Critical Care & Intensive Care Flashcards
7 cards from real BCA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Critical Care & Intensive Care flashcards as text
A patient with ARDS is receiving neuromuscular blockade. According to the ACURASYS trial, what is the primary benefit of 48-hour cisatracurium infusion in early severe ARDS?
Answer: Improved 90-day survival and reduced barotrauma
The ACURASYS trial showed improved 90-day survival and reduced barotrauma with 48-hour cisatracurium in patients with PaO2/FiO2 <150, though ROSE trial later showed no mortality benefit — the 90-day finding remains referenced.
In a patient with acute liver failure, which complication is the leading cause of early death?
Answer: Cerebral edema and intracranial hypertension
Cerebral edema leading to intracranial hypertension is the most common cause of death in acute liver failure, resulting from astrocyte swelling due to ammonia toxicity.
A diabetic patient in the ICU develops blood glucose of 380 mg/dL with an anion gap of 24, positive ketones, and bicarbonate of 12. What is the most important initial intervention?
Answer: Aggressive IV fluid resuscitation with normal saline
Aggressive IV fluid resuscitation is the first priority in DKA to restore intravascular volume and improve renal perfusion; insulin is started after fluids are initiated and potassium is ≥3.5 mEq/L.
Which chest X-ray finding distinguishes cardiogenic pulmonary edema from ARDS?
Answer: Cardiomegaly and Kerley B lines
Cardiomegaly, Kerley B lines, pleural effusions, and vascular redistribution suggest cardiogenic pulmonary edema rather than ARDS, which typically lacks these findings.
A patient develops heparin-induced thrombocytopenia (HIT) while on UFH for DVT prophylaxis. Which anticoagulant should be used?
Answer: Argatroban or bivalirudin
Direct thrombin inhibitors (argatroban, bivalirudin) are the standard treatment for HIT; all heparin products including LMWH must be stopped immediately.
In a patient with massive pulmonary embolism and hemodynamic instability, which is the preferred reperfusion strategy when available?
Answer: Systemic thrombolysis with alteplase
Systemic thrombolysis (alteplase 100 mg IV over 2 hours) is the recommended reperfusion strategy for massive PE with hemodynamic compromise when there is no absolute contraindication.
In severe traumatic rhabdomyolysis, which urine target is recommended to prevent acute tubular necrosis?
Answer: Urine output 1-3 mL/kg/hr with alkalinization
Aggressive IV fluid resuscitation targeting urine output of 1-3 mL/kg/hr, with urine alkalinization to pH >6.5, helps prevent myoglobin precipitation and renal tubular injury.