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BCCCP Cheat Sheet

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Critical Care

  • 23% of exam
  • Critical Illness Devices & ECMO Hemodynamics Post-ICU Syndrome

Therapeutics & Patient Management

  • 57% of exam
  • Sepsis Sedation & Delirium Pharmacotherapy by System Toxicology Treatment Monitoring

Professional Practice

  • 20% of exam
  • Medication Safety Quality Improvement Scholarship Practice 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 CR

  • Lungs, kidneys, liver, heart, brain, and blood
  • Lungs: ARDS Kidneys: AKI Liver: shock liver Blood: DIC

VA ECMO vs VV ECMO CR

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 CR

  • 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 CR

  • 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 CR

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 CR

  • 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 CR

  • 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 TH

  • Lactate, cultures, antibiotics, fluids, then source control
  • Lactate: measure level Cultures: before antibiotics Antibiotics: within 1 hour Fluids: 30 mL/kg

Norepinephrine vs Vasopressin TH

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 TH

  • 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 TH

  • 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 TH

  • Positive four combative, zero calm, negative five unarousable
  • +4: combative 0: alert and calm -5: unarousable

Analgosedation vs Sedation-First TH

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 TH

  • 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 TH

  • 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 TH

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 TH

  • Acetaminophen toxicity → N-acetylcysteine
  • Opioid toxicity → Naloxone
  • Calcium channel blocker overdose → High-dose insulin
  • Digoxin toxicity → Digoxin immune Fab

Cardiology & Arrhythmias TH

  • 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 TH

  • 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 TH

  • 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 TH

  • 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 TH

  • 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 TH

  • 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 PR

  • FMEA before, RCA after, PDSA to improve
  • FMEA: proactive RCA: reactive PDSA: improve cycle

FMEA vs RCA PR

FMEA

  • Proactive risk analysis
  • Before an error occurs

RCA

  • Reactive error analysis
  • After an error occurs
  • Before error vs after error

Medication Safety & Quality PR

  • 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 PR

  • 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

BCCCP

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