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
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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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