A 62-year-old man with community-acquired pneumonia has BP 78/42 mmHg, HR 118, lactate 5.2 mmol/L, and cool extremities. Per the Surviving Sepsis Campaign 2021 1-hour bundle, which intervention is required?
Sepsis
Question · Easy
A patient with septic shock remains hypotensive (MAP 58 mmHg) on norepinephrine 0.4 mcg/kg/min after adequate fluid resuscitation. Per SSC 2021, the next most appropriate step is to add:
Question · Medium
Chapter 1: Exam Orientation: Format, Blueprint & Study Strategy
1.1 ABIM Critical Care Medicine Exam: Format, Blueprint & Study Strategy
Study guide
A patient with septic shock on norepinephrine 0.5 mcg/kg/min and vasopressin 0.03 U/min remains vasopressor-dependent for 6 hours. Per SSC 2021, which therapy should be added?
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In a septic shock patient who has received 60 mL/kg of balanced crystalloid and remains hypotensive with rising vasopressor requirements, SSC 2021 suggests:
A 55-year-old with pneumonia has PaO2 70 mmHg on FiO2 0.8, PEEP 10, bilateral infiltrates, and no evidence of cardiogenic edema on echo. By the Berlin definition, ARDS severity is:
Pulmonary
Question · Hard
Per the ARDSnet lung-protective ventilation strategy, initial tidal volume should be set at which target?
Chapter 2: Acute Respiratory Failure & ARDS
2.1 ARDS Definition, Pathophysiology & Phenotypes
A patient with severe ARDS (PF 85) remains hypoxemic on 6 mL/kg IBW tidal volume, PEEP 14, FiO2 1.0. Per PROSEVA, which intervention has been shown to reduce mortality?
In severe ARDS (PF <120) with persistent ventilator dyssynchrony, the ACURASYS trial and subsequent analyses support a 48-hour infusion of which agent?
Per EOLIA (and subsequent Bayesian re-analysis), VV-ECMO should be considered in severe ARDS when which criteria are met?
A patient with acute hypoxemic respiratory failure (non-hypercapnic) has PF 180 on simple face mask. FLORALI (NEJM 2015) supports which initial respiratory support strategy?
2.2 Lung-Protective Mechanical Ventilation
Which ventilator mode delivers a preset tidal volume with patient-triggered or machine-triggered breaths, and provides full support with volume targeting on each breath?
Airway pressure release ventilation (APRV) is characterized by:
A patient with severe asthma is intubated and mechanically ventilated. Which strategy best prevents dynamic hyperinflation and barotrauma?
A 70-year-old with COPD exacerbation has pH 7.28, PaCO2 65, and accessory muscle use. What is the first-line respiratory support?
2.3 Refractory ARDS: Prone Positioning, Neuromuscular Blockade & VV-ECMO
Which ventilator mode varies support in proportion to the patient's own diaphragmatic electrical activity using an esophageal catheter?
A patient ventilated for ARDS passes an SBT with an RSBI of 65. Which finding argues MOST strongly AGAINST extubation?
Per the TRACMAN trial, elective tracheostomy within 4 days of intubation (compared with tracheostomy after 10 days) showed:
Which rapid shallow breathing index (RSBI) value is most predictive of successful extubation?
Chapter 3: Obstructive Airways, Pulmonary Vascular & Pleural Emergencies
3.1 Severe Asthma & COPD Exacerbations in the ICU
In a patient with submassive pulmonary embolism (PE) with RV dysfunction but normal blood pressure, which intervention does current guidance favor?
A patient with ARDS and refractory hypoxemia is placed on VV-ECMO. Which cannulation configuration is typical?
Harlequin (north-south) syndrome occurs in peripheral VA-ECMO because:
Cardiovascular
A 68-year-old post-ROSC after VF cardiac arrest remains comatose. Per current AHA post-arrest guidance (following TTM2 2021), targeted temperature management should:
3.2 Massive & Submassive Pulmonary Embolism
Multimodal neuroprognostication after cardiac arrest is most reliable when performed at which time point, assuming no confounders?
Which hemodynamic pattern is most consistent with cardiogenic shock?
A mixed venous oxygen saturation (SvO2) of 55% most likely indicates:
A ScvO2 (central venous oxygen saturation) drawn from the SVC approximates SvO2 but typically runs:
3.3 Pulmonary Hypertension & Right Ventricular Failure in the ICU
A patient has AKI with serum creatinine rising from 0.9 to 2.2 mg/dL over 48 hours and urine output 0.4 mL/kg/hr for 10 hours. KDIGO stage is:
Renal
Per AKIKI and STARRT-AKI, in AKI without an emergent indication (life-threatening hyperkalemia, pulmonary edema refractory to diuretics, severe acidemia, uremic complications), RRT initiation should:
A hemodynamically unstable AKI patient on norepinephrine requires RRT for refractory hyperkalemia. Which modality is preferred?
The principal mechanism of solute clearance in continuous venovenous hemofiltration (CVVH) is:
3.4 Massive Hemoptysis, Complex Pleural Effusions & Thoracic Drainage
A patient in septic shock has serum K 6.7 mEq/L, peaked T-waves, and creatinine 4.2 mg/dL. Which is the FIRST priority?
In the SMART trial, use of balanced crystalloid (Lactated Ringer's, Plasma-Lyte) vs normal saline for ICU resuscitation was associated with:
A 45-year-old with severe TBI has an ICP of 28 mmHg despite HOB 30°, sedation, and normocarbia. Which is the next appropriate step?
Neurocritical
Cerebral perfusion pressure (CPP) should be maintained at what target in severe TBI per Brain Trauma Foundation 2016 guidelines?
Chapter 4: Airway, Parenchymal & Nonthrombotic Pulmonary Emergencies
4.1 Airway Management, Upper-Airway Obstruction & Artificial-Airway Complications
A patient with aneurysmal subarachnoid hemorrhage has a secured aneurysm on day 2. Which medication is routinely given to reduce delayed cerebral ischemia (DCI)?
An ICU patient with altered mental status has a continuous EEG showing repetitive sharp waves at 2 Hz without clinical seizures. This pattern is most consistent with:
Brain death determination requires apnea testing. Which PaCO2 criterion must be met to support apnea?
A patient with ischemic stroke and large-vessel occlusion presents 4 hours after symptom onset with NIHSS 18. Which intervention offers the greatest mortality and functional benefit?
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