EDAIC Intensive Care Medicine 3 — Questions and Answers
Question 1: The Richmond Agitation-Sedation Scale (RASS) target of 0 to -1 in a mechanically ventilated patient means:
- Deep sedation with no response to voice
- Light sedation — alert or briefly awakens to voice (Correct answer)
- Moderate sedation — responds only to physical stimulation
- Combative and violent
Correct answer: Light sedation — alert or briefly awakens to voice
RASS 0 = alert and calm; RASS -1 = drowsy but eye-opening >10s to voice; both indicate light sedation, the current guideline target.
Question 2: Transfusion trigger in a stable, non-bleeding ICU patient without active cardiac ischemia per current evidence is:
- Hemoglobin <10 g/dL
- Hemoglobin <9 g/dL
- Hemoglobin <7 g/dL (Correct answer)
- Hemoglobin <8 g/dL
Correct answer: Hemoglobin <7 g/dL
The TRICC trial and subsequent evidence support a restrictive transfusion threshold of Hb <7 g/dL in stable ICU patients.
Question 3: In diabetic ketoacidosis management, insulin infusion should begin only after:
- Blood glucose is <14 mmol/L
- Serum potassium is ≥3.5 mmol/L (Correct answer)
- Bicarbonate is >15 mmol/L
- Urine output is established
Correct answer: Serum potassium is ≥3.5 mmol/L
Insulin drives potassium intracellularly; starting insulin with hypokalemia risks life-threatening arrhythmias, so K⁺ must be ≥3.5 mmol/L first.
Question 4: A patient with suspected meningitis in the ICU — what is the correct order of management?
- CT head → lumbar puncture → antibiotics
- Blood cultures → antibiotics → CT head → lumbar puncture (Correct answer)
- Lumbar puncture → antibiotics → CT head
- CT head → antibiotics → lumbar puncture
Correct answer: Blood cultures → antibiotics → CT head → lumbar puncture
Blood cultures and immediate antibiotics take priority over CT or LP to avoid delays that worsen outcome in bacterial meningitis.
Question 5: Permissive hypercapnia in lung-protective ventilation is generally acceptable up to a PaCO2 of:
- 45 mmHg
- 55 mmHg
- 70 mmHg (Correct answer)
- 90 mmHg
Correct answer: 70 mmHg
PaCO2 up to 70 mmHg (pH ≥7.20) is generally tolerated in permissive hypercapnia when low tidal volumes are required for lung protection.
Question 6: Which electrolyte abnormality is most commonly associated with prolonged QT interval and torsades de pointes in ICU patients?
- Hyperkalemia
- Hypomagnesemia (Correct answer)
- Hypernatremia
- Hypercalcemia
Correct answer: Hypomagnesemia
Hypomagnesemia reduces cellular threshold for arrhythmia and prolongs QT; IV magnesium is also the treatment for torsades de pointes.
Question 7: In the management of status epilepticus refractory to two benzodiazepines, the next agent should be:
- Propofol infusion
- IV levetiracetam, valproate, or fosphenytoin (Correct answer)
- Ketamine bolus
- IV labetalol
Correct answer: IV levetiracetam, valproate, or fosphenytoin
After two benzodiazepine doses, established status epilepticus warrants a second-line anti-epileptic (levetiracetam, valproate, or fosphenytoin) before inducing anesthesia.
EDAIC Intensive Care Medicine 3
The Richmond Agitation-Sedation Scale (RASS) target of 0 to -1 in a mechanically ventilated patient means: