Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Question and Answer Session 1

Question and Answer Session 1

Pdf Summary

The document contains various clinical scenarios and questions related to critical care medicine. Here is a brief summary of each scenario:<br /><br />1. An adult patient presents to the ICU after surgery. The appropriate antimicrobial regimen should be de-escalated based on culture results and clinical progress. Guidelines recommend a 4-7 day course of therapy.<br /><br />2. Stress ulcer prophylaxis in a patient with septic shock is associated with increased risks of nosocomial pneumonia and Clostridium difficile diarrhea. The use of proton pump inhibitors (PPIs) is more common but there is no evidence for its superiority over histamine-2 receptor antagonists (H2RAs).<br /><br />3. A patient with confusion and headache after a motor vehicle accident is most likely experiencing herpes simplex virus type 1 (HSV-1) encephalitis. Acyclovir is the recommended early treatment.<br /><br />4. In a patient with flail chest and respiratory failure, early rib fracture fixation is the most helpful course of action.<br /><br />5. A patient with delayed-onset peritonitis after a motor vehicle accident likely has a pancreatic injury, specifically due to a Chance fracture or seatbelt fracture.<br /><br />6. A positive focused assessment with sonography in trauma (FAST) examination in a hypotensive trauma patient indicates the need for an emergent exploratory laparotomy to control ongoing hemorrhage.<br /><br />7. Thromboelastography (TEG) measures whole blood coagulation. A TEG tracing with an elevated percentage of clot that has dissipated at 30 minutes (LY30) is most consistent with hyperfibrinolysis.<br /><br />8. A patient with acute alcoholic hepatitis presents with tenderness in the right upper quadrant, an enlarged liver, ascites, obtundation, and elevated transaminases.<br /><br />9. Portopulmonary hypertension in a patient with end-stage liver disease increases perioperative mortality in liver transplantation. Optimizing patients by reducing pulmonary pressures and vascular resistance may improve outcomes.<br /><br />Each scenario includes a rationale and references for further reading.

Keywords

ICU patient

antimicrobial regimen

de-escalation

septic shock

stress ulcer prophylaxis

herpes simplex virus type 1 encephalitis

rib fracture fixation

peritonitis

focused assessment with sonography in trauma

thromboelastography

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