Postoperative Surgical Complications, Abdominal Compartment Syndrome and Critical Care Nutrition — WACS Viva & Clinical Scenarios (ICU & HDU)

Exam-style postoperative surgical complications, abdominal compartment syndrome and critical care nutrition viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 42-year-old male (ASA IVE) is transferred to ICU following an 8-hour emergency laparotomy for ruptured amoebic liver abscess and fecal peritonitis. He received 9 liters of crystalloids and 4 units of uncrossmatched blood intraoperatively. Over the first 6 postoperative hours, his peak inspiratory airway pressure rises from 22 cmH2O to 38 cmH2O, urine output drops to 5 mL/hr, and MAP declines to 55 mmHg. Intra-vesical pressure is measured at 24 mmHg. Discuss your systematic management of this intra-abdominal crisis.
• SCENARIO 2: A 30-year-old female (ASA IIIE) on day 6 post-emergency resection for strangulated small bowel obstruction develops a high-output enterocutaneous fistula discharging 1800 mL/day of enteric contents. She is cachectic (BMI 15.2 kg/m2), hypoalbuminemic (albumin 16 g/L), with potassium 2.8 mmol/L and phosphate 0.4 mmol/L. Total Parenteral Nutrition (TPN) is prescribed. Detail your strategy for preventing refeeding syndrome and instituting safe metabolic support.
• SCENARIO 3: A 55-year-old male (ASA IIIE) with severe polytrauma has been mechanically ventilated for 14 days via an endotracheal tube in ICU. Multiple attempts at spontaneous breathing trials have failed due to shallow rapid breathing, diaphoresis, and severe ICU-acquired weakness. Outline your assessment for weaning failure, the role of tracheostomy, and a rehabilitation protocol.
• SCENARIO 4: A 64-year-old male (ASA IIIE) on day 3 post-Whipple procedure in HDU becomes acutely agitated, hallucinating, pulling at his central line and arterial line, and attempting to climb out of bed. His CAM-ICU score is positive. Formulate your diagnostic workup to exclude acute surgical/metabolic catastrophes and your pharmacological/non-pharmacological management plan.