–4 CURB65 score, 169–70 Cushing’s response, 74 cyanide poisoning, 39 cyanosis, anaemic patients, 251 death See also brain death diagnosis of, 14, 84 donation after circulatory, 124–5, 194–5, 324–5 organ donation after, 236, 324–5 decision making, patient, 233, 308–9 decompression sickness, 204 decontamination, medical equipment, 41, 168 defibrillation threshold, factors affecting, 221, 256–7 timing of, 1, 22–3 delayed cerebral ischaemia (DCI), subarachnoid haemorrhage, 11, 67–8 delirium, 121, 177–8 assessment, 11, 70–1 management, 225, 275–6 risk factors, 228, 288–9 demeclocycline, 102 diabetic ketoacidosis (DKA), 13, 79 diarrhoea, Clostridium difficile associated, 121, 178–9 disinfection medical equipment, 5, 40–1, 119, 168 skin, 7, 50–1 disseminated intravascular coagulation (DIC), 229, 291–2 distributive shock, 38, 248 dobutamine, 238–9 donation after circulatory death (DCD), 124–5, 194–5, 324–5 donation, organ, 236, 324–5 dopamine, 262 drowning, 7, 49–50, 126, 200–1 drug-induced nephrotoxicity, 19, 105–6 drug metabolism, critically ill patients, 235–6, 320–1 drug monitoring, therapeutic, 7–8, 52–3 330 echinocandins, 64 echocardiography, 268–9 eclampsia, severe, 14, 80–1 ecstasy (MDMA), 19–20, 106–7 edrophonium test, 83 electrical safety, 112, 134–5, 222–3, 264 electrocardiogram (ECG) 12-lead monitoring, 222, 262–3 changes in hyperkalaemia, 129, 216, 270, 271 changes in hypokalaemia, 10, 62–3, 229, 292–3 conditions with characteristic changes, 11, 69–70 electroencephalography (EEG), 116, 156–7 encephalitis, herpes simplex, 228, 289–90 endotracheal intubation See tracheal intubation end-tidal carbon dioxide (CO2 ) monitoring, 115, 151–2 energy requirements, basal, 217, 239–40 enteral nutrition, nasogastric tube insertion, 234, 315–16 enterococci, vancomycin-resistant (VRE), 221, 258–9 epiglottitis, adult, 226, 280–1 epinephrine 139, 145, 238–9 equipment, medical cleaning, 5, 40–1, 168 Spaulding classification, 119, 168 escharotomy, 66, 294 ethanol See alcohol ethylene glycol poisoning, 233, 311–19 extended-spectrum ␤-lactamase (ESBL) producing bacteria, 117, 161 extracorporeal membrane oxygenation (ECMO), 11, 66–7 EZ-IO intraosseous device, 252–3 factor V Leiden, 72 FAST intraosseous device, 252–3 FAST ultrasound scan, 301, 302 femoral triangle, 231–2, 302–3 FEV1 /FVC ratio, 54 fever, 32 Fick principle, 56, 169 fluconazole, 63 fluid management burns, 115–16, 152–3, 294 hypernatraemia, 35 multiple trauma, 264 reducing acute kidney injury risk, 261–2 sepsis, 173, 218, 241–2 shock, 33 fomepizole, 319 fondaparinux, 27, 298 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 gas transfer, pulmonary, 53, 54 gastric stress ulcer prophylaxis, 13, 76–7, 234–5, 316–17 gastrointestinal bleeding, acute upper, 2, 27–8 general surgical patients, with severe sepsis, 14, 79–80 Glasgow Coma Scale (GCS), 7, 48–9 traumatic brain injury, 226, 278–9 Glasgow–Blatchford scoring system, 28 glucose control severe sepsis, 29 surgical patients, 321 Gram-positive bacilli, 113, 139–40 gray (Gy), 109 great saphenous vein, 133 group A streptococcal toxic shock syndrome, 211 Guillain–Barr´e syndrome (GBS), 230, 296–7 haemoglobin (Hb), target ranges, 235, 318–19 hand hygiene, 223–65, 266 head injury See traumatic brain injury heart block, complete, 147–8 heart failure acute (AHF), causes, 122–3, 184–5 acute pulmonary oedema See pulmonary oedema, acute cardiogenic