Topics for the exam

1) PROCEDURES

Airway management

• Manual airway manoeuvres *

• Endotracheal intubation – indication, technique

• Laryngeal masks – indication, technique *

• Bag mask ventilation, Guedel airway *

• Tracheostomy – indication, advantages in long-term ventilation, complications

• Respiratory distress in a tracheostomy patients

• Oxygen therapy – low flow, high flow (HFNO)

Invasive procedures

• Arterial catheter – indications, uses, complications

• Venous access – techniques, choice of technique

• Central venous catheter – indications, technique, complications, drugs given through CVC

• Management of the patient with pneumothorax – emergency chest decompression, chest drainage - technique

• Intraosseous access – indications, localisation, technique, complications

• Nasogastric tube, gastric lavage

Ultrasound techniques in emergency and critical care

• FAST - focused assessment with sonography in trauma – uses, projections

• Focussed echocardiography in emergency medicine, RUSH – (Rapid Ultrasound for Shock and Hypotension), ultrasound in the diagnostics of reversible causes of cardiac arrest

• Ultrasonography of the lungs and pleura

• Uses of ultrasonography in invasive procedures – cannulation, chest drainage, peripheral nerve blocks

2) PHARMACOLOGY

Drugs used in critical care incl. Dosages

Adrenaline, amiodarone, morphine, alteplase, heparin, flumazenil, naloxone, phenytoin, tranexamic acid, atropine

Antibiotics

• General principles of antibiotic therapy in sepsis

• PK/PD approach to antibiotics, practical consequences

• Overview of antibiotics used in critical care + dosages in the following antibiotics: vancomycin, ampicilin, ceftriaxone, meropenem, gentamicin

• Antibiotic prophylaxis in surgery

• Surveillance of antimicrobial use

Vasoactive drugs

Adrenalin, noradrenalin, vasopressin, dobutamine, ephedrine

Others

• Acute pain therapy, analgesics, multimodal analgesia, opiates, patient-controlled analgesia

• Sedatives used in critical care, sedation holiday

• Fluid therapy – crystalloids, colloids – advantages, disadvantages

3) CARDIOLPUMONARY RESUSCITATION

• Cardiopulmonary resuscitation

  • Advanced cardiopulmonary resuscitation with drugs and equipment in the hospital and outside (Advanced life support)

  • Management of haemodynamically significant bradycardia

  • Management of haemodynamically significant tachycardia

  • Reversible causes of cardiac arrest - 4H, 4T

• Recognising the sick patient, prevention of in-hospital cardiac arrest

  • Structured assessment of the acutely ill – structured approach ABCDE, recognising the cause and immediate management *

  • Approach to the unconscious patient *

  • EWS - early warning scoring systems

• Principles of initiating and terminating cardiopulmonary resuscitation

• Postresuscitation care

4) NON-TECHNICAL SKILLS AND CRM (CRISIS RESOURCE MANAGEMENT) IN CRITICAL AND EMERGENCY

• Early call for help, safe communication, SBAR/RSVP *

• Leadership and followership –roles assigned in the team, principles of effective communication between team members, (sharing the mental model, closed loop communication, speaking up, graded assertiveness) *

• Fixation error – prioritization, delegating, step back method *

5) CRITICAL CARE – SPECIAL PART

RESPIRATORY FAILURE AND MECHANICAL VENTILATION

• Pathophysiology:

  • Lung volumes

  • Compliance, resistance, time constant

  • Dynamic hyperinflation

  • Pressure-volume diagram, hysteresis, pathophysiology of recruitment manoeuvre

  • Ventilation vs perfusion, West zones, alveolocapillary reflex, VQ ratio and VQ mismatch

  • Respiratory failure, types (partial vs. global), causes

  • ARDS - definition, Berlin criteria, phases of ARDS, differential

• Mechanical ventilation

  • ARDS - principles of ventilator settings, protective ventilation, prone position

  • Mechanical ventilation - characteristics of the respiratory cycle in pressure and volume controlled ventilation, PEEP, assisted ventilation

  • Non-invasive ventilation: indications, contraindications, hemodynamic effect of CPAP in pulmonary oedema

  • Ventilator associated pneumonia (VAP) - prevention, diagnostic criteria, therapy (choice of antibiotics, length of therapy)

• Management of the most common causes of respiratory failure: COPD exacerbation, status asthmaticus, pneumonia

CARDIOVASCULAR PATHOLOGY AND EMERGENCIES IN CARDIOLOGY

• Pathophysiology

  • Determinants of oxygen delivery

  • Relationship between global oxygen consumption and delivery, central venous oxygen saturation (ScvO2) as a hemodynamic parameter

  • Determinants of stroke volume - preload and Frank-Starling law, afterload, contractility

  • Dissociation curve of haemoglobin, Bohr´s effect

• Effect of mechanical ventilation on intrathoracic pressure and hemodynamic parameters (cardiopulmonary interactions during mechanical ventilation)

• Shock - definition, types of shock (cardiogenic, obstructive, hypovolaemic, distributive), compensatory mechanisms, stages of shock

• Clinical signs of shock and organ hypoperfusion

• Invasive measurement of arterial blood pressure, arterial waveform - shape and description of the normal waveform

