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CICM general questions.
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CICM general questions.
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CICM general questionsAeromedical transport environmental issues - ANS-Cold and risk of hypothermia
Noise limits clinical examination
Poor lighting
Difficult access to patient
Acceleration/Deceleration injuries (cardiac/head injured)
Reduced Partial pressures of PO2
Pressurisation issues
Expansion of intra-cavity trapped gases
APACHE - ANS-Acute Physiology and Chronic Health Evaluation score
Parameters: 1st 24 hours: physiology , biochemistry and haematology and acid-base,
with high-risk diagnoses and GCS
Excludes: cardiac surgery and <16yo (PIM tool)
Body treatment area - ANS-Higher risk of microshock
- residual current devices will cut current
- isolation transformers with line isolation monitors (prevent loss of power to vital
equipment)
Brain death confirmatory testing indications - ANS-1. Further information for a family
having difficulty with diagnosis
2. No clear cause for coma (uncertain mechanism)
3. Possible drug or metabolic effect
4. Incomplete cranial nerve examination (eye/ear injury)
5. Cervical cord injury present
6. Cardiorespiratory instabilty precludes apnoea testing
Cardiac treatment area - ANS-Area where microshock is mitigated as direct electrical
contact with heart is life-threatenting
Equipotential earthing system
Cardiopulmonary problems post ICU - ANS-1. compromised airway clearance
2. decreased lung volumes
3. oxygen dependency
Cause of fixed dilated pupils - ANS-Brain dead
Hypoxia
, Hypothermia
Anticholinergics toxidrome
Catecholamines
Sympathomimetic amine overdose
Barbiturate overdose
Belladona-like plant alkaloid poisoning
Blue-ringed octopus poisoning
Botulism
Curare/curare-like poisoning
Tetrodotoxin poisoning
Clinical brain death testing - ANS-Preconditions: a valid mechanism, absence of
neurodepressant or neuromuscular blockers, absence of hypothermia, absence of
metabolic or endocrine cause.
1. Fixed, dilated pupils (bilateral)
2. Absent corneal reflexes
3.. Absent caloric testing (no wax of haeotympanum)
4.. Absent oculocephaplic reflex
5.. Absent cough and gag
6. Apnoea testing - FiO2 1.0 or 2L/min via catheter - PCO2 rises on ABG with no
triggering of ventilator or detected ETCO2 at 2 minutes
Clinical Information systems (implementation issues) - ANS-1. vendor characterisitics
2. preliminary evaluation of needs
3. ongoing site visits
4. interfaces required, needed
5. ongoing technical support issues
Clinical Information Systems value - ANS-Continuous recording of data
Allows clear documentation
Electronic prescribing
Integerated service information regarding patient
Access to decision support systems
Audit trail for medicolegal purposes and Q&A
Confirmatory brain death testing - ANS-Test twice at 4 hours after clinical time of brain
death (coma, apnoea, bloss of brainstem reflexes) and reason for brain death congruent
1. Clinical
2. Radioloigcal: 4 vessel angiography
3. Radioisotope: Tc99m-labelled red cell perfusion scan
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