levosimendan, 98 systolic, treatment, 14, 82–3 heat stroke, 3, 32 HELICS criteria, ventilator-associated pneumonia, 52, 242 heliox, acute severe asthma, 37 heparin 298 See also low-molecular-weight heparin heparin-induced thrombocytopenia (HIT), 19, 104–5 hepatic failure, acute See acute liver failure herpes simplex encephalitis, 228, 289–90 high-frequency oscillatory ventilation (HFOV), ARDS, 149 histamine H2 receptor antagonists (H2 RAs), 76, 316 human albumin solution (HAS), 190 hyperbaric oxygen therapy, 99, 126–7, 203–4 hypercalcaemia, severe, 226, 279–80 hyperchloraemic metabolic acidosis, 199–200 hyperglycaemia refeeding syndrome, 174 stress, 9, 59–60 hyperkalaemia causes, 118, 163–4 ECG changes, 129, 216, 270, 271 hypermagnesaemia, 123, 188–9 hypernatraemia, 3–4, 34–5 hypertensive emergencies, 225–6, 276–7 hyperthermia, 32 hyperthyroidism, thyroid storm, 125, 196–7 hypertonic saline, 199, 249 hyperventilation, raised intracranial pressure, 198, 309 hypokalaemia, 229, 292–3 ECG changes, 10, 62–3 hyponatraemia acute confusion, 249 causes, 116, 153–4, 265–6, 267 central pontine myelinolysis risk, 325 SIADH, 101, 266 hypotension See also shock causes, 4, 38 hypothermia massive blood transfusion, 300 physiological effects, 115, 149–50 therapeutic, 64, 199, 221, 259–60 hypovolaemic shock, 38, 248 hypoxaemia, 220, 252 immunoglobulin, intravenous, 128, 211 infections hand hygiene and, 223–65, 266 microbiological surveillance, 219, 249–50 surgical site, 236, 321–2 transplant recipients, 213 infectious diseases, notifiable, 127, 204–5 influenza, 118, 165–6, 227, 283–4 Injury Severity Score (ISS), 273 inotropic drugs, 4, 35–6 shock, 33 Intensive Care Delirium Screening Checklist (ICDSC), 71 intercostal chest drains (ICDs), 126, 201–2 internal jugular vein, 42 intra-abdominal hypertension, 102, 270 intra-abdominal pressure monitoring, 269, 270–1 intra-aortic balloon pump (IABP), 13, 77–8 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 Index foot, venous drainage, 133 fresh frozen plasma (FFP), 190, 291–2 furosemide, 262 331 Index intracranial pressure (ICP) monitoring, 118–19, 166–7 raised, management, 125, 198–9, 233, 309–10 intraosseous (IO) route access devices for adults, 220, 252–3 drug administration, 6, 45–6 versus tracheal route, 269 intravenous immunoglobulin, 128, 211 itraconazole, 63 jugular venous bulb oxygen saturation, 229, 293–4 Kerley B lines, 132 lactate, serum, 267 lactic acidosis, 114, 144–5, 199 large bowel pseudo-obstruction, acute, 124, 191–2 lasting power of attorney (LPA), 308 leg, venous drainage, 112, 133–4 levosimendan, 18, 98 Listeria monocytogenes, 140 lithium toxicity, 126, 202–3 liver transplantation referral criteria, 95, 305 loop diuretics, heart failure, 82 low-molecular-weight heparin (LMWH), 29, 298 lumbar puncture (LP), 8–9, 57–8 structures traversed, 15, 85–6 lung-protective ventilation (LPV), ARDS, 149 332 magnesium therapy acute severe asthma, 37 eclampsia, 81 excess, 188–9 magnetic resonance imaging (MRI), unconscious/obtunded trauma patients, 277, 306 mannitol, 198–9 massive blood transfusion, 231, 299–300 massive obstetric haemorrhage, 127, 206 mast-cell tryptase, 8, 56–7 MDMA (3, 4-methylenedioxy-Nmethylamphetamine; ecstasy), 19–20, 106–7 mechanical ventilation See ventilation, artificial meningitis aseptic, 72 bacterial, causes, 12, 71–2 meropenem, 11, 69 metabolic acidosis ethylene glycol