Nutrition

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).

Endocrinology

Endocrinology is a topic that is tightly aligned with neurological disease, infectious diseases, nephrology, and postoperative management; in fact, the endocrine system is a chemical version of the neurological system. In many respects, it is entangled with all of critical care and is a substantial topic even on the core anesthesiology examination. In the same vein, endocrinopathies of various types are an ideal method through which an examination board can generate material. When once considers the scope and breadth of endocrinopathies, this system generally effects every critically ill patient while also serving as an indicator for disease in other systems. These concepts are empowering when mastered and add tremendous clinical dexterity to the clinician when applied in the intensive care unit.

Renal Acid–Base

The renal system plays a critical role in maintaining normal blood pressure, acid–base and electrolyte balance, volume status, and clearance of metabolites. Impairments to kidney function directly affect all other organ systems and have significant implications for morbidity in the critical care setting. Understanding renal disease, it treatment and its replacement is imperative to effectively managing patients in the intensive care unit. This chapter focuses on diagnostic modalities for assessing renal function, acid–base disorders, infection, and electrolyte abnormalities. Here, the authors also focuses on differentiating prerenal, intrinsic renal, and postrenal causes of acute kidney failure, strategies for prevention, and the various forms of dialysis.

Cardiovascular I

Cardiovascular disease management is a hallmark skill in critical care medicine, and the most common data source includes the classic electrocardiogram (ECG); as such, ECG findings are frequently used in this chapter. Critical care board examinations frequently require the examinee to be able to recognize various key illnesses, sometimes with limited information; in order to solve such problem, gleaning an appropriate differential diagnosis from the question stem is needed in order to generate the correct solution. Reflecting this concept, images provided on an exam may be of limited diagnostic value and of low quality. This chapter aims to provide the reader with an experience in this realm that would be useful for success on the examination and at the bedside.

Pulmonology

The management of pulmonary disease and mechanical ventilation encompasses part of the core of critical care medicine. Because physician anesthesiologists routinely manage ventilators on a daily basis, functional elements of mechanical ventilation are not heavily emphasized in this chapter, though the authors seek to avoid taking knowledge of this topic by the reader for granted. On the converse, this chapter seeks to emphasize clinically realistic and testable concepts that address authentic management decisions for patients with respiratory failure or pathophysiology related to critical illness. Additionally, complications associated with ongoing mechanical ventilation and pertinent diagnostic processes are tested in this chapter with some questions that demand rote knowledge of mechanical ventilation. Pulmonary disease represents a significant component of all critical care examinations and is a key element of practice for the every intensivist.

Gastroenterology

Gastrointestinal and hepatic disease is seen as a complicating factor for some of the most acute and chronically ill patients in the intensive care domain. These patients are not only academically challenging but also clinically challenging and commonly fall into the practice of general surgery as well as hepatology. This chapter reviews the laboratory and clinical presentations of these patients, along with discussion pertaining to common sources of morbidity. Furthermore, scoring systems and acuity markers for these patients are reviewed, along with practical management approaches. Disturbances in the gastrointestinal system are a hallmark of the perioperative patient and should be expected on the examination and in practice.

Hematology and Oncology

Hematologic and oncologic disorders pose unique challenges, particularly in the setting of chronic disease. Many of the pathological states in this chapter are seen in subspecialized practice settings but are required knowledge universally because of the frequency of such patients suddenly deteriorating as disease and age progress. The rise of novel oral anticoagulants and their reversal agents adds to the complexity of this topic. The surgical population in particular requires the application of this knowledge set for safe patient care. As result, coagulopathy is definitively in the wheelhouse of every perioperative physician and can be expected to have daily application in practice.

Central Nervous System

Neurological critical illness presents a unique set of challenges for the perioperative intensivist. An understanding of the significance and management of this pathophysiology holds particular pertinence in the neurosciences intensive care unit but also in every type of surgical unit. Neurological disease is prevalent in nearly every intensive care unit environment, and in-depth knowledge of this system is necessary to provide excellent care. This chapter aims to cover disease processes and management that every intensivist should know as well as a few unique scenarios.

Cardiovascular II

Cardiac dysfunction and hemodynamic instability comprise another hallmark pathology seen in the intensive care unit. Some could argue that cardiovascular compromise is the most common indication for intensive care management. This chapter aims to emphasize more non-traditional means of managing the patient with cardiac dysfunction up to and including mechanical devices. Additionally, the reader will find cases involving echocardiography which is commonly tested and growing in importance, particularly in the surgical population as volume assessment is challenging when only conventional means are applied. It is our hope that by the end of this chapter, the reader will have experienced a 360 degree perspective of the range of cardiac disease questions with an eye towards the types of questions which may be on the horizon for future examinations.

Statistics, Ethics, and Management

While regulatory, management, and statistics concepts are commonly considered pertinent primarily for examinations, the mastery of this skillset allows for effective leadership in an intensive care unit. In the modern multidisciplinary model of critical care, an intensivist needs to be comfortable interpreting quality metrics as well as medical literature. Additionally, an understanding of the regulatory role of government and how such policies affect the care of patients is directly pertinent to interactions with hospital administrators and peers of other specialties. This chapter provides a general overview of these concepts for the examination, but the reader is encouraged to read more into the background of these topics in order to gain a practical mastery of these concepts for practice.