Critical Care/General Management 1

1. An obese 55 year-old female with end-stage renal disease undergoes percutaneous placement of a large bore dialysis catheter. Due to numerous other attempts at dialysis catheter placement, the only available point of access was her left subclavian. Just before the dialysis nurse arrives to initiate hemodialysis, she is noted to be hypotensive. On exam, she has very prominent neck veins and her heart sounds are muffled. Of the following, what is the most appropriate next step?

2. Which of these vasopressors has predominantly alpha activity?

3. Which of these conditions would cause pulmonary capillary wedge pressure (PCWP) to underestimate the left ventricular end diastolic pressure (LVEDP)?

4. Which organism is most commonly isolated in patients with DSWI?

5. What hemodynamic changes are seen in a patient with cardiac tamponade?

6. Which of these does NOT result in low SvO2?

7. In what percent of cardiac surgery patients does HIT occur?

8. A patient is placed on venovenous ECMO but is unable to receive anticoagulation. Which of the following the patient most at risk for?

9. Which of the following represents a proper indication for venovenous (VV) ECMO for a patient with acute respiratory distress syndrome (ARDS)?

10. In ARDS the following findings are present EXCEPT:

11. The most appropriate statement regarding the benefit of “Lung rest” as a ventilation strategy in ECMO:

12. Which of the following is not a consideration in ECMO cannulation strategy?

13. Which of the following is NOT a physiologic benefit of prone positioning:

14. The principle of lung protective ventilation is:

15. Which of the following represents a likely contraindication to ECMO?

16. Blood flow in pumpless extracorporeal lung assist (PECLA) is driven by:

17. Advanced maneuvers for the management of refractory ARDS include all of the following EXCEPT:

18. 45-year-old female is 14 hours s/p mechanical AVR. The operation was uncomplicated and early postoperative course uneventful. During the 14th hour she started to complain of feeling nauseous and diaphoretic at times. Her SBP had been ranging from 110-120 but now was 70-80/50’s with a HR in the 120’s. CO is noted to be 3L/min by fick method. What is the next best step in management?

19. All of the following are a symptom of low cardiac output EXCEPT:

20. The direct Fick method determines cardiac output as a measure of:

21. Factors that determine cardiac output are all of the listed below, EXCEPT:

22. The most appropriate statement regarding the ECMO circuit include: