Theme 6:
Immediate life-
threatening
conditions
Summary
1
,Inhoud
Week 1: Basic life support ....................................................................................................................... 6
Primary survey ..................................................................................................................................... 6
Critical care medicine ........................................................................................................................ 11
Clinical approach to the critically ill patient .................................................................................. 11
Applied cardiorespiratory physiology ........................................................................................... 11
Cardiovascular assessment and monitoring of critically ill patients ............................................. 13
Less invasive techniques for assessing cardiac function and guiding volume replacement ......... 13
Disturbances in acid-base balance ................................................................................................ 13
Shock, sepsis and acute disturbances in haemodynamic function ............................................... 14
Respiratory failure ......................................................................................................................... 17
Acute respiratory distress syndrome ............................................................................................ 17
Acute kidney injury ........................................................................................................................ 18
Neurocritical care .......................................................................................................................... 19
Outcomes ...................................................................................................................................... 19
Major injury ....................................................................................................................................... 20
Chest injuries ................................................................................................................................. 22
Soft tissue injuries and burns ............................................................................................................ 25
Soft tissue injury ............................................................................................................................ 25
Major soft tissue injury.................................................................................................................. 25
Peripheral nerve injuries ............................................................................................................... 26
Necrotising fasciitis........................................................................................................................ 27
Burns.............................................................................................................................................. 27
Immunity, inflammation and infection ............................................................................................. 31
The immune system ...................................................................................................................... 31
Inflammation ................................................................................................................................. 31
Wound healing .............................................................................................................................. 32
Chronic inflammation .................................................................................................................... 33
Infection ........................................................................................................................................ 34
Sepsis ............................................................................................................................................. 34
Skin infections ................................................................................................................................... 37
Physiology.......................................................................................................................................... 39
Physiology: THE curves ...................................................................................................................... 44
Acid-base regulation...................................................................................................................... 48
Fracture management ....................................................................................................................... 50
Spine .............................................................................................................................................. 50
2
, Management of spinal paralysis.................................................................................................... 51
Pelvis .............................................................................................................................................. 52
Week 2: Acute back/abdominal/thorax pain ........................................................................................ 54
Introduction....................................................................................................................................... 54
IC physiology...................................................................................................................................... 56
Physiology: Respiratory insufficiency ................................................................................................ 60
Vascular emergencies: aortic dissection and thoracic aneurysm ..................................................... 64
Hypovolaemic shock and traumatic aortic rupture........................................................................... 69
Abdominal pain and shock ................................................................................................................ 74
Gastro-intestinal bleeding ................................................................................................................. 79
Pathophysiology, clinical features and diagnosis of vascular disease affecting the limbs................ 81
Vascular insufficiency of the limb.................................................................................................. 81
Symptoms and signs in the limb .................................................................................................... 82
Pain ................................................................................................................................................ 83
Skin changes .................................................................................................................................. 84
Lower limb ulceration.................................................................................................................... 85
Limb swelling ................................................................................................................................. 87
Managing lower limb arterial insufficiency: the diabetic foot and major amputations ................... 88
Acute lower limb ischaemia .......................................................................................................... 88
Management of the acutely ischaemic limb ................................................................................. 88
Aneurysms and other peripheral arterial disorders .......................................................................... 90
Aneurysms ..................................................................................................................................... 90
Arterial insufficiency in other organs ............................................................................................ 92
Long-term follow-up after surgery ................................................................................................ 92
Week 3: Shortness of breath ................................................................................................................. 93
Introduction....................................................................................................................................... 93
IC physiology...................................................................................................................................... 96
Meet the expert ................................................................................................................................ 99
Asthma........................................................................................................................................... 99
Pulmonary embolism................................................................................................................... 100
Empyema ..................................................................................................................................... 100
Venous thromboembolic disease .................................................................................................... 102
Diagnosis...................................................................................................................................... 103
Management ............................................................................................................................... 104
Breathlessness ................................................................................................................................. 106
Lung cancer ..................................................................................................................................... 108
3
, Non-small cell lung cancer........................................................................................................... 108
