[...]... luid from the abdomen 2 ᭢ SURGICAL CRITICAL CARE VIVAS ᭿ A ABDOMINAL TRAUMA : INVESTIGATIONS What are the positive criteria with DPL? ᭹ Lavage f luid appears in the chest drain or urinary catheter ᭹ Frank blood on entering the abdomen ᭹ Presence of bile or faeces ᭹ Red cell count of Ͼ100,000/␮l ᭹ White cell count of Ͼ500/␮l ᭹ Amylase of Ͼ175 U/ml 3 SURGICAL CRITICAL CARE VIVAS A ACCESSING THE THORAX... pneumocytes ↓ Surfactant ↓ Compliance Atelectasis ↓ Lung volumes ↑ Work of breathing Infection Where PVR = Pulmonary vascular resistance ᭢ SURGICAL CRITICAL CARE VIVAS Epithelial injury ↑ Secretions & retention A ACUTE RESPIRATORY DISTRESS SYNDROME 17 SURGICAL CRITICAL CARE VIVAS A ACUTE RESPIRATORY DISTRESS SYNDROME Proliferative phase: 5–10 days later With a proliferation of Type-II pneumocytes ᭿ There... (strictly speaking, a metabolite), urea and creatinine 20 ᭢ SURGICAL CRITICAL CARE VIVAS ᭹ ᭹ ᭹ ᭹ A Liver function tests Sepsis screen: blood cultures, wound swab, urine and sputum cultures Radiology: such as a chest radiograph ECG: for arrhythmias or myocardial infarction AGITATION AND SEDATION What is the purpose of sedation in the critical care setting? ᭹ Anxiolysis ᭹ Analgesia ᭹ Amnesia ᭹ Hypnosis... medullary ischaemia ᭢ 11 SURGICAL CRITICAL CARE VIVAS A ᭹ ᭹ ᭹ Tubular cell ischaemia and necrosis leads to cells being shed into the tubular lumen, causing obstruction This promotes a ‘back-leak’ of tubular f luid into the interstitium, increasing the interstitial hydrostatic pressure This reduces tubular f luid reabsorption and worsens oliguria ACUTE RENAL FAILURE Name some common drugs of surgical importance... 13 SURGICAL CRITICAL CARE VIVAS A ᭹ ᭹ Renal replacement therapies: dialysis or filtration Management of the underlying trigger, e.g obstruction, sepsis, glomerulonephritis What is the prognosis of acute renal failure? Mortality of renal failure on its own is in the order of 5–10% Depending on the cause, often there is good recovery of renal function within several weeks ACUTE RENAL FAILURE 14 ᭿ SURGICAL. . .SURGICAL CRITICAL CARE VIVAS Functional residual capacity Glassow coma score Glomerular filtration rate Heparin-induced thrombocytopenia syndrome Human immunodeficiency virus Human leucocyte antigen Her Majesty’s... anterior sternotomy (‘clamshell’ incision): this incision runs from below one nipple to the contralateral side, dividing the body of the sternum in-between It permits emergency access to the 4 ᭢ SURGICAL CRITICAL CARE VIVAS Which important piece of anaesthetic equipment is required for thoracotomy, and why? The double-lumen endobronchial tube This permits the use of one-lung anaesthesia where one lung may... drain may be placed, both exiting sub-costally Briefly mention some important local complications of thoracotomy Wound complications ᭹ Early: ᭿ Immediate dehiscence from poor technique ᭢ 5 SURGICAL CRITICAL CARE VIVAS A Haematoma formation Poor pain control leading to atelectasis, retention of secretions, hypoxia and infection Intermediate: ᭿ Infection, leading to wound dehiscence Late: ᭿ Post-thoracotomy... pneumonectomy May also occur following re-expansion of a chronically collapsed or compressed lung from effusion ᭹ Late: ᭿ Chronic broncho-pleural fistula ᭿ Empyema ACCESSING THE THORAX ᭹ 6 ᭿ SURGICAL CRITICAL CARE VIVAS A ACID-BASE Define the pH The pH is Ϫlog10 [Hϩ] What is the pH of blood? 7.36–7.44 Where does the acid load (H؉) in the body come from? Most of the Hϩ in the body comes from CO2 generated... Henderson–Hasselbalch equation describe, and how is it derived? This equation, which may be applied to any buffer system, defines the relationship between dissociated and undissociated ᭢ 7 SURGICAL CRITICAL CARE VIVAS A acids and bases It is used mainly to describe the equilibrium of the bicarbonate system − CO2 + H2O H2CO3 H+ + HCO3 The dissociation constant, K= [H+ ][HCO− ] 3 [H2CO3 ] Therefore [H+ . alt="" Surgical Critical Care Vivas Greenwich Medical Media Limited Mazyar Kanani BSc (Hons) MBBS (Hons) MRCS (Eng) Surgical Critical Care Vivas For my wife, Pauline Cornelia O’Keeffe Surgical Critical. line insertion’) 183 Pulmonary Thromboembolism 187 Pulse Oximetry 192 SURGICAL CRITICAL CARE VIVAS ᭢ vi SURGICAL CRITICAL CARE VIVAS CONTENTS ᭿ vii Renal Replacement Therapy 194 Respiratory Assessment. pressure PSV Pressure support ventilation PTH Parathormone PVR Pulmonary vascular resistance SURGICAL CRITICAL CARE VIVAS LIST OF ABBREVIATIONS ᭢ ix LIST OF ABBREVIATIONS RAA Renin-angiotensin-aldosterone SAMG