Critical Care

Abdominal Anatomy

Define/Describe - Overview of abdominal regions and divisions... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Abdominal Trauma

The management of abdominal trauma has undergone a paradigm shift over the last three decades, moving away from "mandatory laparotomy" for all penetrating wounds toward a sophisticated approach of Selective...

Abdominal Trauma

Answer: Quick Answer : Abdominal trauma evaluation requires systematic assessment combining clinical examination, imaging (FAST and CT), and laboratory investigations. Blunt injuries are managed non-operatively in...

Acalculous Cholecystitis in Critical Care

Post-cardiac surgery patient with unexplained sepsis and RUQ tenderness... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Acid-Base Disorders

Systematic Approach: pH → Primary disorder → Anion gap → Compensation → Delta ratio... CICM Second Part exam preparation.

Acid-Base Physiology

Answer: Acid-base physiology describes the mechanisms that maintain arterial pH within the narrow range of 7.35-7.45. This regulation occurs through three integrated systems: chemical buffers (immediate), respiratory...

Acute Coronary Syndromes

Classification based on ECG and troponin: STEMI (ST elevation + troponin rise), NSTEMI (no ST elevation + troponin ri... CICM Second Part exam preparation.

Acute Epiglottitis in Adults

Acute epiglottitis is a life-threatening inflammatory condition affecting the epiglottis and surrounding supraglottic structures, capable of progressing rapidly to complete airway obstruction. Following widespread...

Acute Heart Failure

Key Facts The "Flash" Phenomenon : In hypertensive AHF, symptoms arise from fluid redistribution (sympathetic-mediated vasoconstriction) rather than total body volume overload. Time is Myocardium : Every hour of delay...

Acute Heart Failure in ICU

Nohria-Stevenson classification divides AHF into four profiles based on congestion (wet/dry) and perfusion (warm/cold... CICM Second Part Written, CICM Secon

Acute Kidney Injury (Adult)

KDIGO 2012 Classification: Three-stage system based on creatinine and urine output... CICM Second Part exam preparation.

Acute Kidney Injury (AKI)

The diagnosis is established using the KDIGO (2012) criteria , which defines AKI as a rise in serum creatinine of ≥26.5 µmol/L within 48 hours or a 1.5-fold increase from baseline. Management is focused on identifying...

Acute Kidney Injury in Children

Acute kidney injury (AKI) in children represents a sudden decline in kidney function characterised by rising serum creat... MRCPCH exam preparation.

Acute Kidney Injury Pathology

Acute Kidney Injury (AKI) is classified by KDIGO into Stages 1-3 based on creatinine rise and urine output. Pathophysiologically, AKI is divided into pre-renal (hypoperfusion), intrinsic (tubular, glomerular,...

Acute Liver Failure

Key Facts The Definition Triad : 1. Acute onset (less than 26 weeks), 2. Coagulopathy (INR ≥1.5), 3. Encephalopathy. The "Killer" Mechanism : Cerebral oedema leading to brainstem herniation is the most common cause of...

Acute Liver Failure

Acute Liver Failure is a high-yield topic for CICM examinations, testing core ICU competencies:... CICM Second Part, FCICM exam preparation.

Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is a life-threatening surgical emergency caused by inadequate blood flow to the intestin... CICM Second Part exam preparation.

Acute Pancreatitis

Diagnostic criteria: 2 of 3 (pain, lipase greater than 3× ULN, imaging)... CICM Second Part exam preparation.

Acute Respiratory Distress Syndrome (ARDS) - Adult

Comprehensive critical care guide to Acute Respiratory Distress Syndrome covering Berlin criteria, pathophysiology, lung-protective ventilation, prone positioning, ECMO, and evidence-based management for postgraduate...

Acute Respiratory Distress Syndrome (ARDS) - Adult

Comprehensive critical care guide to Acute Respiratory Distress Syndrome covering Berlin criteria, pathophysiology, lung-protective ventilation, prone positioning, ECMO, and evidence-based management for postgraduate...

Acute Sepsis - Paediatric

Sepsis in children is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.... MRCPCH exam preparation.

Acute Severe Asthma in Adults

Acute severe asthma is a medical emergency characterised by progressive bronchospasm, airway inflammation, and mucus hyp... MRCP exam preparation.

Acute Soft Tissue Infection

Acute soft tissue infections (SSTIs) represent a spectrum of bacterial infections affecting the skin, subcutaneous tissu... MRCS exam preparation.

Acute Valvular Dysfunction

Acute valvular dysfunction represents sudden failure or severe deterioration of heart valve function, causing either reg... MRCP exam preparation.

Acute-on-Chronic Liver Failure (ACLF)

Key Facts Incidence : Occurs in 25–35% of patients hospitalized for acute decompensation of cirrhosis. Mortality : 28-day mortality ranges from 23% (Grade 1) to 75% (Grade 3). Pathophysiology : Massive systemic...

Adrenal Crisis

Adrenal crisis is an acute, life-threatening state of cortisol deficiency that requires immediate recognition and treatm... CICM Second Part exam preparation.

Advanced Life Support - Adult

Adult Advanced Life Support provides the framework for managing cardiac arrest beyond basic CPR and AED use. ALS incorpo... ACEM Primary Written, ACEM Primary V

Alcohol Withdrawal in ICU

Compare symptom-triggered vs fixed-schedule benzodiazepine protocols (evidence, dosing, advantages)... CICM Second Part exam preparation.

Amniotic Fluid Embolism

Hypoxia - Acute respiratory failure, cyanosis, pulmonary edema... CICM Fellowship Written, CICM Fellowship Viva exam preparation.

Amniotic Fluid Embolism (AFE)

Amniotic Fluid Embolism (AFE) is a catastrophic, unpredictable obstetric emergency characterised by the sudden onset of ... MRCOG exam preparation.

Anaesthesia for the Septic Patient

Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection, with septic shock defined as sepsis with persistent hypotension requiring vasopressors despite adequate fluid...

Analgesia in ICU

Pain Assessment: "I would use the BPS or CPOT score, validated in non-communicative ICU patients, with a threshold of... CICM Second Part exam preparation.

Anaphylactic Shock

Adrenaline is the ONLY first-line medication - IM 0.5 mg (1:1,000) into anterolateral thigh... CICM Second Part, ACEM Fellowship exam preparation.

Anticoagulation Reversal

Warfarin reversal: 4F-PCC 25-50 U/kg achieves INR below 1.5 in 10-30 minutes; vitamin K 5-10 mg IV for sustained reve... CICM Second Part exam preparation.

Antimicrobial Pharmacology in Critical Care

Time-dependent killing (beta-lactams): efficacy depends on duration above MIC (%T MIC). Target 50-100% of dosing inte... CICM First Part Written, CICM First

Aortic Dissection

Beta-blockade FIRST: Esmolol or labetalol to target HR below 60 bpm (reduces dP/dt)... CICM Second Part exam preparation.

ARDS Pathology

Define/Describe - Berlin Definition, DAD as histopathological correlate... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Arterial Line Monitoring

An arterial line (arterial catheter) provides continuous invasive blood pressure monitoring and allows frequent arterial... CICM Second Part exam preparation.

Ascites and Spontaneous Bacterial Peritonitis

Ascites is the pathological accumulation of fluid in the peritoneal cavity, occurring in 50% of patients with compensated cirrhosis within 10 years of diagnosis. It represents a critical transition from compensated to...

Ascites Management in Critical Care

Ascites and its complications are high-yield CICM Second Part topics appearing regularly in:... CICM Second Part Written, CICM Second Part Hot Case exam prepara

Aspiration Pneumonia

Key Facts Incidence : Accounts for 5-15% of community-acquired pneumonia; up to 30% in nursing home residents Pathogenesis : Failure of airway protective mechanisms → aspiration of colonised oropharyngeal/gastric...

Asthma in ICU (Status Asthmaticus)

Comprehensive CICM Second Part clinical guide to Status Asthmaticus (acute severe asthma) in the ICU, covering pathophysiology, dynamic hyperinflation, auto-PEEP, mechanical ventilation strategies, permissive...

Atrial Fibrillation in ICU

Incidence 20–40% in ICU patients; new-onset AF (NOAF) associated with 2–4× increased mortality and prolonged ICU stay... CICM Second Part exam preparation.

