Page 12 of 13

AS7.1-5 | Intensive Care Management — Assignment

Instructions

1. Read the patient vignette below carefully.

Vignette: A 62-year-old male with poorly controlled diabetes mellitus (Type 2) and a 30 pack-year smoking history is admitted to the general medicine ward with pneumonia. Over the next 18 hours he deteriorates: respiratory rate 34/min, SpO2 78% on 10 L/min oxygen via non-rebreather mask, blood pressure 88/52 mmHg, heart rate 122/min, temperature 39.4°C, GCS 11 (E3V3M5). ABG on 10 L/min O2: pH 7.25, PaO2 52 mmHg, PaCO2 38 mmHg, HCO3 16 mEq/L, lactate 5.1 mmol/L. Chest X-ray shows bilateral patchy consolidation. Weight 70 kg (ideal body weight 70 kg).

1. Write an ICU Admission Decision section (approximately 150-200 words): State clearly whether this patient meets ICU admission criteria, justify your decision using specific clinical findings from the vignette, and name the organ systems that are failing or threatened.

1. Write a Monitoring Plan section (approximately 150-200 words): List the monitoring modalities you would institute in the ICU for this patient, explaining the physiological rationale for each (e.g., why an arterial line, why continuous SpO2, why hourly urine output measurement).

1. Write an Initial Ventilator Management Plan section (approximately 200-250 words): Assume the patient is intubated via rapid sequence intubation. Calculate and specify: tidal volume (mL and mL/kg IBW), respiratory rate, FiO2, PEEP, and the mode of ventilation you would use. State your target SpO2, PaO2, and pH. Explain why you chose these settings and what safety alarm limits you would set. Apply the ARDS lung-protective strategy.

1. Write a Complications and Monitoring Review section (approximately 100-150 words): List two specific complications of mechanical ventilation that this patient is at risk for, explain the monitoring sign that would alert you to each, and describe your initial response.

1. Reference your factual claims (doses, targets, criteria) to Morgan and Mikhail's Clinical Anesthesiology or Ajay Yadav's Textbook of Anaesthesia where applicable.

Length: 700-900 words across all four sections combined.

Grading Rubric — Intensive Care Management Assignment Rubric

Criterion	Points	Full-marks descriptor
ICU Admission Decision: Accuracy and completeness of clinical reasoning — correct identification of meeting/not meeting criteria, specific organ systems named, relevant clinical findings cited	20 pts	All relevant organ failures or threats identified with specific clinical evidence; clear, accurate reference to ICU admission criteria; logical and complete justification with no factual errors
Monitoring Plan: Comprehensiveness and physiological rationale — covers cardiovascular, respiratory, renal, and metabolic monitoring with mechanistic justification for each modality	20 pts	All four monitoring domains covered (cardiovascular, respiratory, renal, metabolic) with accurate physiological rationale for each modality; integrated and clinically realistic plan
Ventilator Management Plan: Accuracy of lung-protective settings — correct tidal volume calculation using IBW, appropriate mode, FiO2, PEEP, targets stated, and safety rationale explained	30 pts	Tidal volume correctly calculated as 6 mL/kg IBW (420 mL for 70 kg); mode specified and appropriate (e.g., volume control); FiO2, PEEP, rate, and oxygenation targets all stated; plateau pressure target <30 cmH2O cited; safety alarm rationale explained; no factual errors
Complications and Monitoring: Accuracy in identifying ventilator complications, their monitoring signatures, and initial management responses	30 pts	Two specific, relevant complications identified (e.g., ventilator-associated pneumonia, barotrauma/pneumothorax, haemodynamic compromise from PEEP, auto-PEEP); monitoring sign for each is accurate and specific; initial management response is correct and actionable