Critical Care Medicine: Common ICU Conditions

Question · easy

A 72-year-old woman with urosepsis is hypotensive (BP 82/50 mm Hg) but has warm, flushed extremities and a wide pulse pressure. Point-of-care assessment suggests a high cardiac output. Which category of shock best fits this presentation?

Distributive shock Hypovolemic shock Cardiogenic shock Obstructive shock

Question · easy

Which of the following is a criterion of the quick SOFA (qSOFA) screening score?

Heart rate >100/min Respiration rate ≥22/min PaO2/FiO2 ratio <300 Platelet count <100,000/μL

Question · medium

A 66-year-old man is admitted with community-acquired pneumonia. Which finding best satisfies the Sepsis-3 definition of sepsis?

A single positive blood culture for coagulase-negative staphylococcus Fever and tachycardia meeting two SIRS criteria A serum lactate level >2 mmol/L without organ dysfunction Suspected infection with an acute SOFA score increase of ≥2 points

Question · medium

A 70-kg man presents to the emergency department with suspected sepsis, BP 78/44 mm Hg, and a serum lactate of 5.2 mmol/L. According to the hour-1 bundle and initial resuscitation guidance, what is the most appropriate initial management?

Start norepinephrine immediately and withhold fluids until central venous access is obtained Administer 25% albumin as the initial resuscitation fluid because it expands intravascular volume more efficiently Blood cultures, serum lactate, broad-spectrum antibiotics within 1 hour, and a 30 mL/kg crystalloid bolus (≈2,100 mL) begun within the first hour Delay antibiotics until culture results identify the causative organism

Question · hard

A 58-year-old man with septic shock remains hypotensive (MAP 58 mm Hg) despite 4 L of crystalloid and escalating-dose norepinephrine. Which is the most appropriate approach to glucocorticoid therapy?

Give high-dose hydrocortisone (>400 mg/day) for 1–2 days to rapidly reverse shock Perform an ACTH stimulation test and give hydrocortisone only if the cortisol response is blunted Add hydrocortisone 200 mg/day because shock is refractory to fluids and vasopressors Start hydrocortisone because glucocorticoids improve outcomes in all patients with sepsis, with or without shock

Critical Care Medicine: Common ICU Conditions — Shock and Sepsis