Australian Marine Envenomation

Immediate vinegar (4-6% acetic acid) for ALL jellyfish stings - inactivates undischarged nematocysts... CICM Second Part Written, CICM Second Part Hot Case e

Australian Snake Envenomation

Pressure Immobilisation Bandage (PIB) - DO NOT REMOVE until antivenom ready... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Australian Spider Envenomation

Funnel-web: Pressure Immobilisation Bandaging (PIB) immediately, CSL Funnel-Web Spider Antivenom, ICU admission... CICM Second Part Written, CICM Second Part

Autonomic Nervous System Anatomy

Define/Overview - Division of autonomic nervous system, general organization... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Benzodiazepine Overdose

Understanding the pharmacological basis of benzodiazepine toxicity, recognition of high-risk scenarios (particularly opioid co-ingestion), and appreciation of the risks associated with antidote administration are...

Benzodiazepine Overdose

Benzodiazepine overdose causes CNS depression ranging from mild sedation to coma, typically described as "coma with stab... ACEM Primary Written, ACEM Primary V

Beta-Blocker and Calcium Channel Blocker Overdose

ABCDE, high-flow O₂, secure large-bore IV access (2 x 14G)... CICM Primary Written, CICM Fellowship Written exam preparation.

Beta-Blocker Overdose

Beta-blocker overdose represents a life-threatening cardiovascular emergency characterized by profound bradycardia, hypo... MRCP, FRACP exam preparation.

Blood Component Therapy

Restrictive transfusion (Hb 70 g/L): TRICC, TRISS, and TRICS-III trials support restrictive thresholds in most ICU po... CICM Second Part Written, CICM Secon

Blood Gas Analyzers in ICU

Comprehensive guide to blood gas analyzer technology, measurement principles (pH electrode, Severinghaus CO2 electrode, Clark O2 electrode), co-oximetry, electrolyte measurement, lactate, pre-analytical errors, quality...

Bowel Obstruction

SBO vs LBO: Small bowel (60-70% adhesions) vs large bowel (50-60% cancer)... CICM Second Part exam preparation.

Brachial Plexus and Regional Anaesthesia

Formation - Roots from ventral rami, contributions from C5-T1... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Bradyarrhythmias & Heart Block in ICU

Atropine 0.5-1 mg IV (max 3 mg) - first-line for symptomatic bradycardia... CICM Second Part exam preparation.

Brain Death and Organ Donation

Brain death and organ donation appear in multiple CICM exam formats:... CICM Second Part, FCICM exam preparation.

Brain Injury Pathology - Primary and Secondary Injury Mechanisms

Define Primary vs Secondary Injury - Temporal and mechanistic distinction... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Breaking Bad News in Intensive Care

Breaking bad news is one of the most challenging and frequent tasks in intensive care practice. Studies indicate ICU cli... CICM Fellowship Written, CICM Fellow

Bronchiolitis

Key Clinical Features : Coryza prodrome (1-3 days) followed by cough, tachypnoea, wheeze, crackles Work of breathing: subcostal and intercostal recession, nasal flaring, grunting Hypoxia (SpO2 <92%) indicating need...

Bronchoscopy Equipment

Bronchoscope Types: Flexible video (standard adult OD 5.0-5.5mm, slim 3.5-4.2mm, therapeutic 6.0-6.4mm), rigid (stain... CICM Second Part Written, CICM Secon

Burnout and Wellbeing in ICU

Organizational/Structural (most effective): Workload modification, adequate staffing, rostering... CICM Second Part Written, CICM Second Part Hot Case exam p

Burns Assessment and Management

Burns are tissue injuries caused by heat (thermal), chemicals, electricity, radiation, or friction, representing one of ... MRCS, FRACS exam preparation.

Burns in ICU

Burns in ICU require systematic assessment of total body surface area (TBSA) and burn depth, aggressive fluid resuscitat... CICM Second Part exam preparation.

Burns Pathology

Define/Describe - Jackson zones, burn depth classification... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Calcium Channel Blocker Overdose

Calcium channel blocker (CCB) overdose is a potentially lethal cardiovascular poisoning characterized by profound bradycardia, hypotension, cardiogenic shock, and metabolic derangements including hyperglycaemia....

Calcium Disorders: Hypocalcemia and Hypercalcemia

Calcium gluconate 10% 10-20 mL IV over 10-20 minutes (0.9-1.8 mmol Ca2+)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Can't Intubate Can't Oxygenate (CICO)

What is it? Can't Intubate Can't Oxygenate (CICO) is a life-threatening airway emergency where tracheal intubation has failed AND oxygenation cannot be achieved via facemask or supraglottic airway (SGA). This...

Carbon Dioxide Transport & Elimination

Answer: Carbon dioxide (CO2) is transported in blood via three mechanisms: dissolved CO2 (7-10%) , bicarbonate (70-80%) , and carbamino compounds (20-23%) . The enzyme carbonic anhydrase catalyzes the reversible...

Carbon Monoxide and Cyanide Poisoning

100% oxygen via non-rebreather or intubation (reduces CO half-life from 4-5 hours to 60-90 minutes)... CICM Second Part Written, CICM Second Part Hot Case ex

Carbon Monoxide Poisoning

Carbon monoxide (CO) poisoning is a leading cause of fatal poisoning worldwide, resulting from inhalation of CO gas which binds haemoglobin with 200-250 times greater affinity than oxygen, forming carboxyhaemoglobin...

Cardiac Anatomy & Coronary Circulation

Define/Describe - Overview of cardiac chambers, orientation in thorax... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Cardiac Arrest - Adult

Cardiac arrest is the cessation of mechanical cardiac activity confirmed by the absence of a palpable central pulse, unr... ACEM Primary Written, ACEM Primary V

Cardiac Arrhythmias in ICU

Cardiac arrhythmias are common in ICU patients (10-20% incidence) and require systematic assessment of hemodynamic stabi... CICM Second Part exam preparation.

Cardiac Monitors and Telemetry in ICU

Comprehensive guide to cardiac monitoring in the intensive care unit including ECG acquisition, lead placement, continuous monitoring parameters, alarm management, derived indices (HRV, QTc), arrhythmia detection,...

Cardiac Tamponade

Cardiac tamponade is life-threatening compression of the heart by fluid (blood, effusion) in the pericardial space impairing diastolic filling and reducing cardiac output. Pathophysiology: Pericardial pressure...

Cardiac Tamponade in Adults

Cardiac tamponade is a life-threatening cardiovascular emergency characterized by accumulation of fluid within the pericardial space, resulting in elevated intrapericardial pressure and impaired ventricular filling....

Cardiogenic Shock

Cardiogenic shock is cardiac pump failure causing inadequate tissue perfusion despite adequate or elevated filling press... CICM Second Part exam preparation.

Cardiogenic Shock

Cardiogenic shock occurs when the heart fails to pump sufficient blood to meet metabolic demands, resulting in systemic ... ACEM Primary Written, ACEM Fellowshi

Cardiopulmonary Resuscitation (CPR) - Adult

Cardiopulmonary resuscitation (CPR) is a lifesaving technique combining chest compressions and rescue ventilations to maintain circulatory flow and oxygenation during cardiac arrest. High-quality CPR is the...

Cardiovascular Physiology

Cardiovascular physiology forms the foundation of critical care practice, informing haemodynamic monitoring, vasoactive ... CICM Fellowship Written, CICM Fellow

Central Venous Access

High-Yield Topics: Indications and contraindications (absolute vs relative) Site selection: IJ (preferred), subclavian, femoral, PICC Ultrasound guidance (mandatory, complication reduction) Seldinger technique vs...

Cerebral Blood Flow & Autoregulation

Normal CBF values: 50 mL/100g/min total; grey matter 80-100, white matter 20-25 mL/100g/min... CICM First Part Written, CICM First Part Viva exam preparation

Chest Trauma

<Flashcard question="What is the approximate incidence of blunt vs penetrating chest trauma?" answer="Blunt trauma accou... CICM Second Part exam preparation.

Chest Tube Insertion (Intercostal Drain)

Chest tube insertion (intercostal drain, tube thoracostomy) is a critical procedure for evacuation of air or fluid from the pleural space. The triangle of safety (anterior border of latissimus dorsi, lateral border of...

Chronic Kidney Disease in the ICU

Assess dialysis access patency and recent dialysis schedule... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Coagulation Cascade & Fibrinolysis

Primary haemostasis involves platelet adhesion (via vWF-GPIb), activation (shape change, granule release), and aggreg... CICM First Part Written, CICM First

Coagulation Disorders Pathology

Coagulation disorders in critical illness result from complex interactions between inflammation, endothelial dysfunction, and haemostatic pathways. DIC involves simultaneous coagulation activation (tissue factor...

Congenital Heart Disease in ICU

Congenital Heart Disease (CHD) encompasses structural abnormalities of the heart and great vessels present at birth, affecting 8-10 per 1,000 live births. CHD represents the most common congenital malformation and a...

Consent and Capacity in Intensive Care

Valid consent requires three elements: voluntary decision (free from coercion), informed (adequate disclosure of mate... CICM Second Part Written, CICM Secon

Contrast-Induced Nephropathy / Contrast-Associated Acute Kidney Injury (CA-AKI)

Definition (KDIGO): Serum creatinine rise ≥26.5 μmol/L within 48 hours OR ≥50% increase within 7 days of contrast exp... CICM Second Part Written, CICM Secon

COPD Exacerbation in ICU

Corticosteroids for 5 days (REDUCE trial evidence)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

COVID-19

COVID-19 (Coronavirus Disease 2019) is a systemic viral illness caused by the novel coronavirus SARS-CoV-2 (Severe Acute... MRCP, USMLE exam preparation.

Cricothyroidotomy

Critical Management Principles : Indication : CICO situation (Plan D) - cannot intubate AND cannot oxygenate Preferred technique : Scalpel-bougie-tube (DAS 2015) - transverse stab incision through CTM Cricothyroid...

Crisis Resource Management in Intensive Care

Crisis Resource Management (CRM) represents a systematic approach to managing extreme demand for critical care services,... CICM Fellowship Written, CICM Fellow

Croup (Laryngotracheobronchitis)

Key Clinical Features : Viral prodrome (1-2 days of coryza, low-grade fever) Barking "seal-like" cough (hallmark) Inspiratory stridor (biphasic = severe) Hoarse voice Worse at night, often improves during day NO...

CRRT Pharmacology

Continuous Renal Replacement Therapy (CRRT) profoundly alters drug pharmacokinetics through three primary mechanisms: co... CICM Fellowship Written, CICM Fellow

Crush Injury & Crush Syndrome

Crush injury is compressive trauma to body parts causing direct tissue damage through mechanical disruption and ischemia... MRCP, EDIC exam preparation.

Damage Control Resuscitation

Damage Control Resuscitation (DCR) is a systematic approach to managing life-threatening hemorrhagic shock that prioriti... ACEM Fellowship Written, ACEM Fellow

Defibrillators and Cardioversion

Comprehensive guide to defibrillation physics, waveforms, device types, energy selection, pad placement, synchronized cardioversion, transcutaneous and transvenous pacing for CICM Second Part examination.

Delirium in ICU

Delirium is an acute fluctuating disturbance of consciousness and cognition affecting 30-50% of ICU patients (70-80% of ... CICM Second Part exam preparation.

Delirium in ICU: Assessment, Prevention and Management

Definition (DSM-5): Acute disturbance in attention and awareness that develops over hours to days and fluctuates in s... CICM Second Part Written, CICM Secon

Dengue Fever

Dengue fever is the most prevalent mosquito-borne viral infection worldwide, caused by the dengue virus (DENV), a single... MRCP exam preparation.

Dexmedetomidine: Pharmacology and Clinical Use

Dexmedetomidine is a highly selective alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties. Mechanism : Acts on alpha-2A receptors in locus coeruleus (sedation), spinal cord (analgesia), and...

Diabetes Insipidus and SIADH: Water Balance Disorders in ICU

Confusing SIADH with cerebral salt wasting - Volume status is key: euvolemic (SIADH) vs. hypovolemic (CSW)... CICM Second Part Written, CICM Second Part Hot

Diabetic Ketoacidosis (Adult)

Diabetic Ketoacidosis (DKA) is a life-threatening acute metabolic emergency characterized by the pathognomonic triad of hyperglycemia , ketosis , and metabolic acidosis . It represents a state of absolute or relative...

Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

Comprehensive evidence-based guide to DKA and HHS management in the intensive care unit, covering pathophysiology, fluid resuscitation, insulin therapy, electrolyte replacement, and complications

Dialysis Machines (IHD, CRRT)

Three Clearance Mechanisms: Dialysis machines remove solutes via diffusion (small molecules &lt;500 Da), convection (... CICM Second Part Written, CICM Secon

Difficult Airway in ICU

ICU intubation is high-risk: Peri-intubation adverse events occur in 45% of ICU intubations (INTUBE study), including... CICM Second Part exam preparation.

Difficult Airway Management

The difficult airway occurs in 1-6% of emergency department intubations and carries mortality of 25-30% if mismanaged, p... ACEM Primary Written, ACEM Primary V

Digoxin and Lithium Toxicity

Digoxin Na+/K+-ATPase inhibition: Results in increased intracellular Na+, which reduces the Na+/Ca2+ exchanger activi... CICM Second Part exam preparation.

Disaster Medicine and Mass Casualty ICU

Disaster medicine encompasses the medical response to events that overwhelm local healthcare capacity, requiring extraor... CICM Fellowship Written, CICM Fellow

Disaster Preparedness in Intensive Care

Activate Hospital Incident Command System (HICS)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Disseminated Intravascular Coagulation

Treat the underlying cause (definitive treatment - sepsis source control, delivery in obstetric DIC)... CICM Second Part exam preparation.

Disseminated Intravascular Coagulation (DIC)

Key Facts Always secondary : DIC is never a primary diagnosis — identify and treat the underlying cause Pathophysiology : Uncontrolled thrombin generation → microthrombi formation → consumption of platelets and...

Distributive Shock (Adult)

Distributive shock is characterized by profound systemic vasodilation leading to maldistribution of blood flow and inadequate tissue perfusion despite normal or elevated cardiac output. Unlike hypovolemic or...

DOAC-Associated Bleeding in Adults

Direct oral anticoagulants (DOACs) have revolutionized anticoagulation therapy, offering predictable pharmacokinetics wi... MRCP, FRCEM exam preparation.

Donation after Brain Death (DBD) - Expanded Donor Management

Donation after Brain Death (DBD) is the process of organ retrieval following formal determination of death by neurological criteria. Brain death triggers a biphasic autonomic response : an initial catecholamine storm...

Donation After Circulatory Death (DCD)

DCD appears frequently in CICM Second Part examinations as a standalone topic or combined with end-of-life care:... CICM Second Part, FCICM exam preparation.

Drowning

Key Facts Definition : Respiratory impairment from submersion/immersion in liquid (WHO 2002) Global burden : 236,000 deaths annually; 90% in low- and middle-income countries Primary injury mechanism : Hypoxia from...

Drowning - ICU Management

Day 1-3 post-drowning with ARDS requiring mechanical ventilation... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Drug Interactions in Critical Care

Drug interactions represent one of the most significant preventable causes of adverse events in the intensive care unit, affecting up to 70-80% of critically ill patients. The ICU environment is uniquely hazardous:...

ECMO Cannulation and Vascular Access

Extracorporeal membrane oxygenation (ECMO) cannulation establishes vascular access for temporary mechanical circulatory and/or respiratory support. Two configurations exist: (1) Veno-arterial (VA) - femoral vein...

ECMO Circuits and Equipment

VV-ECMO Configuration: Drains deoxygenated blood from venous system (typically femoral/jugular), passes through oxyge... CICM Second Part Written, CICM Secon

ECMO Pharmacology

Extracorporeal membrane oxygenation (ECMO) profoundly alters drug pharmacokinetics (PK) and pharmacodynamics (PD) throug... CICM Fellowship Written, CICM Fellow

Electrical Cardioversion

ALWAYS press SYNC button before cardioversion - asynchronous shock in R-on-T can precipitate ventricular fibrillation... ACEM Fellowship Written, ACEM Fellow

Electrical Injury and Lightning Strike

Electrical injuries cause devastating deep tissue damage, cardiac arrhythmias, and systemic complications disproportionate to visible burns. Key principles:

Electrolyte Disorders in ICU

Hyponatremia correction rate: Maximum 8-10 mmol/L per 24 hours; high-risk patients (alcoholism, malnutrition, hypokal... CICM Second Part exam preparation.

Electrolyte Physiology

Answer: Electrolyte physiology encompasses the regulation of sodium, potassium, calcium, magnesium, phosphate, and chloride ions that are essential for cellular function, neuromuscular activity, and acid-base balance....

End-of-Life Discussions in Intensive Care

End-of-life (EOL) discussions in the intensive care unit (ICU) represent some of the most challenging and consequential ... CICM Fellowship Written, CICM Fellow

Endocrine Physiology (Adrenal, Thyroid, Pituitary)

Endocrine physiology is fundamental to understanding the stress response in critical illness, metabolic regulation, and ... CICM First Part Written, CICM First

Enteral Nutrition in Critical Care

Enteral nutrition (EN) is the preferred method of nutritional support in critically ill patients with a functioning gast... CICM Fellowship Written, CICM Fellow

External Ventricular Drain

An external ventricular drain (EVD), also known as a ventriculostomy, is a temporary catheter placed into the lateral ve... CICM Second Part exam preparation.

