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  <head>
    <title>062-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Critical care foundations">
      <outline text="Orientation and recognition">
        <outline text="Support failing physiology, treat cause, prevent harm"/>
        <outline text="Organ failures interact">
          <outline text="Ventilation alters circulation"/>
          <outline text="Shock injures kidney and brain"/>
          <outline text="Immobility weakens respiratory muscles"/>
        </outline>
        <outline text="Targets, reassessment, minimal invasiveness, team"/>
        <outline text="Trends and concern outweigh a single score"/>
        <outline text="Airway-to-exposure assessment while calling help"/>
        <outline text="Monitoring should answer a question">
          <outline text="Lines and blood draws cause infection and anaemia"/>
        </outline>
      </outline>
      <outline text="Oxygen physiology and delivery">
        <outline text="Delivery is cardiac output times oxygen content">
          <outline text="Haemoglobin-bound oxygen dominates content"/>
          <outline text="Normal saturation cannot offset anaemia or low flow"/>
        </outline>
        <outline text="Falling delivery raises extraction">
          <outline text="Sustained imbalance: lactate, organ failure, cell death"/>
        </outline>
        <outline text="Lactate is not a direct oxygen meter"/>
        <outline text="Excess oxygen causes atelectasis and oxidative injury"/>
        <outline text="Cannulae low flow, Venturi controlled concentration"/>
        <outline text="High-flow oxygen reduces dead space and work"/>
        <outline text="Oximetry limits: perfusion, pigment, dyshaemoglobins"/>
      </outline>
      <outline text="Non-invasive respiratory support">
        <outline text="Continuous pressure recruits alveoli, lowers afterload"/>
        <outline text="Bilevel adds inspiratory assistance"/>
        <outline text="Best in cardiogenic oedema, hypercapnic obstruction"/>
        <outline text="Unsafe without airway protection or with vomiting"/>
        <outline text="Reassess within minutes to hours">
          <outline text="Worsening acidosis, rate, consciousness mean failure"/>
          <outline text="Prolonged failed trials delay definitive airway"/>
        </outline>
      </outline>
      <outline text="Intubation and ventilation">
        <outline text="Intubation is a physiological procedure">
          <outline text="Correct hypotension before positive pressure"/>
          <outline text="Positive pressure reduces venous return"/>
        </outline>
        <outline text="Rapid-sequence induction limits aspiration time"/>
        <outline text="Confirm with sustained exhaled carbon dioxide"/>
        <outline text="Tidal volume and rate remove carbon dioxide"/>
        <outline text="Inspired oxygen and end-expiratory pressure oxygenate"/>
        <outline text="Targets and synchrony matter more than mode"/>
      </outline>
      <outline text="Lung protection and distress syndrome">
        <outline text="Injury from stretch, pressure, cyclic opening"/>
        <outline text="Tidal volume from predicted body weight">
          <outline text="Lung size follows height and sex"/>
        </outline>
        <outline text="Limit plateau and driving pressures"/>
        <outline text="End-expiratory pressure prevents collapse"/>
        <outline text="Distress syndrome: bilateral opacities, not cardiac">
          <outline text="Low tidal volume, conservative fluid after shock"/>
          <outline text="Prone positioning for severe disease"/>
        </outline>
        <outline text="Permissive hypercapnia not for raised intracranial pressure"/>
      </outline>
      <outline text="Synchrony and liberation">
        <outline text="Agitation may reflect pain, delirium, secretions"/>
        <outline text="Treat cause before escalating sedation"/>
        <outline text="Analgesia-first light sedation"/>
        <outline text="Liberation needs improving cause and airway protection"/>
        <outline text="Breathing trial tests integrated reserve">
          <outline text="Upper-airway obstruction can still defeat extubation"/>
        </outline>
        <outline text="High-flow or non-invasive support if high risk"/>
      </outline>
      <outline text="Shock and circulation">
        <outline text="Low volume, pump failure, vasodilation, obstruction"/>
        <outline text="Central venous pressure predicts response poorly"/>
        <outline text="Fluid challenge has dose, response, stopping rule">
          <outline text="Excess fluid impairs gas exchange and recovery"/>
        </outline>
        <outline text="Norepinephrine first line for distributive shock"/>
        <outline text="Inotropes for persistent low output">
          <outline text="Arrhythmia and oxygen demand cost"/>
        </outline>
        <outline text="Source control treats the mechanism"/>
      </outline>
      <outline text="Kidney and metabolic support">
        <outline text="Diuretics do not restore injured nephrons"/>
        <outline text="Replacement therapy for complications, not creatinine"/>
        <outline text="Intermittent haemodialysis rapid, continuous if unstable"/>
        <outline text="Avoid hypoglycaemia; tight control harmful"/>
        <outline text="Early enteral feeding when gut works"/>
        <outline text="Steroids for adrenal insufficiency, refractory sepsis"/>
      </outline>
      <outline text="Neurological critical care">
        <outline text="Serial pupils, motor responses, sedation breaks"/>
        <outline text="Intracranial pressure worsened by hypoxia, hypotension"/>
        <outline text="Brief hyperventilation only bridges herniation"/>
        <outline text="Status epilepticus: benzodiazepine then longer agent"/>
        <outline text="Electroencephalography for non-convulsive seizure"/>
        <outline text="Brain death is a formal legal process"/>
      </outline>
      <outline text="Infection, delirium, and outcomes">
        <outline text="Cultures must not delay antibiotics"/>
        <outline text="Fever also from drugs, thrombosis, transfusion"/>
        <outline text="Daily device removal review"/>
        <outline text="Delirium: fluctuating inattention and cognition">
          <outline text="Minimise benzodiazepines and anticholinergics"/>
        </outline>
        <outline text="Time-limited trials with a review point"/>
        <outline text="Survivors: weakness, cognitive impairment, distress"/>
      </outline>
    </outline>
  </body>
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