CICM SAQ 2010.1 Q18
Questions
18. A previously fit and well 24 year old man sustained an isolated C5-C6 spinal injury following a diving accident resulting in a tetraplegia. The spinal fracture was surgically fixed the following day and the patient was extubated on Day 6 of his ICU admission. Within 4 hours of extubation, the patient developed respiratory distress requiring urgent rapid sequence induction and reintubation. The patient sustained a cardiac arrest soon after intubation.
- 18.1. List five (5) likely causes of cardiac arrest in this patient.
- 18.2. Outline how you would determine the cause of the cardiac arrest.
- 18.3. List three (3) metabolic and three (3) gastrointestinal complications seen after spinal cord transection.
Answers
Answer and interpretation
18.1. List five (5) likely causes of cardiac arrest in this patient.
- Oesophageal intubation
- Hypoxic cardiac arrest (unrelated to oesophageal intubation due to delayed or
- unanticipated difficulty with intubation)
- Suxamethonium induced hyperkalemia
- Incidental PE
- Autonomic dysfunction from the spinal injury.
- Tension pneumothorax
- Anaphylaxis
Candidates presenting other reasonable causes were given credit
18.2. Outline how you would determine the cause of the cardiac arrest.
- Capnograph to check tube position and reintubate if not in the right position
- Urgent serum K
- ECG
- CTPA
- Echo
- CXray
18.3. List three (3) metabolic and three (3) gastrointestinal complications seen after spinal cord transection.
Metabolic
- Hyponatremia (SIADH)
- Immobilisation hypercalcemia and Nitrogen wasting hypothermia
GI
- Ileus
- acute gastric dilatation stress ulcerations
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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