Extracorporeal Membrane Oxygenation

VV-ECMO for severe ARDS: Indications, timing, patient selection, management strategies... CICM Second Part exam preparation.

Extracorporeal Membrane Oxygenation (ECMO): VV and VA Configurations, Cannulation, and Management

Extracorporeal Membrane Oxygenation (ECMO) provides temporary cardiopulmonary support by draining venous blood, removing carbon dioxide and adding oxygen through a membrane oxygenator, and returning oxygenated blood...

Extradural Haematoma

The classic presentation features the "lucid interval" an initial brief loss of consciousness following trauma, apparent recovery to near-normal neurological status, followed by rapid deterioration as the haematoma...

Extubation Criteria

Extubation is the planned removal of an endotracheal tube after determining a patient can maintain adequate spontaneous ... ACEM Primary Written, ACEM Fellowshi

Eye Anatomy and Pupillary Reflexes

Overview - Pupil anatomy and control mechanisms... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Failed Intubation Drill

Failed intubation occurs in 1-3% of emergency department intubations and can rapidly deteriorate to a CICO (Can't Intuba... ACEM Primary Written, ACEM Primary V

Family Conferences and Communication in ICU

70-90% of ICU Deaths Involve Treatment Decisions: Most deaths in ICU are preceded by decisions to limit or withdraw t... CICM Second Part Written, CICM Secon

Fat Embolism Syndrome

Key Facts Timing : 12-72 hours after injury (peak 24-48 hours; rarely less than 12 hours or &gt;1 week) Classic triad : Respiratory insufficiency (75-95%) + neurological dysfunction (60-80%) + petechial rash (20-50%)...

Fetal and Neonatal Physiology

The CICM First Part examination frequently tests fetal and neonatal physiology as it underpins understanding of duct-dep... CICM First Part Written, CICM First

Flexible Bronchoscopy in ICU

Red Flag Warning: Hypoxemia and hemodynamic instability are the most common life-threatening complications. Always pre-oxygenate with 100% FiO₂, monitor vital signs continuously, and have immediate airway rescue...

Fluid Compartments & Distribution

Answer: Total body water (TBW) comprises approximately 60% of body weight in adult males (42L in a 70kg individual), distributed between the intracellular fluid (ICF) compartment (40% body weight, 2/3 TBW, 28L) and...

Fournier's Gangrene

Fournier's gangrene is a rare but life-threatening form of necrotising fasciitis affecting the perineum, genitalia, and ... MRCS, MRCP exam preparation.

Fournier's Gangrene

Fournier's Gangrene is a fulminant, life-threatening necrotising fasciitis of the perineum, genitalia, and perianal regi... FRCS exam preparation.

Futility and Ethics Consultation in Intensive Care

Futility and ethics consultation appear frequently in CICM examinations:... CICM Second Part Written, CICM Second Part Viva exam preparation.

Gastrointestinal Physiology

The gastrointestinal tract performs four critical functions: motility (propulsion and mixing), secretion (digestive enzy... CICM First Part Written, CICM First

Guillain-Barré Syndrome

The pathophysiology involves molecular mimicry, where antibodies generated against infectious agents cross-react with peripheral nerve components, leading to demyelination (in acute inflammatory demyelinating...

Guillain-Barré Syndrome

\u003e One-liner: Guillain-Barré Syndrome is an acute immune-mediated polyradiculoneuropathy causing rapidly ascending f... CICM Second Part exam preparation.

Guillain-Barré Syndrome (Adult)

Guillain-Barré Syndrome (GBS) is an acute, post-infectious, immune-mediated polyneuropathy representing the most common ... MRCP exam preparation.

Haemodynamic Monitoring in ICU

Comprehensive guide to invasive and non-invasive haemodynamic monitoring techniques in critically ill patients, including arterial lines, central venous pressure, pulmonary artery catheters, pulse contour analysis,...

Haemophagocytic Lymphohistiocytosis

Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome characterized by pathological... MRCP, USMLE Step 2/3 exam preparatio

Health Literacy and Patient Education in ICU

Assume universal low health literacy - Use plain language with everyone... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Healthcare-Acquired Infections

ICU Impact: HAIs affect 10-30% of ICU patients, associated with 2-3-fold increased mortality, prolonged ICU stay (median +8 days), and excess healthcare costs (AUD 18,000-50,000 per case).

Heat Stroke in Adults

Comprehensive evidence-based guide to the diagnosis and emergency management of heat stroke in adults, including pathophysiology, cooling methods, and multi-organ complications

HELLP Syndrome

Maternal stabilisation: Airway, breathing, circulation with blood product support... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Heparin-Induced Thrombocytopenia

STOP ALL HEPARIN (including flushes, heparin-coated catheters, LMWH)... CICM Second Part exam preparation.

Heparin-Induced Thrombocytopenia (HIT)

The hallmark of HIT is the combination of: Thrombocytopenia (platelet drop 50% from baseline) Timing (5-10 days after heparin initiation, or less than 24 hours if recent prior exposure) Thrombosis (30-50% of untreated...

Hepatic Drug Dosing in ICU

Answer: Hepatic drug dosing in critical illness requires understanding of liver physiology, drug metabolism pathways, and the impact of liver disease on pharmacokinetics. The liver receives 25-30% of cardiac output...

Hepatic Encephalopathy

Domain Key Focus Areas ------------ --------------------- Classification Type A/B/C, West Haven Grades 0-4, Covert vs Overt HE Pathophysiology Ammonia-glutamine-astrocyte swelling hypothesis, neuroinflammation,...

Hepatic Failure Pathology

Acute liver failure (ALF) is defined as severe hepatic dysfunction with coagulopathy (INR ≥1.5) and encephalopathy in a patient without pre-existing liver disease, developing within 26 weeks of symptom onset....

Hepatic Physiology

The liver is the largest solid organ (1.4-1.8 kg), receiving 25% of cardiac output through a unique dual blood supply: p... CICM First Part Written, CICM First

Hepatorenal Syndrome (HRS)

HRS occurs almost exclusively in the context of decompensated cirrhosis with ascites, though it can occasionally complicate acute liver failure and alcoholic hepatitis. The syndrome carries an extremely poor...

Hepatorenal Syndrome (HRS)

Volume expansion with 20-25% albumin (1 g/kg/day for 2 days, max 100g/day)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Hospital-Acquired Pneumonia

Hospital-acquired pneumonia (HAP) is pneumonia that develops ≥48 hours after hospital admission and was not incubating a... MRCP exam preparation.

Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Hospital-acquired pneumonia (HAP) is defined as pneumonia that develops 48 hours or more after hospital admission and wa... MRCP, FFICM exam preparation.

Hyperosmolar Hyperglycaemic State (HHS)

Unlike Diabetic Ketoacidosis (DKA), HHS develops insidiously over days to weeks, leading to a much more profound fluid deficit (often 10–22 litres). The mortality rate of HHS remains high (15–20%), significantly...

Hyperosmolar Hyperglycaemic State (HHS)

HHS is characterised by a relative insulin deficiency that is sufficient to prevent lipolysis and ketogenesis but insufficient to facilitate glucose utilisation or suppress hepatic gluconeogenesis. This results in...

Hypertensive Emergency

Select appropriate parenteral antihypertensive agents... CICM Second Part exam preparation.

Hyperthermia and Heat Stroke

Heat stroke is a life-threatening hyperthermic emergency with core temperature 40°C and neurological dysfunction. Rapid cooling is the priority. Key principles:

Hypoglycaemia in Critical Care

Comprehensive evidence-based guide to hypoglycaemia recognition, prevention, and management in the ICU, including NICE-SUGAR trial evidence, counter-regulatory hormone physiology, treatment protocols, and glucose...

Hypophosphataemia

The most clinically significant scenario is refeeding syndrome , where malnourished or starved patients develop acute, life-threatening hypophosphataemia upon carbohydrate refeeding due to rapid intracellular...

Hypovolaemic Shock

Hypovolaemic shock is a clinical state of inadequate tissue perfusion resulting from reduced intravascular volume. It is... CICM Second Part exam preparation.

Hypovolemic Shock (Adult)

Hypovolemic shock is a life-threatening circulatory failure state characterised by inadequate intravascular volume to ma... MRCP, FRCEM exam preparation.

ICD Emergencies in ICU

"What is the difference between magnet application and device deactivation?"... CICM Second Part exam preparation.

