CICM SAQ 2010.1 Q7

7.1. The following image is of the blood sample tubes into which a specimen of blood from a critically ill patient had been drawn by the phlebotomist.

  • (a) What does this image show?
  • (b) List three (3) causes for this appearance in blood samples from critically ill patients
  • (c) If the condition causing this appearance in the blood tubes were to be long standing, what clinical signs specific to this condition may be found in this patient?

7.2. This is an image of a 13 year old boy who rode his motorbike into a single strand of fencing wire, was thrown off and walked 500 metres for help. He now complains of difficulty in breathing. On examination he has stridor.

  • (a) How would you manage stridor in this boy?
  • (b) How will you secure his airway? Give reasons.

Answers

Answer and interpretation

7.1. (a) What does this image show?

A creamy supernatant in blood tubes (serum and plasma) due to severe hypertriglyceridaemia (lipaemic serum).

7.1. (b) List three (3) causes for this appearance in blood samples from critically ill patients

  • Familial hyperlipidemia
  • Propofol infusion
  • TPN use
  • Pancreatitis from hyperlipidemia

7.1. (c) If the condition causing this appearance in the blood tubes were to be long standing, what clinical signs specific to this condition may be found in this patient?

Eyes

  • Lipaemia retinalis
  • Corneal arcus senilis
  • Xanthelasma

Skin

  • Xanthomata
  • Tendon
  • Eruptive

7.2 (a) How would you manage stridor in this boy?

  • Oxygen
  • Maintain spont vent in position of comfort until airway secure Nebulised adrenaline
  • Heliox
  • Prepare difficult airway equipment
  • Call for assistance

7.2 (b) How will you secure his airway? Give reasons.

Options

  • Tracheostomy under LA – the safest option available
  • Awake fibreoptic intubation -may risk further laryngotracheal separation
  • Gas induction with surgeon present for emergency tracheostomy
  • Avoid cricothyroidotomy – risk of further damage
  • RSI contraindicated – cricoid pressure may cause laryngotracheal separation
Exams LITFL ACEM 700

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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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