poisoning, 311 high anion gap, 125–6, 199–200 management, 128–9, 214 physiological effects, 17, 93–4 metabolic alkalosis, causes, 233, 310–11 methaemoglobinaemia, 39 methicillin-resistant Staphylococcus aureus (MRSA), 230–1, 299 microbiological surveillance, 219, 249–50 micronutrient requirements, 234, 314–15 microscopic polyangiitis (MPA), 307 microshock, 135, 264 Miller–Fisher syndrome, 296, 297 Monro–Kellie doctrine, 309 Multiple Organ Dysfunction Score (MODS), 218, 246 multiple trauma advanced trauma life support (ATLS), 222, 263–4 early management, 128, 211–12 myasthenia gravis (MG), 14, 83 myocardial infarction (MI) localisation, 111–30, 131 non ST-elevation (NSTEMI), 27 ST-elevation See ST-elevation myocardial infarction thrombolysis contraindications, 27, 230, 296 N-acetyl cysteine (NAC), 95, 193, 305 N-acetyl-p-benzo quinone imine (NAPQI), 94, 304 nasogastric feeding tubes, insertion, 234, 315–16 near-infrared spectroscopy (NIRS), 267 neck, anterior triangle, 5, 41–2 necrotising fasciitis, 15–16, 89–90 needle pericardiocentesis, 217, 240–1 nephrotoxicity, drug-induced, 19, 105–6 neurogenic shock, 38 neurological death See brain death neutropenic sepsis, 15, 86–7 NICO monitor, 169 nimodipine, 68 non-invasive ventilation (NIV), 37, 48, 65 norepinephrine, 128, 210, 238 notifiable infectious diseases, 127, 204–5 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 obstetric haemorrhage, massive, 127, 206 obtunded trauma patients, cervical spine clearance, 232, 305 oesophageal Doppler monitoring (ODM), cardiac output, 221, 257–8 oesophageal varices, bleeding See variceal bleeding open abdomen, 19, 102–3 organ donation and transplantation, 236, 324–5 oseltamivir, 283–4 oxygen delivery (DO2 ), 43, 246–52 oxygen therapy COPD, 65 hyperbaric, 99, 126–7, 203–4 toxic effects, 18, 99 P/F ratio, 22 pacing, emergency cardiac, 114–15, 147–8 pancreatitis, acute causes, 123, 189 severe (SAP), management, 231, 300–1 paracetamol (acetaminophen) overdose, 17, 94–5 acute liver failure, 232, 304–5 paraquat poisoning, 123, 185–6 parenteral nutrition (PN), 4, 36, 127, 208 Parkland formula, 115–16, 152–3 peak expiratory flow rate (PEFR) tests, 53, 54 percutaneous coronary intervention (PCI), primary, 27, 296 pericardial effusions, 180, 240–1 pericardiocentesis, needle, 217, 240–1 peripheral tissue perfusion, measures of, 266–8 pH arterial blood, 155 venous blood, 44 phenylephrine, 238–9 plasma drug monitoring, 7–8, 52–3 platelet transfusions, 16, 92–3 pleural effusions exudative, 97–8, 176 Light’s criteria, 120–1, 175–6 transudative, 17–18, 97–8 pneumonia See community-acquired pneumonia, ventilator associated pneumonia pneumothorax spontaneous primary (PSP), 3, 30–1, 227, 282–3 spontaneous secondary (SSP), 3, 30–1 positive pressure ventilation complications, 114, 143–4 physiological effects, 220, 253–4 post-partum haemorrhage (PPH), 206 post-traumatic stress disorder (PTSD), 236, 323–4 powers of attorney, 308 P-POSSUM scoring system, 122, 183–4 precordial thump, 227, 282 pregnant patients, critically ill, 233–4, 313 pressure-support ventilation (PSV), 47, 154 prone positioning, ARDS, 149 proton-pump inhibitors (PPIs), 76, 316 pulmonary artery (PA) catheters, 117, 159–60 complications, 228, 287–8 pulmonary capillary wedge pressure (PCWP), 159, 288 pulmonary embolism hypoxaemia, 251 risk factors, 12, 72–3 pulmonary function tests, 8, 53–4 pulmonary