ICU Administration and Management: Structure, Staffing, Governance, and Quality

ICU Levels (IC-1): Level 1 = stabilization and short-term ventilation before transfer; Level 2 = indefinite multi-sys... CICM Second Part Written, CICM Secon

ICU Design and Environment

The ICU physical environment significantly impacts patient outcomes, staff well-being, and family experience. Evidence-b... CICM Fellowship Written, CICM Fellow

ICU Outreach and Rapid Response Systems

Afferent limb: Monitoring, track-and-trigger systems, escalation protocols... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

ICU Ventilators - Types and Modes

Ventilator Classification: ICU ventilators are classified by pressure type (positive vs negative), power source (pneu... CICM Second Part Written, CICM Secon

ICU-Acquired Weakness (ICUAW)

Definition and Classification: ICUAW umbrella term; CIP vs CIM vs overlap... CICM Second Part exam preparation.

Idiopathic Pulmonary Fibrosis (IPF)

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease (ILD) of unknown aeti... MRCP exam preparation.

Immune Dysfunction Pathology in Critical Illness

Immune dysfunction in critical illness encompasses both hyperinflammation (SIRS) and immunosuppression (CARS/immunoparalysis). The initial pro-inflammatory response involves PAMP/DAMP recognition, cytokine release...

Immune System Physiology

Answer: Immune system physiology describes the coordinated network of cells, tissues, and molecules that protect the host from pathogens. The immune system comprises two interconnected arms: innate immunity...

Infective Endocarditis

Infective endocarditis (IE) is infection of the endocardial surface, most commonly affecting heart valves. Diagnosis req... CICM Second Part exam preparation.

Infusion Pumps and Drug Delivery

Pump Classification: ICU infusion pumps include volumetric pumps (peristaltic mechanism, 0.1-999 mL/h), syringe pumps... CICM Second Part Written, CICM Secon

Interprofessional Communication in ICU

Interprofessional communication is a cornerstone of safe, effective intensive care delivery. Communication failures are ... CICM Fellowship Written, CICM Fellow

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome

"Define IAH and ACS. Outline the grading system for IAH."... CICM Second Part exam preparation.

Intra-abdominal Sepsis and Peritonitis

Intra-abdominal sepsis represents a spectrum from localized infection to generalized peritonitis with systemic organ dys... CICM Second Part exam preparation.

Intra-aortic Balloon Pump

IABP-SHOCK II trial is practice-changing: Randomized 600 patients with AMI-related cardiogenic shock to IABP vs optim... CICM Second Part exam preparation.

Intracerebral Hemorrhage

Blood pressure control : Target SBP 140-180 mmHg within 1 hour (INTERACT2), avoiding aggressive lowering to 110-139 mmHg (ATACH-2 showed no benefit and increased renal adverse events) Reversal of coagulopathy :...

Intracranial Pressure Management

Intracranial pressure (ICP) is normally 5-15 mmHg (supine). Cerebral perfusion pressure (CPP) = MAP - ICP (target 60-70 mmHg). Monro-Kellie doctrine : Fixed intracranial volume (brain 80%, CSF 10%, blood 10%). ICP...

Intracranial Pressure Monitoring Systems

Monro-Kellie Doctrine: The cranium is a rigid box with fixed volume ( 1,400-1,700 mL); the sum of brain (80%), blood ... CICM Second Part Written, CICM Secon

Intraosseous Access

Intraosseous (IO) access provides rapid, reliable vascular access when peripheral IV cannulation fails or is unlikely to succeed within 90 seconds. It is the recommended second-line vascular access route in cardiac...

Invasive Candidiasis

Risk factors are ubiquitous in intensive care: broad-spectrum antibiotics, central venous catheters (CVCs), Total Parenteral Nutrition (TPN), abdominal surgery, neutropenia, immunosuppression, renal replacement...

Invasive Fungal Infections in ICU

Echinocandins are first-line for candidemia in critically ill patients (PMID: 28635507, 28482886)... CICM Second Part exam preparation.

Invasive Pressure Monitoring in ICU

Comprehensive guide to invasive haemodynamic pressure monitoring including arterial lines, central venous pressure, pulmonary artery catheters, transducer physics, waveform analysis, dynamic response testing, and...

Ischemic Stroke

Time-critical interventions include NIHSS assessment, non-contrast CT brain, CT angiography, and rapid team activation f... CICM Second Part exam preparation.

Legionnaires' Disease

The disease represents 2-9% of community-acquired pneumonia (CAP) cases but accounts for a disproportionately high number of severe pneumonia cases requiring ICU admission. Mortality ranges from 5-10% in...

Liver Transplantation ICU Management

Liver transplantation is a high-frequency CICM Hot Case and SAQ topic because it integrates:... CICM Second Part Written, CICM Second Part Hot Case exam prepara

Local Anaesthetics

Define - What are local anaesthetics, classification... CICM First Part Written, CICM First Part Viva exam preparation.

Lower Airway & Bronchial Tree Anatomy

Overview - Define lower airway, list structures... CICM First Part Written, CICM First Part Viva exam preparation.

Lumbar Puncture

ICU-Specific Considerations : Meningitis: Do NOT delay antibiotics for LP - give ceftriaxone/vancomycin + dexamethasone immediately SAH: LP for xanthochromia if CT negative and presentation greater than 12 hours from...

Lumbar Puncture (Emergency)

CT before LP is required if: age greater than 60, immunocompromised, CNS disease history, recent seizure, focal neuro... ACEM Fellowship Written, ACEM Fellow

Lumbar Spine and CSF Dynamics

Define/Describe - Overview of lumbar spine anatomy... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Magnesium Toxicity and Management in Obstetrics

One-liner : Magnesium toxicity in obstetrics is a potentially life-threatening iatrogenic complication of therapeutic magnesium sulfate administration, characterized by progressive neuromuscular and cardiovascular...

Major Haemorrhage in Adults

Major haemorrhage is life-threatening acute blood loss requiring immediate massive transfusion and source control. It is defined by transfusion of ≥4 units of packed red blood cells (pRBC) in less than 1 hour, ≥10...

Massive Haemorrhage and Transfusion

Massive haemorrhage is defined as loss of 50% total blood volume within 3 hours, or blood loss exceeding 150 mL/min. Mortality ranges from 30-40% for trauma-related massive transfusion and 10-20% for surgical...

Massive Hemoptysis - ICU Management

Position bleeding side DOWN - protect the non-bleeding lung... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Massive Transfusion Protocol

Definition of massive transfusion: greater than 10 units PRBC/24h OR greater than 4 units/1h with ongoing bleeding OR... CICM Second Part exam preparation.

Massive Transfusion Protocol

Massive transfusion occurs in approximately 10-25% of major trauma patients requiring blood products. Mortality ranges f... ACEM Primary Written, ACEM Primary V

Massive Transfusion Protocol (Adult)

A massive transfusion protocol (MTP) is a standardized institutional approach to rapidly deliver large volumes of blood products to patients with life-threatening hemorrhage. MTP activation streamlines blood bank...

Maternal Sepsis

One-liner : Maternal sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection during pregnancy, childbirth, or the postpartum period, requiring early recognition using modified...

Mechanical Ventilation Modes

Define the mode (control variable, trigger, limit, cycle)... CICM Second Part exam preparation.

Medical Ethics in ICU

Medical ethics in intensive care provides a framework for navigating complex decisions involving critically ill patients... CICM Fellowship Written, CICM Fellow

Medicolegal Aspects in Intensive Care

Medicolegal aspects in intensive care encompass the legal framework governing consent, capacity, substitute decision-mak... CICM Second Part Written, CICM Secon

Meningitis and Encephalitis

Nasopharyngeal colonization → bacteremia → blood-brain barrier (BBB) penetration... CICM Second Part exam preparation.

Meningitis and Encephalitis in Adults

Meningitis and encephalitis are life-threatening infections of the central nervous system requiring immediate recognition and treatment. Bacterial meningitis is inflammation of the meninges caused predominantly by...

Micronutrient Deficiencies in Critical Care

Micronutrient deficiencies are common in critically ill patients, with prevalence ranging from 30-80% depending on the m... CICM Fellowship Written, CICM Fellow

Mucormycosis

A comprehensive guide to Mucormycosis, covering epidemiology, molecular pathophysiology of angioinvasion, clinical manifestations across all forms (rhinocerebral, pulmonary, disseminated, cutaneous), diagnostic...

Multi-Organ Dysfunction Syndrome (MODS) Pathology

Multi-Organ Dysfunction Syndrome (MODS) is the progressive, potentially reversible dysfunction of two or more organ systems arising from an acute threat to systemic homeostasis. MODS represents the final common...

Myasthenia Gravis Crisis

Pathophysiology: Anti-AChR antibodies (85%), anti-MuSK (5%), complement-mediated destruction vs functional blockade... CICM Second Part exam preparation.

