A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and
complains of a headache and nausea. He reports he ran out of blood
pressure meds three days ago, but also appears to be confused to the date
...
A 56 yr-old male is admitted to the ICU with a blood pressure of 225/135 and
complains of a headache and nausea. He reports he ran out of blood
pressure meds three days ago, but also appears to be confused to the date
and situation. What is the most appropriate treatment approach? -Correct
Answer= Rapidly lower the diastolic pressure to 100 with IV antihypertensive
meds, then continue to gradually reduce the diastolic pressure to 85 with
oral antihypertensive meds.
The maximum initial decrease should be no more than 25% reduction from
initial presenting value. Reducing the blood pressure too quickly can lead to
cerebral edema or renal failure.
A patient has sepsis, receives Lactated ringers 500ml IV bolus. Which finding
indicate that this intervention is having it's intended effect? -Correct
Answer= ScvO2 of 72%
Early goal directed therapy for sepsis includes early fluid resuscitation at 30
ml/kg to maintain a CVP of 8-12 or 12-15 if mechanically ventilated, MAP
greater than 65, ScvO2 greater than 70%, and urine output greater than 0.5
kg/hr
72 male patient in ICU for 6 days on the ventilator for treatment of a COPD
exacerbation. He has been receiving VTE prophylaxis and subcutaneous
Heparin since admission. Today his platelet count decreased significantly to
43,000 and was found to have new DVT on his right upper extremity. What
do you suspect is the most likely cause of these findings? -Correct Answer=
HIT
The hallmark sign of HIT is a significant decrease in platelet count over a 24
hours period (>50%) within 5-10 days of administering Heparin. The other
hallmark sign is a new development of DVT despite being on VTE
prophylaxis.
TRALI: -Correct Answer= is a complication from a blood transfusion reaction,
which causes acute lung injury typically within 6 hours of a blood transfusion.
2 Hallmark signs of HIT: -Correct Answer= Decrease in platelet count over a
24 hr period.
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