Clinical Knowledge and Skills Flashcards

A patient with septic shock remains hypotensive after 30 mL/kg IV crystalloid. MAP is 58 mmHg. What is the first-line vasopressor?

Answer: Norepinephrine

Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its potent alpha-adrenergic effect with less tachycardia than dopamine.

Which ventilator setting change is most appropriate when a patient on volume-controlled ventilation develops a sudden increase in peak airway pressure with unchanged plateau pressure?

Answer: Suction the endotracheal tube for secretions

An isolated rise in peak pressure with stable plateau pressure indicates increased airway resistance, most commonly from secretions or bronchospasm, not reduced lung compliance.

A critically ill patient has serum sodium of 118 mEq/L and is having seizures. What is the immediate treatment?

Answer: Administer 3% hypertonic saline IV

Symptomatic severe hyponatremia with seizures requires immediate 3% hypertonic saline to raise sodium by 1-2 mEq/L/hr until symptoms resolve.

Which parameter best reflects oxygen delivery adequacy at the tissue level in hemodynamically unstable patients?

Answer: Mixed venous oxygen saturation (SvO2)

SvO2 reflects the balance between oxygen delivery and consumption; values below 65% indicate inadequate oxygen delivery relative to tissue demand.

A patient on heparin infusion develops a platelet count drop from 280,000 to 80,000 over 5 days with new thrombosis. What is the most appropriate action?

Answer: Discontinue heparin and start a direct thrombin inhibitor

This presentation is classic for heparin-induced thrombocytopenia (HIT) with thrombosis; all heparin products must be stopped and a non-heparin anticoagulant initiated.

Which clinical finding distinguishes neurogenic pulmonary edema from cardiogenic pulmonary edema in a trauma patient?

Answer: Normal or hyperdynamic cardiac function with elevated ICP history

Neurogenic pulmonary edema occurs after central nervous system injury with intact or hyperdynamic cardiac function, distinguishing it from cardiogenic causes.

A patient with acute liver failure develops asterixis, confusion, and EEG slowing. Which intervention directly targets the underlying mechanism of hepatic encephalopathy?

Answer: Lactulose administration to reduce ammonia absorption

Lactulose acidifies colonic contents and traps ammonia as ammonium, reducing its absorption and lowering serum ammonia levels in hepatic encephalopathy.