CICM SAQ 2012.1 Q1


Outline the Intensive Care management of a 25-year-old male who has fulfilled brain death criteria and is awaiting surgery for organ donation.


Answer and interpretation

Temperature Maintenance:

  • Hypothermia is common due to: cold fluids, heat loss through exposure, inability to vasoconstrict or shiver, reduced metabolic rate.
  • Maintain normal core temperature
    — Cover patient
    — Warm room
    — Warming blanket
    — Warm fluids especially high volume o Humidification

Respiratory support:

  • Aim to avoid fluid overload
  • Aim for adequate Sp02 and normocarbia with lowest Fi02 and limit tidal volumes
  • Bronchoscopy for persisting collapse
  • Chest physiotherapy may be helpful

Circulatory Support:

  • Immediately prior to brain death there is often a period of sympathetic hyperactivity with associated tachycardia and hypertension. This is lost following brain death commonly resulting in vasodilation and hypotension
  • Maintain adequate mean arterial pressure. Use judicious volume expansion and low dose
  • inotropes (usually noradrenaline)
  • Monitor peripheral perfusion and urine output regularly
  • Continue maintenance fluids

Metabolic haematology and biochemistry:

  • Diabetes insipidus is common and if not recognized and treated can quickly lead to hypernatraemia and hyperosmolality
  • Measure electrolytes and creatinine regularly and treat as appropriate to maintain normal
  • ranges
  • Treat Diabetes insipidus with desmopressin (DDAVP) 4-8μgrams intravenously and repeat if necessary, or low dose vasopressin
  • Start low dose insulin infusion if blood glucose persistently above 12mmol/L
  • Stop bleeding, correct coaguloapthy, thrombocytopaenia and anaemia
  • Avoid hypernatraemia
  • Other electrolyte abnormalities – K, PO4, Ca, Mg
  • Consider thyroxine replacement


  • Family – counsel, explain, keep updated
  • Liaison with donor coordinator and surgical retrieval teams
Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a 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 three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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