Five Short Answer Questions

Five SAQs

1. A patient passed 100mls of heavily bloodstained urine after suffering severe pelvic injury. How will you manage this problem?
--comment: in answering this question take note that the main clue is SEVERE pelvic injury. This patient is suffering from significant impact and also other injuries. The trauma care and resuscitation according to ATLS apply.

2. What is the lupus anticoagulant? What is its relevance to ICU practice?
----interesting question

3. Critically evaluate the role of percutaneous tracheostomy in the ICU.

A. Bedside percutaneous tracheostomy has now become an alternative to operative surgical tracheostomy:

-requires less time to perform

-less expensive

-typically performed sooner (OR doesn't have to be scheduled)

Complications may be less frequent with percutaneous tracheostomy than surgical tracheostomy. Results of a study of 46 patients (CCM 1991), when compared to ST: PT is performed in shorter time and significantly less haemorrhage, stomal infection, pneumothorax, all pre-decannulation adverse events, pre decannulation problems per procedure, tracheal stenosis and cosmetic deformity.

In a metaanalysis of 17 randomised, controlled trials (1212 patients), percutaneous tracheostomy decreased wound infections compared to both surgical tracheostomy done in the OR and ICU. (Critical Care 2006)

Percutaneous tracheostomy also decreased bleeding and mortality when compared to surgical tracheostomy performed in OR only.

The second metaanalysis showed perioperative complications (including death, serious cardiorespiratory events, and minor complications) were rare but more common with percutaneous tracheostomy. In contrast minor postoperative complications were more common among patients receiving surgical tracheostomy. (CCM 1999)

The different outcomes of the two meta analysis may reflect the different techniques used to perform PT.

-the first meta-analysis included only studies that used percutaneous dilational tracheostomy. In contrast the second meta-analysis included studies of PT performed using a variety of techniques.

-A recent RC study showed no difference in long term (median 20 m0nth) follow up.(CCM 2006)

-Disadvantages of PT include an increased risk of anterior tracheal injury and posterior tracheal wall perforation.

Taken together, the data suggest Percutaneous dilational tracheostomy offers numerous advantages compared to surgical tracheostomy.
The benifit of PT may be substantially less depending on the technique employed.

4. An audit of central venous catheters (CVC) in your ICU shows sepsis related rate of 30% . Outline what you will do?
----This is an audit question

5. Critically evaluate the use of plasma troponin in the critically ill patient.
---is a critically evaluate question
at the end of the debate must include ---in my opinion or in my practice....