EDAIC Intensive Care Medicine 4 — Questions and Answers
Question 1: Neuromuscular blockade in ARDS is recommended within the first 48 hours when:
- P/F ratio <200 mmHg with FiO2 >0.6 (Correct answer)
- Driving pressure >15 cmH2O despite optimization
- P/F ratio <150 mmHg persisting after prone positioning
- Patient is agitated on RASS +2 despite sedation
Correct answer: P/F ratio <200 mmHg with FiO2 >0.6
ACURASYS trial criteria and current practice recommend NMB for moderate-severe ARDS (P/F <150) but it is used selectively; the 2019 ROSE trial showed no benefit in all ARDS, so indications are debated at P/F <150–200.
Question 2: A patient develops fever, rigors, and hypotension 30 minutes after starting a blood transfusion. The immediate action is:
- Slow the transfusion rate and give antipyretics
- Stop the transfusion and send blood samples for cross-match and cultures (Correct answer)
- Give IV hydrocortisone and continue transfusion
- Administer furosemide and continue transfusion
Correct answer: Stop the transfusion and send blood samples for cross-match and cultures
Acute hemolytic transfusion reaction must be excluded immediately by stopping the transfusion, returning the blood product, and sending samples.
Question 3: Which pulmonary artery catheter-derived parameter best reflects left ventricular preload?
- Central venous pressure (CVP)
- Pulmonary artery occlusion pressure (PAOP) (Correct answer)
- Pulmonary artery systolic pressure
- Mixed venous oxygen saturation (SvO2)
Correct answer: Pulmonary artery occlusion pressure (PAOP)
PAOP (wedge pressure) reflects left atrial pressure and thus left ventricular end-diastolic pressure when measured correctly.
Question 4: In hypertensive emergency with acute aortic dissection, the preferred agent to reduce blood pressure is:
- IV labetalol or esmolol (β-blocker first) (Correct answer)
- IV sodium nitroprusside alone
- IV hydralazine
- Oral amlodipine
Correct answer: IV labetalol or esmolol (β-blocker first)
β-blockade must precede any vasodilator in aortic dissection to prevent reflex tachycardia, which increases aortic shear stress.
Question 5: Stress ulcer prophylaxis in ICU patients is most clearly indicated in patients who have:
- Any ICU admission >24 hours
- Mechanical ventilation >48 hours or coagulopathy (Correct answer)
- Serum creatinine >200 µmol/L
- SOFA score ≥4
Correct answer: Mechanical ventilation >48 hours or coagulopathy
Mechanical ventilation >48 hours and coagulopathy are the two strongest independent risk factors identifying patients who benefit from stress ulcer prophylaxis.
Question 6: Which acid-base pattern is most consistent with a patient chronically on loop diuretics presenting to the ICU?
- Metabolic acidosis with high anion gap
- Metabolic alkalosis with low chloride and low potassium (Correct answer)
- Respiratory alkalosis with normal anion gap
- Mixed metabolic acidosis and respiratory alkalosis
Correct answer: Metabolic alkalosis with low chloride and low potassium
Loop diuretics cause chloride and potassium wasting, leading to contraction alkalosis with hypochloremia and hypokalemia.
Question 7: A patient in the ICU has a core temperature of 32°C after cardiac arrest managed with targeted temperature management. When should rewarming begin?
- Immediately after ROSC
- After 12 hours at target temperature
- After 24 hours at target temperature (Correct answer)
- When hemodynamics are fully stable, regardless of time
Correct answer: After 24 hours at target temperature
Current TTM protocols maintain target temperature (32–36°C) for 24 hours before controlled rewarming at ≤0.25–0.5°C/hour.
EDAIC Intensive Care Medicine 4
Neuromuscular blockade in ARDS is recommended within the first 48 hours when: