Critical Care
23%of exam
Critical IllnessDevices & ECMOHemodynamicsPost-ICU Syndrome
Therapeutics & Patient Management
57%of exam
SepsisSedation & DeliriumPharmacotherapy by SystemToxicologyTreatment Monitoring
Professional Practice
20%of exam
Medication SafetyQuality ImprovementScholarshipPractice Management
Quick Facts
- Exam
- BCCCP
- Credential
- Critical Care Pharmacist
- Questions
- 150 (125 scored)
- Time
- 3h 45m
- Pass
- 500/800 scaled
- Format
- Pearson VUE CBT
- Level
- Specialty certification
- Blueprint
- Jan 2024 ECO
MODS Organ Systems
Lungs, kidneys, liver, heart, brain, and blood
Lungs: ARDSKidneys: AKILiver: shock liverBlood: DIC
VA ECMO vs VV ECMO
VA ECMO
- Supports heart and lungs
- Arterial and venous cannulation
- Treats cardiogenic shock
VV ECMO
- Supports lungs only
- Venous-venous cannulation only
- Preserves native cardiac function
Heart failing vs lungs only
ICU Device Selection
- Respiratory failure only→VV ECMO
- Cardiac plus respiratory failure→VA ECMO
- LV unloading needed→Impella or IABP
- AKI, hemodynamically unstable→CRRT
- AKI, hemodynamically stable→Intermittent hemodialysis
Critical Illness Concepts
- PICS
- Post-ICU functional decline
- SIRS
- Two or more vital criteria
- ICU-AW
- Critical illness neuromyopathy
- MODS
- Multi-organ dysfunction syndrome
- Risk factors
- Age, comorbidity, frailty, sepsis
CVP vs PAOP
CVP
- Right heart filling pressure
- Measured via central line
PAOP
- Left heart filling pressure
- Measured via PA catheter
Right heart vs left heart
Devices & Mechanical Support
- IABP
- Augments diastolic coronary flow
- Impella
- Percutaneous LV unloading pump
- VA ECMO
- Cardiac plus respiratory support
- VV ECMO
- Respiratory support only
- CRRT
- Continuous renal replacement therapy
- Ventilator modes
- AC, SIMV, PSV, PRVC
Hemodynamic Monitoring
- MAP goal
- 65 mmHg or higher
- CVP
- Right heart filling pressure
- PAOP
- Left heart filling pressure
- SvO2
- Oxygen extraction marker
- Arterial line
- Continuous blood pressure monitoring
- Cardiac output
- Heart rate times stroke volume
Sepsis 3-Hour Bundle Order
Lactate, cultures, antibiotics, fluids, then source control
Lactate: measure levelCultures: before antibioticsAntibiotics: within 1 hourFluids: 30 mL/kg
Norepinephrine vs Vasopressin
Norepinephrine
- First-line vasopressor agent
- Alpha-1 receptor agonist
- Titratable dosing
Vasopressin
- Add-on agent only
- Fixed low dose
- Norepinephrine-sparing effect
First-line vs add-on agent
Vasopressor Selection
- Septic shock first-line→Norepinephrine
- Persistent shock on norepinephrine→Add vasopressin
- Cardiogenic shock, low output→Dobutamine
- Refractory vasoplegia despite pressors→Add hydrocortisone
- Bradycardic cardiac arrest→Epinephrine
Sepsis & Septic Shock
- 30 mL/kg
- Crystalloid within 3 hours
- Lactate 4+
- Severe hypoperfusion, aggressive resuscitation
- Norepinephrine
- First-line vasopressor choice
- Vasopressin add-on
- NE-sparing fixed low dose
- Antibiotics
- Within one hour
- Blood cultures
- Drawn before antibiotics
- Source control
- Within 6-12 hours
RASS Scale Direction
Positive four combative, zero calm, negative five unarousable
+4: combative0: alert and calm-5: unarousable
Analgosedation vs Sedation-First
Analgosedation
- Treats pain first
- Less sedative exposure
- Current best practice
Sedation-first
- Sedates before treating pain
- Higher oversedation risk
- Older outdated approach
Pain-first is preferred standard
Sedation & Analgesia Choice
- Need rapid on/off→Propofol
- Avoid respiratory depression→Dexmedetomidine
- Hemodynamically unstable patient→Fentanyl
- Pain-driven agitation→Treat analgesia first
- Delirium risk high→Avoid benzodiazepines
Sedation, Analgesia & Delirium
- RASS
- Sedation depth scale
- CAM-ICU
- Delirium screening tool