Myasthenic Crisis

One-liner : Myasthenic crisis is life-threatening respiratory failure from severe weakness in myasthenia gravis requiring early intubation, immunotherapy (IVIg or plasma exchange), and ICU management.

Myocarditis

The diagnosis requires high clinical suspicion, particularly in young patients presenting with cardiac symptoms following viral illness. Cardiac magnetic resonance imaging (CMR) has emerged as the gold standard...

Myocarditis

Fulminant myocarditis (rapid onset below 2 weeks, severe LV dysfunction EF below 35%, cardiogenic shock) has better l... CICM Second Part exam preparation.

Myxedema Coma

Management requires immediate IV thyroid hormone replacement (T4 loading dose 200-500 mcg, or combination T4 + T3), but ... CICM Second Part, FCICM exam prepara

Myxoedema Coma

Key Facts The "Winter Peak" : Over 90% of cases occur during winter months due to cold-induced stress on minimal thermogenic reserves. The T4-T3 Block : In severe illness, the peripheral conversion of T4 to active T3...

Near-Drowning and Submersion Injury

Near-drowning (submersion with survival 24 hours) causes severe hypoxic brain injury, pulmonary complications, and often hypothermia. Key principles:

Neck and Laryngeal Anatomy

Define/Describe - Overview of neck and laryngeal divisions and boundaries... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Necrotising Fasciitis

The hallmark clinical feature is severe pain that appears disproportionate to the physical examination findings—a result of deep fascial involvement and nerve ischaemia occurring before significant skin changes become...

Necrotizing Fasciitis

Necrotizing fasciitis is classified by microbiology into four types:... CICM Second Part exam preparation.

Neonatal and Paediatric ICU Transport

Neonatal and paediatric ICU transport represents a critical component of modern perinatal and paediatric critical care s... CICM Fellowship Written, CICM Fellow

Neonatal Emergencies

One-liner : Neonatal emergencies encompass critical conditions in the first 28 days of life requiring urgent ICU intervention, characterised by unique transitional physiology, immature organ systems, and different...

Neonatal Resuscitation

PPV Ventilation: Rate: 30-60 breaths/minute (40-60 in term infants, 30-45 in preterm) PIP: 20-25 cm H2O (term), 20-30 cm H2O (preterm) PEEP: 5 cm H2O (avoid in term infants if airway not secured) T-piece device...

Neuroanatomy - Brain & Cerebral Circulation

Overview - Major brain divisions and their functions... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Neurogenic Shock

Pathophysiology: Explain the haemodynamic changes in neurogenic shock following C5 SCI... CICM Second Part exam preparation.

Neuroleptic Malignant Syndrome (NMS)

Supportive care: Aggressive cooling, IV crystalloid resuscitation, benzodiazepines for rigidity/agitation... CICM Second Part Written, CICM Second Part Hot C

Neuromuscular Blockade in ICU

Indications: Severe ARDS, intracranial hypertension, ventilator dyssynchrony, shivering... CICM Second Part, ANZCA Final exam preparation.

Neuromuscular Blocking Agents

Mechanism - NMJ physiology, receptor pharmacology... CICM First Part Written, CICM First Part Viva exam preparation.

Neurophysiology

Neurophysiology encompasses the electrical and chemical processes underlying neuronal function, cerebral blood flow regu... CICM Fellowship Written, CICM Fellow

Non-Invasive Ventilation (NIV)

CPAP vs BiPAP mechanisms - Physiology of positive pressure, effects on work of breathing, preload/afterload... CICM Second Part exam preparation.

Nutritional Deficiencies in Critical Illness

Nutritional deficiencies are highly prevalent in critically ill patients (30-80%), arising from inadequate intake, incre... CICM Second Part Written, CICM Secon

Obesity Drug Dosing in ICU

Obesity significantly alters drug pharmacokinetics (PK) and pharmacodynamics (PD) in critically ill patients, creating complex dosing challenges. The combination of increased adipose tissue, altered organ blood flow,...

Obstetric Haemorrhage - PPH and Massive Transfusion

Primary PPH is defined as blood loss ≥500 mL within 24 hours of vaginal delivery or ≥1000 mL following cesarean section. Major PPH is blood loss 1000 mL or blood loss accompanied by signs of hypovolemia. PPH affects...

Obstetric Hemorrhage

Obstetric hemorrhage is a leading cause of maternal morbidity and mortality worldwide, representing one of the most crit... CICM Fellowship Written, CICM Fellow

Obstructive Shock

Obstructive shock is caused by mechanical obstruction to cardiac filling (tamponade, tension PTX) or ejection (massiv... CICM Second Part exam preparation.

Obstructive Shock (Adult)

Obstructive shock is a form of circulatory failure caused by mechanical obstruction to blood flow into or out of the heart, resulting in critically reduced cardiac output despite normal or increased intravascular...

Oesophageal Varices

Approximately 50% of patients with cirrhosis have varices at the time of diagnosis , with the prevalence increasing to 60-80% in those with decompensated cirrhosis. The annual incidence of new varix formation is 5-8%...

Opioid Analgesics

Classification: Natural, semi-synthetic, synthetic opioids... CICM First Part Written, CICM First Part Viva exam preparation.

Opioid Overdose

Opioid overdose causes life-threatening respiratory depression through μ-opioid receptor agonism in the brainstem. Immed... CICM Fellowship Written, CICM Fellow

Organophosphate and Carbamate Poisoning

Decontamination: Remove clothing, copious water irrigation (staff PPE mandatory)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Organophosphate Poisoning

Organophosphate (OP) poisoning is a life-threatening toxicological emergency resulting from exposure to insecticides (ag... MRCP, FRCA exam preparation.

Oxygen Transport & Delivery

The CICM First Part examination places significant emphasis on oxygen transport physiology as it underpins critical care... CICM First Part Written, CICM First

Pacemaker Emergencies in ICU

Failure to pace/capture in dependent patient: Apply magnet (asynchronous pacing), prepare TCP, correct metabolic abno... CICM Second Part exam preparation.

Paediatric Advanced Life Support (PALS)

Paediatric cardiac arrest differs fundamentally from adult arrest. Most paediatric arrests are asphyxial (respiratory in... ACEM Primary Written, ACEM Primary V

Paediatric Airway Management

The paediatric airway differs fundamentally from the adult airway in anatomy, physiology, and pathology. Children are NO... ACEM Primary Written, ACEM Primary V

Paediatric Respiratory Failure

High-flow oxygen therapy or HFNC (humidified 2 L/kg/min)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Paediatric Sepsis

One-liner : Paediatric sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection in children, characterised by age-specific physiological responses, "cold shock" predominance,...

Paediatric Status Epilepticus

Paediatric SE affects 17-23 per 100,000 children annually with highest incidence in infants &lt;1 year . Febrile seiz... CICM Second Part Written, CICM Secon

Paediatric Trauma

Trauma is the leading cause of death in children 1-14 years, with TBI accounting for 70-80% of trauma-related mortali... CICM Second Part Written, CICM Secon

Palliative Care Principles in Intensive Care

Palliative care in the intensive care unit (ICU) represents a fundamental component of high-quality critical care, focus... CICM Fellowship Written, CICM Fellow

Pandemic Response in Intensive Care

Activate Hospital Incident Command System (HICS)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Paracentesis

Ultrasound guidance is mandatory - reduces dry taps by 95%, complications by 50-70% (PMID: 23867388)... CICM Second Part Written, CICM Second Part Hot Case e

Paracetamol (Acetaminophen) Overdose

Assess risk: Time of ingestion, dose ingested, coingestants, chronic use... CICM Final Written, CICM Final Viva exam preparation.

Paraquat Poisoning

Paraquat (1,1'-dimethyl-4,4'-bipyridylium) is a highly toxic bipyridyl herbicide with 60-90% mortality. Toxicity results... ACEM Primary Written, ACEM Primary V

Patient Safety in ICU

Patient safety in the intensive care unit (ICU) represents one of the most critical domains of modern critical care practice. ICU patients are among the most vulnerable in healthcare, with physiological instability,...

PEA and Asystole (Non-Shockable Rhythms)

PEA is defined as an organised electrical rhythm on the monitor in the absence of a palpable central pulse, while asysto... ACEM Primary Written, ACEM Primary V

Pediatric Traumatic Brain Injury

Traumatic brain injury (TBI) is a leading cause of death and disability in children worldwide. Pediatric TBI differs sig... CICM Fellowship exam preparation.

