Emergency Response & Critical Care Flashcards

In Guillain-Barré syndrome, which finding most strongly supports elective intubation?

Answer: Forced vital capacity below 20 mL/kg

The 20/30/40 rule (FVC <20 mL/kg, MIP weaker than −30, MEP <40 cmH2O) predicts the need for intubation.

A patient in myasthenic crisis needs antibiotics for pneumonia. Which agent should be avoided?

Answer: Levofloxacin

Fluoroquinolones carry an FDA boxed warning because they can worsen myasthenia gravis, as can aminoglycosides.

What apnea test result is consistent with brain death in adults?

Answer: No respiratory effort with PaCO2 ≥60 mmHg or ≥20 mmHg above baseline

The test is positive when there are no breathing efforts despite PaCO2 of at least 60 mmHg or a rise of at least 20 mmHg above baseline.

Which feature best distinguishes serotonin syndrome from neuroleptic malignant syndrome?

Answer: Hyperreflexia and inducible clonus with rapid onset

Serotonin syndrome starts within hours with clonus and hyperreflexia, while NMS develops over days with bradyreflexic lead-pipe rigidity.

A malnourished patient with alcohol use disorder arrives confused with ophthalmoplegia and ataxia. What is the most appropriate treatment?

Answer: High-dose IV thiamine (e.g., 500 mg TID) before or with glucose

Suspected Wernicke encephalopathy needs high-dose parenteral thiamine, and glucose alone can make it worse.

A patient with metastatic prostate cancer has new back pain, leg weakness, and urinary retention. What is the best immediate management?

Answer: IV dexamethasone and urgent MRI of the whole spine

Suspected malignant cord compression needs immediate corticosteroids and whole-spine MRI, since multilevel disease is common.

After cardiac arrest treated with targeted temperature management, when is multimodal neurologic prognostication generally recommended?

Answer: At least 72 hours after return of normothermia

Guidelines advise waiting at least 72 hours after normothermia to avoid confounding from sedation and hypothermia.