- Analgosedation
- Treat pain before sedation
- Sedation holiday
- Daily interruption trial
- Propofol
- Rapid onset and offset
- Dexmedetomidine
- No respiratory depression risk
DKA vs HHS
DKA
- Significant ketosis present
- Type 1 more common
- Prominent metabolic acidosis
HHS
- Minimal ketosis present
- Type 2 more common
- Extremely high glucose
Ketones vs extreme glucose
Antidote Selection
- Acetaminophen toxicity→N-acetylcysteine
- Opioid toxicity→Naloxone
- Calcium channel blocker overdose→High-dose insulin
- Digoxin toxicity→Digoxin immune Fab
Cardiology & Arrhythmias
- Dobutamine
- Inotrope for low output
- Milrinone
- PDE-3 inhibitor, vasodilates
- Amiodarone
- First-line for VT/AF
- STEMI
- PCI within 90 minutes
- Cardiac arrest epi
- 1 mg every 3-5 min
Pulmonology & Ventilation
- ARDS tidal volume
- 6 mL/kg predicted weight
- PEEP
- Prevents alveolar collapse
- Prone positioning
- Severe ARDS, low P/F
- Plateau pressure
- Keep under 30 cmH2O
- Driving pressure
- Plateau minus PEEP
Neurocritical Care
- ICP goal
- Under 22 mmHg
- CPP
- MAP minus ICP
- Status epilepticus
- Benzodiazepine first-line therapy
- tPA window
- 3 to 4.5 hours
- Hypertonic saline
- Osmotic ICP therapy
Renal, Electrolytes & RRT
- CRRT dosing
- 20-25 mL/kg/hr effluent
- Hyperkalemia
- Calcium gluconate stabilizes first
- AKI staging
- KDIGO creatinine and output
- Augmented renal clearance
- Needs higher drug dosing
- Phosphate repletion
- IV if under 1
Toxicology & Antidotes
- Acetaminophen
- N-acetylcysteine antidote
- Opioids
- Naloxone reversal
- Benzodiazepines
- Flumazenil, use cautiously
- Beta-blocker overdose
- High-dose insulin therapy
- Calcium channel blocker
- Calcium, high-dose insulin
- Digoxin toxicity
- Digoxin immune Fab
Hematology & Endocrine Emergencies
- DIC
- Consumptive coagulopathy state
- DKA
- Insulin, fluids, potassium
- HHS
- Very high glucose, minimal ketones
- Adrenal crisis
- Stress-dose hydrocortisone
- Transfusion threshold
- Hemoglobin under 7
Quality Improvement Tool Order
FMEA before, RCA after, PDSA to improve
FMEA: proactiveRCA: reactivePDSA: improve cycle
FMEA vs RCA
FMEA
- Proactive risk analysis
- Before an error occurs
RCA
- Reactive error analysis
- After an error occurs
Before error vs after error
Medication Safety & Quality
- REMS
- Risk mitigation strategy
- FMEA
- Proactive failure analysis
- RCA
- Reactive error analysis
- USP <800>
- Hazardous drug handling standard
- Formulary management
- P&T committee process
Scholarship & Evidence-Based Medicine
- NNT
- Patients treated per benefit
- NNH
- Patients treated per harm
- Sensitivity
- True positive detection rate
- Specificity
- True negative detection rate
- RCT
- Gold-standard study design
Common Traps
CVP ≠ PAOP
CVP reflects right heart ≠ PAOP reflects left heart
VA ECMO ≠ VV ECMO
VA supports heart and lungs ≠ VV supports lungs only
FMEA ≠ RCA
FMEA prevents future errors ≠ RCA explains past errors
Sensitivity ≠ Specificity
Sensitivity finds true positives ≠ Specificity finds true negatives
DKA ≠ HHS
DKA shows significant ketosis ≠ HHS shows minimal ketosis
Norepinephrine ≠ Vasopressin
Norepinephrine is first-line agent ≠ Vasopressin is add-on only
Analgosedation ≠ Sedation-First
Analgosedation treats pain first ≠ Sedation-first oversedates more often
Last Minute
- 1.Critical Care domain weighs 23%
- 2.Therapeutics domain weighs 57%
- 3.Professional Practice domain weighs 20%
- 4.150 total questions, 125 scored
- 5.Exam runs 3 hours 45 minutes
- 6.Passing score is 500 of 800
- 7.Norepinephrine is first-line vasopressor
- 8.30 mL/kg crystalloid within 3h
- 9.RASS measures sedation depth level
- 10.CAM-ICU screens ICU delirium
- 11.VA ECMO supports heart and lungs
- 12.FMEA proactive, RCA reactive tool
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