Chapter 6: Surgical Critical Care Flashcards
A 69-year-old woman with diabetes and peripheral vascular disease presents to the emergency department with sepsis from a necrotizing soft tissue infection. Her blood sugar is 350 mg/dL. Hyperglycemia has been shown to do which of the following?
Increase infectious complications
A 72-year-old woman has acute respiratory failure as a result of a head injury. Which intervention will help prevent ventilator-associate pneumonia?
Keeping the head of the bed elevated
A 65-year-old man is in SICU after undergoing appendectomy and abdominal lavage because of a ruptured appendicitis with diffuse peritonitis. He is noted to have hyperthyroidism. Postoperatively, he develops fever and tachycardia. The diagnosis of thyroid storm in the SICU includes the following features:
Nearly nondetectable TSH levels, elevated T3, T4 and glucose levels.
A 52-year-old woman in the surgical care unit following a motor vehicle crash develops acute kidney injury with ruptured spleen and hemorrhagic shock. Which of the following findings is an urgent indication for renal replacement therapy.
Hyperkalemia
A 24-year-old woman develops acute liver failure secondary to acetaminophen overdose. The most common cause of death in this situation is:
Cerebral edema
A 45-year-old man presents with acute onset of dyspnea and chest pain. Pulmonary embolism is confirmed by CT angiogram. He has a history of heparin-induced thrombocytopenia. The most appropriate initial management includes administration of ?
Argratroban
i. Direct thrombin inhibitor
ii. Prophylaxis for DVT in pts with HIT cc
A 71-year-old patient with a history of alcohol abuse develops the acute onset of confusion and agitation two days after undergoing a femoral-to-popliteal bypass. His heart rate is 120 bpm and blood pressure 150/80mm Hg. His laboratory tests and computed tomography of the head are normal. The most appropriate next step in his management is administration of:
Diazepam
A 70 year old woman is brought into the ICU with respiratory failure after undergoing a sigmoid resection perforate diverticulitis. Which ventilator mode would assume the most work of breathing?
Assist control ventilation
A 56-year-old man develops acute respiratory failure after a bowel resection for ischemic bowel. With an FiO2 of 50% positive and expiratory pressure (PEEP) 5 cm H2-, his PaO2 is 52 torr. Which of the following would be most likely to improve oxygenation?
Increase PEEP**
A 45-year-old man with a history of inflammatory bowel disease requiring steroids as been admitted to the ICU following a high-speed motorcycle accident. On his fifth post-operative day following a splenectomy and internal fixation of bilateral femur fractures, he develops hypotension (85/40 mm Hg), which is refractory to 3000 mL intravenous saline bolus and dopamine infusion. He is afebrile. Oxygenation saturation on room air is 96%. Lab studies are notable for Hct of 38%, WBC 8, Na 129 mEq/L and K+ 5.2 mEq/L. Chest computed tomography is normal. The next appropriate therapeutic action would be?
Administer hydrocortisone.**
