Two hours after admission to the intensive care unit, a 56-year-old man with necrotizing pancreatitis develops profound hypotension. His blood pressure is 80/50 mm Hg and he is started on vasopressors. A central venous access line is placed. Which of the following is most likely to decrease the risk of complications from this procedure?
APlacement of the central venous line in the femoral vein
BReplacement of the central venous line every 7-10 days
CInitiation of anticoagulation after placement
DPreparation of the skin with chlorhexidine and alcohol
EInitiation of periprocedural systemic antibiotic prophylaxis
A 25-year-old woman comes to the physician because of a 2-week history of episodic bleeding from the nose and gums and one episode of blood in her urine. She was treated with chloramphenicol 1 month ago for Rickettsia rickettsii infection. Her pulse is 130/min, respirations are 22/min, and blood pressure is 105/70 mm Hg. Examination shows mucosal pallor, scattered petechiae, and ecchymoses on the extremities. Laboratory studies show: Hemoglobin 6.3 g/dL Hematocrit 26% Leukocyte count 900/mm3 (30% neutrophils) Platelet count 50,000/mm3 The physician recommends a blood transfusion and informs her of the risks and benefits. Which of the following red blood cell preparations will most significantly reduce the risk of transfusion-related cytomegalovirus infection?
AWarming
BIrradiation
CCentrifugation
DWashing
ELeukoreduction
A 24-year-old woman presents to the ED with symptoms of pelvic inflammatory disease despite being previously treated with azithromycin for chlamydial infection. Based on your clinical understanding about the epidemiology of PID, you decide to obtain a gram stain which shows a gram-negative diplococci. What is the next step in order to confirm the identity of the organism described?
APerform an RT-PCR
BCulture in TCBS agar
CCulture in Thayer-Martin media
DObtain an acid fast stain
ECulture in Bordet-Gengou agar
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