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Early sepsis management
A 58-year-old woman is admitted with high-risk sepsis (NEWS2 score 9) suspected to be from a urinary source. She has no cardiac or renal failure. Broad-spectrum intravenous antibiotics have been administered. Intravenous fluid resuscitation is commenced. After an initial bolus of 250 ml of Hartmann's solution over 12 minutes, her blood pressure remains 82/50 mmHg, heart rate 128 bpm, and she remains confused. What t is the most appropriate next step regarding fluid management?
Airway mangement in critical care
Which of the following best explains why the "physiologically difficult airway" differs from the "anatomically difficult airway" and why it is particularly relevant in the ICU?
Legionnaires' Disease
A 58-year-old man presents to the emergency department with a 5-day history of fever, productive cough, and progressive dyspnoea. He has a 30 pack-year smoking history and takes methotrexate for rheumatoid arthritis. On examination, his temperature is 39.2°C, respiratory rate 28/min, and oxygen saturation 88% on room air. Chest radiograph shows right lower lobe consolidation. Initial blood tests reveal sodium 128 mmol/L, phosphate 0.5 mmol/L, and CRP 320 mg/L. Which organism is MOST likely responsible for this presentation?
Necrotizing fasciitis
The skin overlying necrotising fasciitis may appear normal in the early stages of the disease, despite extensive underlying tissue destruction. Which of the following best explains this phenomenon?
Fungal infection in ICU
A 70-year-old woman with chronic obstructive pulmonary disease is intubated and ventilated in the ICU. Tracheal aspirate cultures grow Candida species. She is haemodynamically stable, apyrexial, and her inflammatory markers are not rising. Which of the following best describes the appropriate management in this scenario?
Acute on chronic liver failure in ICU
A 60-year-old man with ACLF grade 3 (4 organ failures) has been receiving maximum intensive care support for 5 days. He is not a candidate for liver transplantation due to active alcohol use and poor social support. His CLIF-C ACLF score is 72 points.
Based on current evidence, which of the following management approaches should be considered next?
Non-invasive ventilation in COPD
When initiating NIV for acute exacerbation of COPD in a patient without suspected OSA, what are appropriate starting pressures?