CICM SAQ 2012.2 Q6

Questions

Q1. The following blood gases, electrolytes and full blood count relate to a 32-year-old woman post-extubation, following an emergency lower segment Caesarian section at 38 weeks gestation for foetal distress during labour:

  • a) Comment on and interpret the arterial blood gases and the acid-base status.
  • b) What is the significance of the haemoglobin concentration and white cell count?

Q2. The following biochemical profile is that of a 68-year-old man who has undergone endovascular repair of an abdominal aortic aneurysm that was technically difficult:

  • What is the likely cause of this biochemical profile?

Q3. List four possible underlying reasons for the above biochemical profile

Answers

Answer and interpretation

Q1. a) Comment on and interpret the arterial blood gases and the acid-base status.

  • Raised A-a gradient of 154 mmHg suggestion shunt and/or V/Q mismatch. Potential explanations are loss of FRC post abdominal surgery, segmental collapse/consolidation or aspiration.
  • Acute respiratory acidosis – normal PCO2 for 38 weeks gestation is 30 mmHg with compensatory reduction in HCO3. CO2 retention is possibly due to pain, narcotics and/or sedation from anaesthetic agents
  • Normal anion gap

Q1. b) What is the significance of the haemoglobin concentration and white cell count?

  • Anaemia and leukocytosis – mild anaemia is physiological in pregnancy.
  • Neutrophil leukocytosis is a normal feature during labour and early post-partum.

Q2. What is the likely cause of this biochemical profile?

  • Rhabdomyolysis from lower limb ischaemia

Q3. List four possible underlying reasons for the above biochemical profile

  • Dehydration
  • Steroid therapy or Cushings
  • GI bleed
  • Protein catabolism
  • Decreased muscle mass
  • Ruptured bladder
Exams LITFL ACEM 700

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CICM

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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