Critical Care & Pain Medicine Flashcards

A patient in the ICU develops acute respiratory distress syndrome (ARDS). Which ventilator strategy has been shown to reduce mortality?

Answer: Low tidal volume ventilation at 6 mL/kg IBW with plateau pressure <30 cmH2O

The ARDSNet trial demonstrated that lung-protective ventilation with 6 mL/kg IBW and plateau pressure <30 cmH2O significantly reduces mortality in ARDS.

Which opioid is preferred for continuous infusion in critically ill patients with renal failure due to its lack of active metabolite accumulation?

Answer: Fentanyl

Fentanyl is preferred in renal failure because it has no clinically significant active metabolites that accumulate, unlike morphine (morphine-6-glucuronide) or meperidine (normeperidine).

In the management of septic shock, what is the recommended initial fluid resuscitation volume within the first 3 hours according to Surviving Sepsis Campaign guidelines?

Answer: 30 mL/kg IV crystalloid

The Surviving Sepsis Campaign recommends at least 30 mL/kg of intravenous crystalloid within the first 3 hours of sepsis-induced hypoperfusion.

A patient on chronic opioid therapy presents with hyperalgesia (increased sensitivity to pain with lower opioid doses). The BEST initial management strategy is:

Answer: Add an NMDA receptor antagonist and consider opioid rotation

Opioid-induced hyperalgesia is best managed by opioid rotation with dose reduction combined with NMDA antagonists (e.g., ketamine) to address central sensitization.

Which of the following is the MOST reliable indicator of adequate fluid resuscitation in a mechanically ventilated patient with septic shock?

Answer: Pulse pressure variation (PPV) <13% after fluid challenge

Pulse pressure variation <13% during mechanical ventilation reliably predicts fluid responsiveness and indicates adequate preload, whereas CVP is poorly predictive.

A patient with complex regional pain syndrome (CRPS) type I fails to respond to NSAIDs and physical therapy. Which intervention has the STRONGEST evidence as a next step?

Answer: Spinal cord stimulation

Spinal cord stimulation has the strongest level of evidence for refractory CRPS type I, demonstrating significant pain reduction and improved function in randomized controlled trials.

During prone positioning for ARDS, which complication requires immediate return to supine position?

Answer: Endotracheal tube displacement or obstruction

Endotracheal tube displacement or obstruction during prone positioning is a life-threatening emergency requiring immediate return to supine position to secure the airway.