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Cert Critical Care(SA) Anaes THE COLLEGES OF MEDICINE OF SOUTH AFRICA Incorporated Association not for gain Reg

No 1955/000003/08 Certificate Examination in Critical Care of the College of Anaesthetists of South Africa 25 August 2009 Paper I (3 hours) All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer) 1 In a resource constrained ICU environment, triage principles are vital to responsible use of critical care resources. Elaborate on what factors would inform your ICU bed triage principles in a South African ICU/PICU. (100) Discuss the role of nutrition in the management of severe sepsis using the following headings a) b) c) d) 3 Requirements. Administration. Pharmaco-nutrients. Complications. (25) (25) (25) (25) [100]

Discuss ventilator associated pneumonia using the following headings a) b) c) d) e) Definition and diagnosis. Pathogenesis. Prevention of cross infection. Other preventative measures. Antibiotic use. (10) (15) (25) (25) (25) [100]

With respect to renal replacement therapy a) b) c) d) e) In an annotated list describe the indications for renal replacement therapy in intensive care. (15) How may renal dysfunction be stratified in the intensive care unit? (20) List the modalities that may be used for renal replacement therapy, indicating the relative advantages and disadvantages of each. (40) Briefly discuss the role of diuretic therapy in the management of oliguric patients with acute kidney injury. (10) List interventions that have been used in the prevention of contrast induced nephropathy and indicate their relative efficacy. (15) [100]

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