oedema, acute cardiogenic initial management, 9, 61–2 radiographic features, 111–12, 132–3 pulse contour analysis (PCA), 3, 29–30 pulse oximetry, 5, 39, 267 pulsus paradoxus, 180 Index nutrition basal energy requirements, 217, 239–40 micronutrient requirements, 234, 314–15 nasogastric tube insertion, 234, 315–16 parenteral See parenteral nutrition QT interval, prolonged, 70, 100, 117, 160 radiation, ionising, 20, 108–10 rapid sequence induction (RSI), 275 red cell transfusion, guidelines, 235, 318–19 refeeding syndrome, 17, 96–7, 120, 173–4 renal replacement therapy (RRT) discontinuation criteria, 12, 73 indications, 228–9, 290–1 solute clearance, 16, 91–2 renal transplant patients, 128, 213 respiratory failure, 43 Revised Trauma Score (RTS), 273 rhabdomyolysis, 13, 78 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 333 Index 334 RIFLE criteria, acute kidney injury, 112, 137 Rockall scoring system, 28 rule of nines, burn area assessment, 272 salbutamol, 238–9 salicylate (aspirin) overdose, 19, 103–4 SAPS II (Simplified Acute Physiology Score II), 113, 137–8 scoring systems critical care, 118, 164–5 trauma, 273–4 seizures See also status epilepticus causes of acute, 5, 40 eclampsia, 81 selective decontamination of digestive tract (SDD), 236, 322–3 selenium, 29, 314 Sengstaken–Blakemore tubes, 127–8, 209 sepsis disseminated intravascular coagulation (DIC), 291 goals of initial resuscitation, 218, 241–2 intravenous immunoglobulin, 211 neutropenic, 15, 86–7 pregnant women, 319 severe See severe sepsis septic shock pathophysiology, 112, 135–7 vasopressin infusion, 162 severe sepsis general surgical patients with, 14, 79–80 recommended therapies, 120, 172–3 supportive therapy, 2, 28–9 shock causes, 4, 38 treatment, 3, 33–4 short bowel syndrome, 15, 88–9 short saphenous vein, 133 shunts, extra- and intrapulmonary, 251–2 sievert (Sv), 109 Simplified Acute Physiology Score II (SAPS II), 113, 137–8 skin disinfection, 7, 50–1 smoke inhalation, 8, 54–5 snake bites, 129, 215 somatosensory evoked potentials (SSEP), 156–7 Spaulding classification, 119, 168 spinal cord injury, acute management, 125, 195–6 spirometry, 53, 54 standardised mortality ratio (SMR), 118, 164–5, 185 statins, heart failure, 82–3 status epilepticus (SE), 219–20, 251 convulsive, 113, 140–1 EEG monitoring, 156 ST-elevation myocardial infarction (STEMI), 27 localisation, 111–30, 131 management, 27 thrombolysis contraindications, 27, 230, 296 sterilisation, medical equipment, 5, 40–1, 119, 168 stress hyperglycaemia, 9, 59–60 stress ulcer prophylaxis, 13, 76–7, 234–5, 316–17 stroke, acute, 227–8, 285–6 subarachnoid haemorrhage (SAH) acute, management, 119–20, 170–1 cerebral vasospasm, 20, 108 delayed cerebral ischaemia, 11, 67–8 surgical patients P-POSSUM scoring system, 122, 183–4 with severe sepsis, 14, 79–80 surgical site infections, 236, 321–2 Surviving Sepsis Campaign (SSC), 29, 173, 241 suxamethonium, 163, 198 synchronised intermittent mandatory ventilation (SIMV), 2, 24–5, 47, 154 syndrome of inappropriate antidiuretic hormone secretion (SIADH), 18, 101–2, 266 systemic inflammatory response syndrome (SIRS), 125, 197–8 temperature core, measurement, 10, 64 regulation, 3, 32 Tensilon test, 83 terlipressin, 28 tetanus, 124, 140, 192–3 therapeutic drug monitoring, 7–8, 52–3 thermoregulation, 3, 32 thiamine deficiency, refeeding syndrome, 174 thrombocytopenia, heparin-induced (HIT), 19, 104–5 thrombolysis acute ischaemic stroke, 285 contraindications in STEMI, 27, 230, 296 thrombophilia, 72 thyroid storm, 125, 196–7 torsade de pointes, 100–1, 117, 160 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 unconscious trauma patients, cervical spine clearance, 226, 277–8 unstable angina (UA), 27 upper gastrointestinal bleeding, acute, 2, 27–8 urinary catheters, 118, 163 urinary output, renal replacement therapy and, 73 vancomycin, 299 vancomycin-resistant enterococci (VRE), 221, 258–9 variceal bleeding Sengstaken–Blakemore tubes, 127–8, 209 Index T-piece trial, weaning from mechanical ventilation, 220 tracheal drug administration, 146, 268–9, 270 tracheal intubation capnography for confirming, 151 indications, 5, 42–3 tracheobronchitis, acute, oxygen-induced, 99 tracheostomy complications of percutaneous, 234, 313–14 indications for percutaneous, 127, 207 weaning methods, 17, 95–6 transfusion-related acute lung injury (TRALI), 6, 46–7, 235, 317–18 transplantation, organ, 236, 324–5 trauma abdominal, 231, 301–2 advanced trauma life support (ATLS), 222, 263–4 alcohol intoxication and, 75 early management, 128, 211–12 obtunded patients, cervical spine clearance, 232, 305 scoring systems, 273–4 unconscious patients, cervical spine clearance, 226, 277–8 Trauma Injury Severity Score (TRISS), 273 traumatic brain injury alcohol intoxication and, 75 Glasgow Coma Scale, 226, 278–9 raised intracranial pressure, 198, 309 tricyclic antidepressants (TCA), toxicity, 1, 23–4 triple H therapy, subarachnoid haemorrhage, 68 tryptase, mast-cell, 8, 56–7 terlipressin, 28 vasculitis, 232–3, 308 vasoconstrictor agents, 33–4 vasopressin, 117–18, 162 venomous snake bites, 129, 215 venous blood gases, 6, 43–4 venous drainage, leg, 112, 133–4 venous oxygen saturation central (ScvO2 ), 43–4, 267 jugular, 293 mixed (SvO2 ), 43–4 venous thromboembolism (VTE) prevention and management, 230, 297–9 risk factors, 72–3 ventilation, artificial complications, 114, 143–4 indications, 5, 42–3 life-threatening asthma, 116, 142, 154–5 physiological effects, 220, 253–4 weaning from, 6–7, 47–8, 220, 254–6 ventilator-associated pneumonia (VAP), 7, 51–2, 218, 242–3 stress ulcer prophylaxis and, 76 ventilator care bundles, 52, 149, 243 ventilators, mechanics of, 111, 131–2 ventricular fibrillation, electrocution-associated, 222–3, 264 ventricular tachycardia (VT), 100–1 voriconazole, 63 water immersion, 126, 200–1 weaning from mechanical ventilation, 6–7, 47–8, 220, 254–6 from temporary tracheostomy, 17, 95–6 Wegener’s granulomatosis (WG), 307 zanamivir, 283–4 335 Downloaded from Cambridge Books Online by IP 216.195.11.197 on Tue Nov 03 11:16:33 GMT 2015 http://ebooks.cambridge.org/ebook.jsf?bid=CBO9781107705623 Cambridge Books Online © Cambridge University Press, 2015 ... Emma, 1983– author Multiple true false questions for the final FFICM / Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton p ; cm Multiple true false questions for the final Faculty of... Online © Cambridge University Press, 2015 Multiple True False Questions for the Final FFICM Emma Bellchambers BMedSci, BMBS, MRCP, FRCA Specialty Trainee in Anaesthesia and Intensive Care Medicine,... Cambridge University Press, 2015 Cambridge Books Online http://ebooks.cambridge.org/ Multiple True False Questions for the Final FFICM Emma Bellchambers, Keith Davies, Abigail Ford, Benjamin Walton