Critical Care & Pain Medicine Flashcards

A patient presents with severe acute pancreatitis and respiratory failure requiring intubation. What is the MOST common cause of early mortality in severe acute pancreatitis?

Answer: Multi-organ dysfunction syndrome (MODS)

Early mortality in severe acute pancreatitis is primarily due to systemic inflammatory response syndrome leading to multi-organ dysfunction syndrome within the first two weeks.

Which interventional pain procedure carries the HIGHEST risk of pneumothorax?

Answer: Stellate ganglion block

Stellate ganglion block carries the highest pneumothorax risk among listed procedures due to its proximity to the apex of the lung and the subclavian vessels.

In patients with traumatic brain injury (TBI) requiring ICU care, what is the target ICP threshold above which treatment is recommended per Brain Trauma Foundation guidelines?

Answer: >20 mmHg

Brain Trauma Foundation guidelines recommend treating ICP when it exceeds 20 mmHg to prevent cerebral herniation and secondary brain injury.

A 55-year-old patient with terminal cancer has uncontrolled pain despite escalating opioids, with intolerable side effects. Which intervention is MOST appropriate?

Answer: Consider intrathecal drug delivery system (implantable pump)

Intrathecal drug delivery via implantable pumps delivers opioids directly to CSF, achieving superior analgesia at dramatically lower doses with fewer systemic side effects in refractory cancer pain.

Which acid-base disorder is MOST commonly seen in early sepsis before fluid resuscitation?

Answer: Respiratory alkalosis with elevated lactate

Early sepsis characteristically presents with respiratory alkalosis (compensatory hyperventilation) combined with lactic acidosis from tissue hypoperfusion.

When performing a celiac plexus neurolytic block for pancreatic cancer pain, which landmark technique uses a posterior approach with the needle tip anterior to the aorta at the T12-L1 level?

Answer: Anterocrural approach

The anterocrural (transaortic) approach places the needle anterior to the aorta at T12-L1, delivering neurolytic solution directly to the celiac plexus with confirmed efficacy.

A mechanically ventilated patient suddenly develops hypotension, elevated peak airway pressures, and decreased breath sounds on the left. The MOST likely diagnosis and immediate action are:

Answer: Left-sided tension pneumothorax; immediate needle decompression at 2nd intercostal space mid-clavicular line

Tension pneumothorax presents with hypotension, elevated airway pressures, tracheal deviation, and absent breath sounds; immediate needle decompression is life-saving.