Small cell lung cancer .................................................................................................................. 108
Metastases in the lung ................................................................................................................ 108
Pulmonary heart disease ................................................................................................................. 110
Pulmonary hypertension ............................................................................................................. 110
Respiratory disease ......................................................................................................................... 112
Asthma......................................................................................................................................... 113
COPD............................................................................................................................................ 114
Pneumonia .................................................................................................................................. 116
Primary spontaneous pneumothorax ......................................................................................... 118
Drugs............................................................................................................................................ 118
The heart ......................................................................................................................................... 119
Arrythmias ................................................................................................................................... 120
Bradycardia.................................................................................................................................. 120
Atrial tachyarrhythmias ............................................................................................................... 122
Ventricular tachyarrhythmias...................................................................................................... 123
Heart failure ................................................................................................................................ 124
Left-sided heart failure ................................................................................................................ 126
Right-sided heart failure .............................................................................................................. 127
Acute heart failure....................................................................................................................... 129
Hypertensive heart disease ......................................................................................................... 130
Valvular heart disease ................................................................................................................. 131
Cardiomyopathies ....................................................................................................................... 132
COVID-19 ARDS ............................................................................................................................... 136
Lung ultrasound in the patient with acute dyspnoea ..................................................................... 139
Week 4: Chest pain.............................................................................................................................. 143
Acute coronary syndromes ............................................................................................................. 143
Anatomy and physiology ................................................................................................................. 147
Angina pectoris ................................................................................................................................ 150
Collapse ........................................................................................................................................... 153
Dyspnoea after myocardial infarction ............................................................................................. 155
ECG in ACS ....................................................................................................................................... 157
Subendocardial ischaemia ........................................................................................................... 159
Transmural ischaemia ................................................................................................................. 161
Tamponade...................................................................................................................................... 164
Acute pericarditis ........................................................................................................................ 164
4
Immediate life-
threatening
conditions
Summary
1
,Inhoud
Week 1: Basic life support ....................................................................................................................... 6
Primary survey ..................................................................................................................................... 6
Critical care medicine ........................................................................................................................ 11
Clinical approach to the critically ill patient .................................................................................. 11
Applied cardiorespiratory physiology ........................................................................................... 11
Cardiovascular assessment and monitoring of critically ill patients ............................................. 13
Less invasive techniques for assessing cardiac function and guiding volume replacement ......... 13
Disturbances in acid-base balance ................................................................................................ 13
Shock, sepsis and acute disturbances in haemodynamic function ............................................... 14
Respiratory failure ......................................................................................................................... 17
Acute respiratory distress syndrome ............................................................................................ 17
Acute kidney injury ........................................................................................................................ 18
Neurocritical care .......................................................................................................................... 19
Outcomes ...................................................................................................................................... 19
Major injury ....................................................................................................................................... 20
Chest injuries ................................................................................................................................. 22
Soft tissue injuries and burns ............................................................................................................ 25
Soft tissue injury ............................................................................................................................ 25
Major soft tissue injury.................................................................................................................. 25
Peripheral nerve injuries ............................................................................................................... 26
Necrotising fasciitis........................................................................................................................ 27
Burns.............................................................................................................................................. 27
Immunity, inflammation and infection ............................................................................................. 31
The immune system ...................................................................................................................... 31
Inflammation ................................................................................................................................. 31
Wound healing .............................................................................................................................. 32
Chronic inflammation .................................................................................................................... 33
Infection ........................................................................................................................................ 34
Sepsis ............................................................................................................................................. 34
Skin infections ................................................................................................................................... 37
Physiology.......................................................................................................................................... 39
Physiology: THE curves ...................................................................................................................... 44
Acid-base regulation...................................................................................................................... 48
Fracture management ....................................................................................................................... 50
Spine .............................................................................................................................................. 50
2
