1 . Intrathoracic upper airway obstruction

• 2 CT-vascular sling around the trachea causing extrinsic compression
• 3. Position, sedation, oxygen, intubation under anesthesia with the smallest ET available
• 4. Definitive cardiovascular surgery to remove the sling

Ans. 2. Supratentorial herniation

• iL: Uneal
• Central (transtentorial)
• Cingulate (subfalcine)
• Transcalvarial infratentorial herruation
• Upward (upward cerebellar or upward transtentorial)
• Tonsillar (downward cerebellar)

No model answer in source material.

Metabolic disorder—high armon gap metabolic acidosis.

• Propylene glycol—used as the vehicle for midazolam.
• High osmolal gap (346-282 = 64).
• fe ON oo de fh Other differentials—methanol, ethylene glycol, salicylate toxicity, other drugs which contain propylene glycol—phenytoin and melphalan.

Only (e) lung disease cause low pO,

• a . Affects only content, not oxygen saturation or pO,
• b. Through d. affect only oxygen saturation and content, not pO,

* The body needs oxygen molecules, so oxygen content takes precedence over partial pressure in determuning degree of hypoxemia. In this problem the amount of oxygen molecules contributed by the dissolved fraction is negligible and will not affect the answer. Also, the paCO, and pH are not needed to answer the question.

• * Patient A Arterial oxygen content = 95 x 7 x 134=89ml10O,/dL
• * Patient B: Arterial oxygen content = .85 x 15 x 1.34 = 17.1 ml Q,/dL
• * Patient A, with the higher paOQ, but the lower hemoglobin content, 1s more hypoxemuc

1 . ChestX-ray suggestive of massive pericardial effusion with rightrmd-zone consolidation

• 2 . Acute emergency therapy—pericardiocentesis
• . Indications for pericardiocentesis
  • a. Clinical features of cardiac tamponade or obstructive cardiogenic shock
  • b. 2 Decho suggestive of diastolic buckling of RA or RV
• . CT scan suggestive of—right subdural hematoma with midline shift
  • bo . Take care of ABC, intubation and hyperventilation
  • . Neurosurgical evacuation of the subdural hematoma is the definitive therapy. Maintain mean arterial pressure to maintain cerebral perfusion pressure (CPP = MAP-ICP). Decongestive measures such as mannitol or 3% NaCl.
  • . Hyponatremia

No model answer in source material.

— . Diabetic ketoacidosis

• . First hour—normal saline bolus 10 ml/kg

• 3. Add KCl in the IV fluids to 60 mEq/L, reduce insulin to 0.5 to 0.8 μ/kg/hour

• Younger age (<3 years), new onset, and longer duration of symptoms, lower pCO₂, severe acidosis (pH <7 1), increased BUN, use of bicarbonate, greater volumes of rehydration fluids (in excess of 4 L/m²/24 hrs) and failure of serum Na to rise with treatment.

• 5. Cerebral edema and hypokalemia

Ans. 9. ARDS

• 1. Acute onset
• 2. Bilateral pulmonary infiltrates on chest radiography
• Pulmonary artery occlusion pressure <18 mm Hg or no clinical evidence of left atrial hypertension
• paO₂: FiO₂ ratio ≤300 = ALl
• 5. paO₂: FiO₂ ratio ≤200 = ARDS

Ans. 10. Left ventricular events

No model answer in source material.

1. Graph suggests progression of drug metabolism from first order kinetics to zero order kinetics with increasing circulating drug levels

• 2. First order kinetics—where a fixed proportion of circulating drug gets metabolised.
• Zero order kinetics—fixed amount of drug irrespective of the circulating drug level gets metabolised.
• 4. Phenytoin

1. Tumour lysis syndrome

• 2. Fluid: 3000 ml/m2
• 3. Allopurinol: 10 mg/kg/day
• HCO₃: 50–80 mEq/L (role controversial)
• 5. Monitor signs of fluid overload, urine output and urinary pH
• 6. Choice of dialysis—hemodialysis

Intensive Care 127 |

• Abnormally placed umbulical arterial line in the subclavian artery.
  • For umbilical arterial ine: High: Between Tj-T,,. In the thoracic aorta above diaphragm between ductus and celiac axis; Low: Between L,-L;, or L,-L,, abdominal aorta, between inferior mesenteric artery and aorta bifurcation
  • For umbilical ver: Just above the diaphragm
  • Warm the other limb; if still pale >1/2 hour, remove the UA line.
  • L-1
  • Use heparin infusion at rate of 0.5-1.0 urut per hour.
• . Airway obstruchon and inhalational injury (singed nasal hairs, carbonaceous material in throat, hoarseness of voice, persistent cough, stridor)
  • Airway management, BC, IV access and flinds, pain management, management of hypothermia
  • . Parkland formula (4 ml/kg/% burn) + mamtenance fluids.
• . HTPS (hypertropic pyloric stenosis)
  • . Hypochloremic metabolic alkalosis
• . HR 120-160, normal beat to beat variability, two accelerations of 15 beat/mun, lasting for 15 sec over a 20 min observahon period.
  • Persistent O, or ventilatory requirement for >28 days for mfants born after 32 weeks or at 36 weeks post-menstrual age for infants born before 32 weeks.
  • . pCO, 55-65, pO;: 50,with a pH >7.2
  • . Stage 1 (suspect): Clinical signs and symptoms and nondiagnostic radiographs Stage 2 (definite): Clinical sign and symptoms with pneumatosis intestinalis on radiograph.
    • Stage 3 (advanced) Above plus crtically ill, impending perforation, proven perforation
  • . Five or more contiguous or eight cumulative clock hours of stage 3 with plus disease in either zone 1 or 2.

No model answer in source material.

No model answer in source material.

No model answer in source material.

No model answer in source material.