Critical Care Medicine: Specific Critical Care Topics

Question · easy

A 34-year-old woman develops urticaria, tongue swelling, and a blood pressure of 78/50 mm Hg five minutes after receiving an antibiotic infusion. Which is the most appropriate FIRST treatment?

Intravenous methylprednisolone Intravenous diphenhydramine Intravenous famotidine Intramuscular epinephrine

Question · medium

A patient is found confused in a home heated by a faulty furnace. Pulse oximetry reads 99% on ambient air. Which statement about diagnosis and management is correct?

Carboxyhemoglobin half-life is approximately 30 minutes on ambient air The normal pulse oximetry reading effectively excludes carbon monoxide poisoning Hyperbaric oxygen is indicated for any detectable carboxyhemoglobin level Blood gas with CO-oximetry is required because pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin

Question · medium

Ten minutes into general anesthesia, a patient develops masseter muscle rigidity, an unexplained rise in end-tidal CO2, tachycardia, and a rapidly climbing core temperature. After immediately discontinuing the triggering agent and initiating active cooling, which medication should be administered?

Cyproheptadine Bromocriptine Succinylcholine Dantrolene

Question · hard

A fire victim rescued from a house fire with burning vinyl furnishings is comatose with profound lactic acidosis. CO-oximetry shows a carboxyhemoglobin of 30%. Which approach to suspected concomitant cyanide poisoning is most appropriate?

Withhold antidotes until serum cyanide levels return, since lactate is nonspecific Hydroxocobalamin; avoid nitrites because smoke-inhalation victims may already have high carboxyhemoglobin levels Methylene blue to reverse cytochrome oxidase blockade Sodium nitrite followed by sodium thiosulfate

Question · hard

A patient pulled from icy water is in cardiac arrest with a core temperature of 24 °C. CPR is ongoing. Which management decision is best supported?

Declare death if the patient does not respond after 30 minutes of standard ACLS with full-dose epinephrine Proceed with extracorporeal life support rewarming (preferably VA-ECMO), guided by the HOPE score when available, and continue CPR until rewarmed Rewarm passively with blankets alone before attempting any advanced resuscitation Administer IV amiodarone and defibrillate aggressively, since medications work normally in deep hypothermia