, Management of spinal paralysis.................................................................................................... 51
Pelvis .............................................................................................................................................. 52
Week 2: Acute back/abdominal/thorax pain ........................................................................................ 54
Introduction....................................................................................................................................... 54
IC physiology...................................................................................................................................... 56
Physiology: Respiratory insufficiency ................................................................................................ 60
Vascular emergencies: aortic dissection and thoracic aneurysm ..................................................... 64
Hypovolaemic shock and traumatic aortic rupture........................................................................... 69
Abdominal pain and shock ................................................................................................................ 74
Gastro-intestinal bleeding ................................................................................................................. 79
Pathophysiology, clinical features and diagnosis of vascular disease affecting the limbs................ 81
Vascular insufficiency of the limb.................................................................................................. 81
Symptoms and signs in the limb .................................................................................................... 82
Pain ................................................................................................................................................ 83
Skin changes .................................................................................................................................. 84
Lower limb ulceration.................................................................................................................... 85
Limb swelling ................................................................................................................................. 87
Managing lower limb arterial insufficiency: the diabetic foot and major amputations ................... 88
Acute lower limb ischaemia .......................................................................................................... 88
Management of the acutely ischaemic limb ................................................................................. 88
Aneurysms and other peripheral arterial disorders .......................................................................... 90
Aneurysms ..................................................................................................................................... 90
Arterial insufficiency in other organs ............................................................................................ 92
Long-term follow-up after surgery ................................................................................................ 92
Week 3: Shortness of breath ................................................................................................................. 93
Introduction....................................................................................................................................... 93
IC physiology...................................................................................................................................... 96
Meet the expert ................................................................................................................................ 99
Asthma........................................................................................................................................... 99
Pulmonary embolism................................................................................................................... 100
Empyema ..................................................................................................................................... 100
Venous thromboembolic disease .................................................................................................... 102
Diagnosis...................................................................................................................................... 103
Management ............................................................................................................................... 104
Breathlessness ................................................................................................................................. 106
Lung cancer ..................................................................................................................................... 108
3
, Non-small cell lung cancer........................................................................................................... 108
Small cell lung cancer .................................................................................................................. 108
Metastases in the lung ................................................................................................................ 108
Pulmonary heart disease ................................................................................................................. 110
Pulmonary hypertension ............................................................................................................. 110
Respiratory disease ......................................................................................................................... 112
Asthma......................................................................................................................................... 113
COPD............................................................................................................................................ 114
Pneumonia .................................................................................................................................. 116
Primary spontaneous pneumothorax ......................................................................................... 118
Drugs............................................................................................................................................ 118
The heart ......................................................................................................................................... 119
Arrythmias ................................................................................................................................... 120
Bradycardia.................................................................................................................................. 120
Atrial tachyarrhythmias ............................................................................................................... 122
Ventricular tachyarrhythmias...................................................................................................... 123
Heart failure ................................................................................................................................ 124
Left-sided heart failure ................................................................................................................ 126
Right-sided heart failure .............................................................................................................. 127
Acute heart failure....................................................................................................................... 129
Hypertensive heart disease ......................................................................................................... 130
Valvular heart disease ................................................................................................................. 131
Cardiomyopathies ....................................................................................................................... 132
COVID-19 ARDS ............................................................................................................................... 136
Lung ultrasound in the patient with acute dyspnoea ..................................................................... 139
Week 4: Chest pain.............................................................................................................................. 143
Acute coronary syndromes ............................................................................................................. 143
Anatomy and physiology ................................................................................................................. 147
Angina pectoris ................................................................................................................................ 150
Collapse ........................................................................................................................................... 153
Dyspnoea after myocardial infarction ............................................................................................. 155
ECG in ACS ....................................................................................................................................... 157
Subendocardial ischaemia ........................................................................................................... 159
Transmural ischaemia ................................................................................................................. 161
Tamponade...................................................................................................................................... 164
Acute pericarditis ........................................................................................................................ 164
4
