ICU Formative Flashcards
Which blood product is most strongly associated with transfusion related acute lung injury (TRALI)?
= C: Fresh Frozen Plasma
- A: Aspirin and IV enoxoparin
- B: Aspirin, clopidogrel, IV heparin and cardiology consult
- C: Dose of IV amoxicillin and have the team review the patient in the morning
- D: Fluid bolus, appropriate antibiotics and surgical review
- E: IV frusemide 40mg and bolus of 4% albumin
= D: Fluid bolus, appropriate antibiotics and surgical review
= D: Nutrition is best given early and by the enteral route. All studies in this area suggest early enteral feeding is associated with the best outcomes.
Which test is the least helpful in monitoring renal function in hospital inpatients?
= C: Serum sodium
- This is the factor that is least affected by renal failure, all the other choices are much more sensitive to renal dysfunction.
As renal failure causes both salt and water retention, plasma sodium concentration changes may not reflect the degree of renal failure.
Which statement is correct regarding methods of reducing intracranial pressure?
= An external ventricular drain can be useful.
Intubation should be performed whenever the patient needs it, fever and seizures both raise ICP, a normal ICP is 5 - 15 mmHg. EVDs are useful as they drain CS to reduce ICP, and can directly measure ICP.
For which electrolyte disturbance would urgent dialysis be an appropriate treatment?
= B: Hyperkalaemia
- This is the life-threatening disturbance. Low phosphate and uric acid cannot be managed by dialysis as it only removes these substances not adds them.
High magnesium is not life threatening unless extremely high (treat with IV calcium) and hyperglycemia is best treated with insulin.
A 94 year old nursing home patient with dementia is admitted to hospital with a leaking abdominal aortic aneurysm. Without an operation she will die. With an operation, she has a slim chance of survival, but the operation and recovery period carry significant risks of mortality and morbidity. The family are wanting ‘everything to be done. What scenario is the best course of action?
= B: Have the surgeon, anaesthetist and intensivist meet with the family and tell them that conservative management is indicated in this case, and organise palliation of the patient
Regarding severe acute pancreatitis, which statement is correct?
= D: Is commonly complicated by multi-organ failure
- Pancreatitis is a non infective process (although may become secondarily infected later in the process), has a high mortality and complication rate. Surgery should be avoided early in the disease process as it is associated with worse outcomes and DVT prophylaxis is essential.
Non-invasive ventilation improves oxygenation in acute pulmonary oedema by all the following methods except:
= C: Increasing dead space
Increasing dead space causes increased CO2 not hypoxia. NIV causes a very small increase in dead space that is not significant. All the other answers are true.
A patient is admitted to ICU with pneumonia resulting in respiratory failure. After 48 hours, the sputum culture grows a methicillin sensitive Staphylococcus aureus (MSSA).
What is the best antibiotic to use to combat this infection?
= B: Flucloxacillin
- It is the treatment of choice for MSSA. Vancomycin is not as potent as flucloxacillin in this scenario and is used for MRSA. Amoxycillin does not kill MSSA, meropenem works but is unnecessary in this scenario and methicillin is only used in laboratories in Australia, it is not used clinically.
- A: Adrenaline
- B: Amiodarone
- C: Atropine
- D: CPR at a ratio of 30:2
- E: Electrical cardioversion
- F: Lignocaine
- G: Magnesium
- H: Noradrenaline
- I: Potassium
- J: Sodium bicarbonate
- K: Transcutaneous pacing
- L: Vasopressin
= D: CPR at a ratio of 30.2. This is directly recommended by the ARC on the ALS algorithm.
- A: Adrenaline
- B: Amiodarone
- C: Atropine
- D: CPR at a ratio of 30:2
- E: Electrical cardioversion
- F: Lignocaine
- G: Magnesium
- H: Noradrenaline
- I: Potassium
- J: Sodium bicarbonate
- K: Transcutaneous pacing
- L: Vasopressin
= A: Adrenaline
- A: Adrenaline
- B: Amiodarone
- C: Atropine
- D: CPR at a ratio of 30:2
- E: Electrical cardioversion
- F: Lignocaine
- G: Magnesium
- H: Noradrenaline
- I: Potassium
- J: Sodium bicarbonate
- K: Transcutaneous pacing
- L: Vasopressin
= E: Electrical cardioversion
- A: Adrenaline
- B: Amiodarone
- C: Atropine
- D: CPR at a ratio of 30:2
- E: Electrical cardioversion
- F: Lignocaine
- G: Magnesium
- H: Noradrenaline
- I: Potassium
- J: Sodium bicarbonate
- K: Transcutaneous pacing
- L: Vasopressin
= IV Magnesium is first line treatment for haemodynamically stable torsade de pointes. Defibrillation should occur if haemodynamically unstable.
- A: Adrenaline
- B: Amiodarone
- C: Atropine
- D: CPR at a ratio of 30:2
- E: Electrical cardioversion
- F: Lignocaine
- G: Magnesium
- H: Noradrenaline
- I: Potassium
- J: Sodium bicarbonate
- K: Transcutaneous pacing
- L: Vasopressin
= K: Transcutaneous pacing.
- The patient remains bradycardic post atropine and still has a low perfusion blood pressure and pulse.
- They do not need CPR as they have regained consciousness. Isoprenaline could also be used here but was not an option.
- Transcutaneous pacing would be the best option.
Write short notes comparing and contrasting the general examination findings of a patient in septic shock versus a patient in cardiogenic shock. (There are no marks for history and investigations).
(6 marks)
- 10 features of each?
Describe the initial investigation and management of the patient who has septic shock. (4 marks)
- 14 points
