Nonpulmonary Critical Care

Question 1

Preferred pain scales in ICU

Answer 1

Behavioral pain scale (BPS) and Critical care pain observation tool (CPOT)

Question 2

First line medication for non-neuropathic pain in ICU

Answer 2

IV opioids

Question 3

First line medication for neuropathic pain in the ICU

Answer 3

Gabapentin or carbamazepine + IV opioids

Question 4

Main side effect of fentanyl

Answer 4

Rigidity

Question 5

Preferred sedation scales in ICU

Answer 5

Richmond agitation sedation scale (RASS) or Riker sedation agitation scale (SAS)

Question 6

5 contraindications for daily sedation vacation

Answer 6

1. Active seizures or ETOH withdrawal
2. Ongoing agitation
3. On paralytic
4. Myocardial ischemia in the past 24 hours
5. Increased ICP

Question 7

Preferred delirium screening tools in ICU

Answer 7

Confusion assessment method for ICU (CAM-ICU) and Intensive care delirium screening checklist (ICDSC)

Question 8

Evidence that haliperidol reduces delirium

Answer 8

None

Question 9

Monitoring parameters for high quality CPR

Answer 9

• ETCO2 > 10
• Coronary perfusion pressure > 20
• Diastolic pressure > 20 on arterial catheter reading

Question 10

Drug that can cause myocardial injury if given < 2 minutes after defibrillation in cardiac arrest

Answer 10

Epinephrine

Question 11

Cooling rate with chilled normal saline

Answer 11

1L of 4 degree NS decreases temp by 1 degree C in 15 minutes

Question 12

9 adverse effects of therapeutic hypothermia

Answer 12

1. Shivering
2. Coagulopathy
3. Impaired leukocyte function
4. Slowed cardiac conduction (bradycardia, QT prolonged)
5. Insuline resistance
6. Cold diuresis (fluid and electrolyte abnormalities)
7. Temperature of ABG must be corrected
8. Increased lactate
9. Slowed drug clearance

Question 13

Platelet transfusion threshold

Answer 13

< 10K regardless of bleeding

<20K if not bleeding but has high risk

<50K if actively bleeding or invasive procedure planned

Question 14

Things that can falsely elevate glucose in finger stick tests

Answer 14

Anemia, hypotension, pressors

Question 15

Which is superior, CRRT or hemodialysis?

Answer 15

Neither, they are equal.

Question 16

3 risk factors requiring GI prophylaxis

Answer 16

Coagulopathy, on vent > 48 hours, and hypotension

Question 17

Nutritional risk assessment tools in ICU

Answer 17

NRS-2002 or NUTRIC

Question 18

Timing to start parenteral nutrion

Answer 18

after 7 days unless high risk

Question 19

Drugs of choice for seizures

Answer 19

Lorazepam for IV

Midazolam for IM

Rectal diazepam if unable to give IV or IM