Critical Care Practice Questions

Q: A 22 year old male patient sustained a burn and presented to the emergency department, on examination nasal hair were singed, on blood investigation Carboxy Hb was raised to 18.5%, and oxygen saturation was 81%, what is the next best step?

Intubation. ***Intubation*** - The patient presents with **singed nasal hair**, which is a significant clinical indicator of **upper airway inhalation injury**, necessitating early airway protection. - A **Carboxyhemoglobin (COHb) level >10-15%** associated with inhalation injury, combined with clinical signs of airway compromise, mandates **prophylactic endotracheal intubation** to prevent airway obstruction due to evolving edema. *100% O2 with NVA* - While **100% oxygen** is the definitive treatment for **carbon monoxide poisoning** to shorten the half-life of COHb, it does not secure the airway in a patient with impending respiratory obstruction from inhalation injury. - This intervention is insufficient as the primary management step when there is an immediate threat to airway patency evidenced by **singed nasal hair** and associated burn stigmata. *Fluid resuscitation according to parkland formula* - Although aggressive **fluid resuscitation** is vital for burn management to prevent hypovolemic shock, it is secondary to **Airway (A)** management in the A-B-C priority framework. - Ensuring a patent airway takes precedence over initiating the **Parkland formula**, even though fluid resuscitation will be required shortly thereafter. *Tracheostomy* - A **tracheostomy** is an invasive surgical procedure typically reserved for cases where **endotracheal intubation** fails or is impossible due to severe upper airway anatomy distortion. - It is not the first-line intervention for immediate airway management in a patient presenting to the emergency department; **orotracheal intubation** is the standard for rapid airway control.

Q: What is the suspected acid-base disorder based on the ABG analysis? pH 7.45 PaCO2 28 mmHg HCO3 20mEq/L

Compensated respiratory alkalosis. ***Compensated respiratory alkalosis*** - The arterial blood gas (ABG) shows a pH at the high end of normal (7.45), representing **respiratory alkalosis** due to the low **PaCO2** (28 mmHg). - The decreased **HCO3** (20 mEq/L) indicates renal **metabolic compensation**, which has brought the pH back toward a normal range. *Compensated Respiratory acidosis* - Respiratory acidosis would present with a primary increase in **PaCO2** (>45 mmHg). - Compensation for respiratory acidosis involves an increase in **HCO3** (bicarbonate retention), which is the opposite of the finding in this patient. *Uncompensated respiratory acidosis* - This would demonstrate an **acidemic** pH ( 7.45) rather than the normal range seen here. - The **HCO3** would be within the normal reference range, signifying a lack of renal **metabolic compensation**.

Q: Which of the following is the best parameter for monitoring septic shock?

Serum lactate. ### Explanation The correct answer is **Serum lactate**. **1. Why Serum Lactate is the Best Parameter:** Septic shock is defined by cellular dysoxygenation and metabolic abnormalities [1]. Serum lactate serves as a surrogate marker for **tissue perfusion and anaerobic metabolism**. In shock, inadequate oxygen delivery to tissues leads to anaerobic glycolysis, resulting in elevated lactate levels. * **Lactate Clearance:** Monitoring the trend of lactate (lactate clearance) is a superior prognostic indicator compared to a single value. A decrease in lactate levels indicates successful resuscitation and improved microcirculation, making it the gold standard for monitoring the adequacy of treatment in septic shock. **2. Why Other Options are Incorrect:** * **Central Venous Pressure (CVP):** Formerly part of "Early Goal-Directed Therapy," CVP is a measure of right atrial pressure [1]. It is a poor predictor of fluid responsiveness and does not reflect tissue-level oxygenation. * **Vasopressor Requirement:** While it indicates the severity of vasomotor tone loss, it does not directly measure whether tissues are being adequately oxygenated. * **Urine Output:** Although a vital sign of end-organ perfusion, it can be influenced by pre-existing renal disease, diuretics, or stress-induced hormonal changes, making it less sensitive than lactate for real-time metabolic monitoring [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Sepsis-3 Definition:** Septic shock is clinically identified by the requirement of vasopressors to maintain a **MAP ≥ 65 mmHg** AND a **serum lactate level > 2 mmol/L** despite adequate fluid resuscitation [1]. * **qSOFA Score:** Includes Respiratory rate ≥ 22/min, Altered mentation (GCS < 15), and Systolic BP ≤ 100 mmHg. * **Target:** The Surviving Sepsis Campaign recommends "guiding resuscitation to normalize lactate" in patients with elevated levels.

Question 1

A 22 year old male patient sustained a burn and presented to the emergency department, on examination nasal hair were singed, on blood investigation Carboxy Hb was raised to 18.5%, and oxygen saturation was 81%, what is the next best step?

Accepted Answer

Intubation

Answer

100% O2 with NVA

Answer

Fluid resuscitation according to parkland formula

Answer

Tracheostomy

Question 2

What is the suspected acid-base disorder based on the ABG analysis? pH 7.45 PaCO2 28 mmHg HCO3 20mEq/L

Accepted Answer

Compensated respiratory alkalosis

Answer

Compensated Respiratory acidosis

Answer

Uncompensated respiratory acidosis

Answer

Uncompensated Respiratory alkalosis

Question 3

A 42-year-old man undergoes therapeutic hypothermia (target temperature 33°C/91.4°F) following cardiac arrest with return of spontaneous circulation. During the cooling phase, he develops shivering, which increases oxygen consumption and interferes with target temperature achievement. He is already on sedation and neuromuscular blockade is being considered. Evaluate the most appropriate management strategy considering both efficacy and safety.

Accepted Answer

Increase sedation and add surface counter-warming of extremities before neuromuscular blockade

Answer

Administer meperidine alone to reduce shivering threshold

Answer

Abandon therapeutic hypothermia due to complications

Answer

Use only mechanical restraints to prevent movement

Answer

Immediate neuromuscular blockade without additional measures

Question 4

Which of the following is the best parameter for monitoring septic shock?

Accepted Answer

Serum lactate

Answer

Central venous pressure (CVP)

Answer

Vasopressor requirement

Answer

Urine output

Question 5

A 56-year-old man admitted to the ICU in respiratory distress is placed on mechanical ventilation with a tidal volume of 900 mL, a rate of 12 breaths/min, and FiO2 50%. PEEP is 10 cm of water. Medications include subcutaneous heparin and aspirin. He now develops tachycardia and a blood pressure of 70/palpation mm Hg. Cardiac examination reveals multiple premature contractions. His arterial blood gas reveals a PO2 of 40 mm Hg. What is the most likely cause of this condition?

Accepted Answer

Pneumothorax

Answer

Cardiac arrhythmia

Answer

Bronchial secretions

Answer

Myocardial infarction

Critical Care — MCQs

Critical Care — MCQs

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