Pelvic Anatomy (Obstetric Relevance)

Define/Describe - Overview of pelvic boundaries and contents... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Pelvic Trauma

Pelvic fractures with hemodynamic instability have mortality of 30-50%. Immediate pelvic binder application and multidis... CICM Second Part exam preparation.

Pericardiocentesis

Ultrasound-guided pericardiocentesis has 90-97% success rate compared to 50-80% for blind technique (PMID: 12628672, ... ACEM Primary Written, ACEM Primary V

Pericarditis and Cardiac Tamponade

Acute pericarditis diagnosis requires ≥2 of 4 criteria: chest pain, friction rub, ECG changes, pericardial effusion (... CICM Second Part exam preparation.

Peripartum Cardiomyopathy

One-liner : Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (LVEF &lt;45%) in the last month of pregnancy to 5 months postpartum, characterised by potential for recovery...

Peripheral Intravenous Access

Peripheral IV access is the most common invasive procedure - 80-90% of hospitalized patients, 330 million PIVCs inser... CICM Second Part Written, CICM Secon

Phaeochromocytoma Crisis

The cornerstone of acute management is alpha-adrenergic blockade FIRST using phentolamine (IV) or phenoxybenzamine (oral), followed only then by beta-blockade to control tachycardia. Beta-blockers administered alone...

Phaeochromocytoma Crisis

Domain Key Focus Areas ------------ --------------------- Catecholamine Synthesis Tyrosine → L-DOPA → Dopamine → Noradrenaline → Adrenaline pathway; rate-limiting enzyme (tyrosine hydroxylase) Receptor Pharmacology...

Pharmacokinetics and Pharmacodynamics in Critical Care

Pharmacokinetics (PK) and pharmacodynamics (PD) are fundamentally altered in critically ill patients, leading to unpredi... CICM Fellowship Written, CICM Fellow

Phosphate and Magnesium Disorders in the ICU

Identify and treat underlying cause (refeeding, DKA treatment, diuretics, alcoholism)... CICM Second Part Written, CICM Second Part Hot Case exam preparation

Platelet Function and Hemostasis

Define/Describe - Platelet structure and origin... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Pneumonia - Community and Hospital-Acquired

Definition: Acute infection of the lung parenchyma acquired outside hospital or within first 48 hours of admission.... CICM Second Part exam preparation.

Pneumothorax in ICU

Comprehensive CICM Second Part clinical guide to Pneumothorax in the ICU, covering classification, aetiology, tension pneumothorax pathophysiology, detection in ventilated patients, needle decompression, chest drain...

Point-of-Care Ultrasound (POCUS)

Parameter Detail ----------- -------- Core Applications eFAST, cardiac views, lung ultrasound, IVC, AAA, DVT, procedural guidance ACEM Credential Core skill - required for Fellowship Minimum Training 25-50 supervised...

Polytrauma

Polytrauma management requires systematic, prioritized care following ATLS principles with damage control resuscitation ... CICM Second Part exam preparation.

Post-Brain Death Donor Management

Post-brain death donor management (PBDM) refers to the comprehensive physiological optimisation of the potential organ d... CICM Fellowship Written, CICM Fellow

Post-Cardiac Arrest Care

Post-cardiac arrest care focuses on minimizing secondary brain injury through targeted temperature management (32–36°C f... CICM Second Part exam preparation.

Post-Cardiac Arrest Care (Adult)

Post-cardiac arrest care encompasses the comprehensive management of patients who achieve return of spontaneous circulation (ROSC) following cardiac arrest. This critical phase addresses the systemic consequences of...

Post-Cardiac Surgery ICU Management

Structured handover using SBAR format (PMID: 21255531)... CICM Second Part exam preparation.

Post-Extubation Stridor & Laryngeal Oedema

Patient extubated 2-4 hours ago with progressive stridor, using accessory muscles, SpO2 falling despite high-flow oxygen... CICM Second Part exam preparation.

Post-Intensive Care Syndrome (PICS)

Definition: PICS encompasses new or worsening impairments in physical, cognitive, or mental health status arising aft... CICM Second Part Written, CICM Secon

Post-Intubation Management

Immediate post-intubation management requires systematic verification of correct ETT placement, secure fixation, and ini... ACEM Primary Written, ACEM Primary V

Post-Resuscitation Care

Post-resuscitation care is the critical phase between ROSC and definitive outcome, determining whether a patient survive... ACEM Primary Written, ACEM Primary V

Potassium Disorders: Hypokalemia and Hyperkalemia

Cardiac membrane stabilisation: Calcium gluconate 10% 10-20 mL IV over 2-5 min (or calcium chloride 10% 5-10 mL via C... CICM Second Part Written, CICM Secon

Pre-eclampsia and Eclampsia

Pre-eclampsia affects 2-8% of pregnancies globally and remains a leading cause of maternal mortality, accounting for 10-... CICM Fellowship Written, CICM Fellow

Pre-Hospital Critical Care

Pre-hospital critical care represents the extension of intensive care interventions into the pre-hospital environment, d... CICM Fellowship Written, CICM Fellow

Prone Positioning in ARDS

Mortality benefit: PROSEVA trial demonstrated 50% relative risk reduction in mortality (16% vs 32%, ARR 16%, NNT=6) i... CICM Second Part exam preparation.

Propofol Infusion Syndrome

"Describe the pathophysiology of propofol infusion syndrome."... CICM Second Part, FCICM exam preparation.

Pulmonary Artery Catheters in ICU

Comprehensive guide to pulmonary artery catheter (Swan-Ganz) monitoring in critically ill patients, including indications, insertion technique, waveform progression, hemodynamic parameters, thermodilution cardiac...

Pulmonary Embolism

Risk stratification systems: Wells score, PERC rule, PESI/sPESI, ESC 2019 classification (high/intermediate-high/inte... CICM Second Part exam preparation.

Pulmonary Hypertension in ICU

Pulmonary hypertension (PH) in ICU represents a critical intersection of elevated pulmonary vascular resistance and righ... CICM Second Part Written, CICM Secon

Quality Improvement Principles

Quality Improvement in intensive care combines rigorous scientific methodology with practical approaches to enhance pati... CICM Fellowship Written, CICM Fellow

Quality Metrics: APACHE, SOFA, ANZROD, and ICU Benchmarking

APACHE II (1985): 12 physiological variables (worst in first 24h) + age points + chronic health points; score 0-71; m... CICM Second Part Written, CICM Secon

Refeeding Syndrome

The clinical consequences are severe and multisystem: cardiac arrhythmias and heart failure (from ATP depletion and electrolyte disturbances), respiratory failure (from diaphragmatic weakness), Wernicke's...

Renal and Retroperitoneal Anatomy

Define/Describe - Overview of kidney position, relations, and structure... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Renal Drug Dosing in ICU

Answer: Assess renal function using multiple measures (eGFR, creatinine clearance, cystatin C) Determine if drug is renally eliminated (≥30% unchanged in urine) Assess loading dose (depends on volume of distribution,...

Renal Physiology

Renal physiology encompasses nephron anatomy and function, glomerular filtration, renal blood flow autoregulation, tubul... CICM Fellowship Written, CICM Fellow

Renal Replacement Therapy

Renal Replacement Therapy (RRT) refers to extracorporeal techniques that replace normal kidney function by removing solu... CICM Second Part exam preparation.

Renal Replacement Therapy (RRT)

Haemodialysis (HD) : Extracorporeal blood purification using diffusive and convective solute removal across a semipermeable membrane. Usually performed in-centre 3 times weekly for 4 hours. Peritoneal Dialysis (PD) :...

Research Methodology in ICU: Study Design, Statistics, and Critical Appraisal

Study Design Hierarchy: RCTs provide highest internal validity for intervention effects; observational studies (cohor... CICM Second Part Written, CICM Secon

Respiratory Physiology

Respiratory physiology provides the foundation for understanding mechanical ventilation, oxygen therapy, and pulmonary p... CICM Fellowship Written, CICM Fellow

Rhabdomyolysis

Rhabdomyolysis represents a clinical syndrome ranging from asymptomatic CK elevation to life-threatening multi-organ fai... ACEM Fellowship Written, ACEM Fellow

Rhabdomyolysis in the ICU

Aggressive IV crystalloid resuscitation: Target urine output 200-300 mL/hr (3 mL/kg/hr)... CICM Second Part Written, CICM Second Part Hot Case exam preparati

Ruptured Abdominal Aortic Aneurysm

Ruptured abdominal aortic aneurysm (rAAA) represents one of the most time-critical vascular emergencies, with overall mo... FRCS exam preparation.

Salicylate Overdose

Volume resuscitation with dextrose-containing fluids (correct dehydration, provide glucose for cerebral metabolism) [... CICM Second Part exam preparation.

