2025 Multiprofessional Critical Care Review: Adult Online-Board Questions

Video Transcription

Video Summary

In this educational session led by experts from Sloan Kettering Cancer Center and Mayo Clinic, a series of board review questions focused on critical care topics such as endocrine emergencies, obstetrics, acid-base and electrolyte disorders were discussed. Key highlights include:<br /><br />- Pheochromocytoma management starts with short-acting alpha blockers (e.g., doxazosin) before surgery, avoiding beta blockers initially to prevent crisis. Phenoxybenzamine is used intraoperatively.<br />- For glycemic control in critically ill patients (e.g., traumatic brain injury), moderate tight control targeting blood glucose 140-180 mg/dL is advised, balancing risk of hypoglycemia and mortality.<br />- Preeclampsia’s hallmark is increased systemic vascular resistance, leading to risks such as pulmonary edema; blood pressure management focuses on agents like labetalol and hydralazine.<br />- In pregnant patients with thrombocytopenia and renal failure (e.g., HUS), induction of labor is preferred over cesarean due to coagulopathy. Plasmapheresis is reserved if refractory.<br />- Placental abruption, identified by retroplacental hypoechoic areas on ultrasound, is a life-threatening obstetric emergency.<br />- Rapid control of severe Cushing syndrome can be achieved with IV etomidate to lower cortisol levels, unlike slower agents such as ketoconazole or mitotane.<br />- NSAID toxicity can cause type 1 (distal) renal tubular acidosis with polyuria and metabolic acidosis due to tubular dysfunction.<br />- In continuous renal replacement therapy (CRRT), vancomycin dosing is most affected by volume of distribution rather than blood flow or filter properties, complicating dosing and necessitating individualized monitoring.<br /><br />These cases reinforce current critical care principles in managing complex endocrine, obstetric, and nephrology emergencies.

Keywords

Pheochromocytoma management

Glycemic control in critical illness

Preeclampsia and blood pressure management

Pregnancy with thrombocytopenia and renal failure

Placental abruption diagnosis

Severe Cushing syndrome treatment

NSAID-induced renal tubular acidosis

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