• Fluid responsiveness prediction - dynamic measurement of preload (pulse-pressure variation, passive leg-raise test), ultrasonographic methods, fluid challenge

• Initial management of emergencies in cardiology

  • Acute myocardial infarction

  • Hemodynamically significant bradycardia and tachycardia

  • Aortic dissection

  • Hypertension crisis

  • Pulmonary embolism

  • Cardiac failure and pulmonary oedema

HAEMOSTASIS AND THROMBOSIS

• Effect of drugs on haemostasis - anticoagulants, antiplatelet drugs, fibrinolytics, antifibrinolytics - mechanism of action, indications, laboratory evaluation of effect, antidotes

• Coagulation tests - INR, aPTT, fibrinogen, antithrombin, D-dimers, anti-Xa, TEG/ROTEM

• Blood products - indications of administration

• Massive transfusion protocol

• Bleeding in patients using warfarin, NOAC, anticoagulants

• Pulmonary embolism - diagnostics, therapy, pathophysiology, effect on hemodynamic

SEPSIS

• Definition, SEPSIS-3

• Septic shock – definition

• Infection vs. colonisation vs. contamination

• Basic pathophysiology of sepsis and MODS (activation of endothelium, cytopathic hypoxia, myocardial dysfunction, immunoparalysis)

• Clinical identification of sepsis, early diagnosis – qSOFA

• Initial therapy of sepsis – the three pillars of therapy

• The role of lactate in the therapy of sepsis

• Antibiotics in sepsis – initial choice and de-escalation

• Antibiotics choice in community acquired infection vs. early and late-onset nosocomial infection, ventilator associated pneumonia

NEUROINTENSIVE CARE

• Pathophysiology

  • Auto regulation of cerebral blood flow

  • Monro-Kellie doctrine and intracranial pressure

  • Examination of brainstem reflexes

  • Intracranial pressure (ICP) and cerebral perfusion pressure (CPP)

• Unconsciousness – Glasgow Coma Scale, differential diagnosis

• Intracranial hypertension – therapy, neuroprotective regimen

• Initial management of emergencies in neurology

  • Stroke, indications for thrombolytic therapy

  • Subarachnoid haemorrhage

  • Subdural and epidural haemorrhage

  • Purulent meningitis

  • Convulsive states, status epilepticus

  • Management of blood pressure in neurological emergencies

  • Traumatic brain injury

METABOLIC DISORDERS

• Acid-base balance

  • Anion gap – calculation, normal values, importance in the interpretation of arterial blood gas

  • Buffer mechanisms, Henderson-Hasselbach equation for the bicarbonate buffer system

  • Potassium and ABG

  • Interpretation of ABG *

  • Metabolic acidosis – types, causes, indications for administration of bicarbonate

  • Metabolic alkalosis

  • Acid-base balance in respiratory disorders

• Regulation of osmolarity and extracellular volume – ADH, RAAS, natriuretic peptides

• Hyperkalemia and hypokalemia - therapy

• Emergencies in diabetes – diabetic ketoacidosis, hypoglycaemia, hyperosmolar hyperglycaemic state

• Lactate and lactic acidosis – causes, types of lactic acidosis, its role as a severity marker and goal values

• Effect of infusion therapy on acid-base balance

ACUTE RENAL FAILURE

• Renal perfusion, renal perfusion pressure, renal auto regulation

• Acute renal failure - KDIGO classification, causes (prerenal, renal, postrenal), consequences (effect on extracellular volume, minerals, acid base balance)

• Drug nephrotoxiciy – NSAID, ACEI, aminoglycosides, iodinated contrast, colloid fluids (mechanisms of nephrotoxicity, prevention)

LIVER FAILURE

• Acute liver failure – causes, symptoms, laboratory findings

• Portal hypertension and bleeding from oesophageal varices – stabilizing the patient, therapy

METABOLIC CHANGES AND NUTRITION OF CRITICALLY ILL

• Physiology of simple starvation

• Pathophysiology of stress starvation and the classic phases of critical illness – hypometabolic phase, hypermetabolic phase, prolonged phase

• Enteral feeding – advantages compared to parenteral feeding, routes of administration

• • Nasogastric tube – insertion, contraindications, complications

  • PEG tube

  • Nasojejunal tube

• Parenteral feeding – indications, routes of administration

• Glycemic control in the critically ill

• Intra-abdominal hypertension and abdominal compartment syndrome

• ICU acquired weakness – risk factors, prevention

TRAUMATOLOGY

• Approach to the polytrauma patient *

• Consumption coagulopathy (vs. disseminated intravascular coagulopathy)

EXTERNAL FACTORS

• Hypothermia – consequences, therapy

• Burns – initial management

• Intoxications: Benzodiazepines, opiates, tricyclic antidepressants, alcohol, sympathomimetics (amphetamines, cocaine), paracetamol

• Anaphylaxis and anaphylactic shock

OTHERS

• Delirium – causes, risks, management on the standard ward and in the ICU

• ECMO – principle, indications

• Transport of the unstable patient

DYING IN THE ICU AND ORGAN DONATION

• Brain death – diagnostics, caring for the deceased organ donor

• Organ donation after brain death and after cardiac death (DCD)

• Difference between withdrawal of treatment and euthanasia