Sedation and Analgesia Protocols in ICU

Analgesia-First Approach: Treat pain before sedation; 50-70% of ICU patients have significant pain, and untreated pai... CICM Second Part Written, CICM Secon

Sedation in ICU

ICU sedation requires titration to target depth using validated scales (RASS), daily interruption protocols, and agent s... CICM Second Part exam preparation.

Sedatives in ICU

Sedatives in ICU primarily act via three mechanisms: (1) GABA-A receptor potentiation (propofol, benzodiazepines), (2) a... CICM First Part Written, CICM First

Sepsis - Paediatric

Phoenix Sepsis Score (2024) replaces SIRS: Score 2+ indicates sepsis (respiratory, cardiovascular, coagulation, neuro... ACEM Fellowship Written, ACEM Fellow

Sepsis and Septic Shock

Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Conse... CICM Second Part exam preparation.

Sepsis Bundles and Early Management

Sepsis-3 validation in external cohorts demonstrated superior predictive validity for mortality compared to SIRS (AUROC ... CICM Second Part exam preparation.

Septic Shock (Adult)

Septic shock is defined as a subset of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities that substantially increase mortality. Under the Sepsis-3 definitions, septic shock requires:

Septic Shock (Adult)

Septic shock is defined as a subset of sepsis characterized by profound circulatory, cellular, and metabolic abnormalities that substantially increase mortality. Under the Sepsis-3 definitions, septic shock requires:

Serotonin Syndrome

Remove precipitating agents immediately (cease all serotonergic drugs)... CICM Second Part Written, CICM Second Part Hot Case exam preparation.

Serotonin Syndrome and Neuroleptic Malignant Syndrome

Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS) are serious, potentially life-threatening drug-induced hyperthermic syndromes characterised by Hyperthermia, Altered Mental Status, Autonomic...

Severe Preeclampsia, HELLP Syndrome, and Eclampsia

Severe preeclampsia is defined as preeclampsia with severe features that indicate end-organ dysfunction and increased risk of maternal and fetal complications. It affects 2-8% of pregnancies globally and remains a...

Severe Sepsis - Adult

Sepsis-3 Definition: Organ dysfunction (SOFA score increase ≥2) caused by infection - SIRS criteria abandoned... ACEM Primary Written, ACEM Primary Viva exam

Severe Traumatic Brain Injury and Decompressive Craniectomy

Severe traumatic brain injury (TBI) is defined by Glasgow Coma Scale (GCS) score of 3-8 following head injury, representing a critical neurosurgical emergency with significant mortality and morbidity. The management...

Shock

Shock is a life-threatening syndrome of acute circulatory failure resulting in inadequate cellular oxygen delivery and t... MRCP, MRCEM exam preparation.

Shock Pathology (Cellular & Mitochondrial)

The CICM First Part examination considers shock pathophysiology a core topic requiring detailed understanding of cellula... CICM First Part Written SAQ, CICM Fi

SIRS and Sepsis Pathology

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The pathophysiology involves recognition of PAMPs and DAMPs by pattern recognition receptors (TLRs), triggering a...

Skeletal Muscle Physiology

Define - Skeletal muscle structure at macroscopic and microscopic levels... CICM First Part Written, CICM First Part Viva exam preparation.

Sleep and Circadian Rhythms in ICU

Sleep is a fundamental physiological process essential for cognitive function, immune modulation, tissue repair, and met... CICM First Part Written SAQ, CICM Fi

Smoke Inhalation Injury

Comprehensive CICM Second Part topic on smoke inhalation injury covering pathophysiology, carbon monoxide and cyanide poisoning, airway management, and ICU treatment strategies for burn patients with evidence-based...

Sodium Disorders: Hyponatremia and Hypernatremia

Acute symptomatic hyponatremia: Hypertonic saline (3%) 100-150 mL bolus over 10-20 minutes... CICM Second Part Written, CICM Second Part Hot Case exam prepar

Spinal Cord and Peripheral Nerve Anatomy

Define/Describe - Overview of spinal cord structure and boundaries... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Status Epilepticus

For the CICM Second Part Examination, candidates must demonstrate:... CICM Second Part exam preparation.

Status Epilepticus in Adults

Status epilepticus (SE) is a neurological emergency defined as continuous seizure activity lasting ≥5 minutes or recurrent seizures without recovery of consciousness between episodes. It represents a failure of the...

STEMI Management in ICU

Comprehensive CICM Second Part clinical guide to STEMI Management in the ICU, covering reperfusion strategies (primary PCI vs fibrinolysis), antiplatelet and anticoagulation therapy, mechanical complications,...

Stress Response and Critical Illness

The stress response to critical illness is a coordinated neuroendocrine-metabolic-inflammatory cascade designed for short-term survival. The HPA axis releases cortisol (essential for vascular tone and...

Stress Ulcer Prophylaxis in Critical Care

Stress-Related Mucosal Disease (SRMD): Distinct from peptic ulcer disease; caused by splanchnic hypoperfusion, mucosa... CICM Second Part Written, CICM Secon

Subarachnoid Hemorrhage

Early aneurysm securing within 24-72 hours (coiling or clipping) to prevent rebleeding (4% within 24 hours, 50% withi... CICM Second Part exam preparation.

Symptom Management in Palliative Care

Palliative care symptom management requires a systematic approach to physical, psychological, and spiritual distress. Pa... CICM Fellowship Written, CICM Fellow

Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or "broken heart syndrome," is an acute, reversible ... MRCP exam preparation.

Targeted Temperature Management (TTM)

Targeted Temperature Management (TTM) involves controlled regulation of body temperature post-cardiac arrest to reduce s... ACEM Primary Written, ACEM Primary V

Teaching and Supervision in ICU

Knowles' Andragogy (1984): Adults learn differently from children - they need to know why, are self-directed, bring e... CICM Second Part Written, CICM Secon

Telemedicine in Intensive Care (Tele-ICU)

Tele-ICU provides intensivist expertise to hospitals lacking 24/7 specialist coverage, reducing mortality by 15-25% a... CICM Second Part Written, CICM Secon

Temperature Regulation

Temperature regulation is a fundamental homeostatic mechanism that maintains core body temperature within a narrow range... CICM Fellowship Written, CICM Fellow

Tetanus

The global burden of tetanus has decreased dramatically over the past three decades, with deaths falling by nearly 90% between 1990 and 2019, primarily due to the WHO's Maternal and Neonatal Tetanus Elimination...

Therapeutic Drug Monitoring in Critical Care

Therapeutic Drug Monitoring (TDM) involves the measurement of drug concentrations in biological fluids to optimize pharm... CICM Fellowship Written, CICM Fellow

Thermoregulation Pathology

Define/Describe - Normal thermoregulation, hypothalamic control... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Thoracentesis

"Describe the technique for diagnostic thoracentesis, including patient positioning, site selection, ultrasound guidance, and Z-track method" (10 marks) "A patient with pneumonia develops a pleural effusion. The...

Thoracic Anatomy

Define/Describe - Overview of thoracic boundaries and contents... CICM First Part Written SAQ, CICM First Part Written MCQ exam preparation.

Thrombotic Thrombocytopenic Purpura and Haemolytic Uraemic Syndrome in Adults

Thrombotic thrombocytopenic purpura (TTP) and haemolytic uraemic syndrome (HUS) are life-threatening thrombotic microang... MRCP exam preparation.

Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome

TTP is defined by severe ADAMTS13 deficiency (below 10%) - this distinguishes it from other TMAs and predicts respons... CICM Second Part exam preparation.

Thyroid Storm

Thyroid storm (thyrotoxic crisis) is a rare but life-threatening endocrine emergency characterized by severe, decompensa... MRCP exam preparation.

Thyroid Storm

Diagnose thyroid storm using Burch-Wartofsky Point Scale (≥45 = storm)... CICM Second Part exam preparation.

Toxic Alcohol Poisoning (Methanol & Ethylene Glycol)

Toxic alcohol poisoning encompasses the ingestion of methanol and ethylene glycol, two substances that undergo hepatic metabolism via alcohol dehydrogenase to produce highly toxic organic acid metabolites. Methanol is...

Toxic Alcohol Poisoning (Methanol and Ethylene Glycol)

ADH inhibition - Fomepizole (preferred) or ethanol to prevent formation of toxic metabolites ... CICM Second Part, CICM Primary exam preparation.

Tracheostomy

Timing of tracheostomy: TracMan trial, early vs late... CICM Second Part exam preparation.

Tracheostomy Care

Tracheostomy patients presenting to the ED require systematic assessment and immediate action for airway emergencies. The most critical emergencies are:

Transfusion Reactions