#january2020mccqe1
A 67-year-old man is evaluated in the surgical intensive care unit. He underwent laparotomy and diverting colostomy for a ruptured diverticulum 72 hours ago, and now has a temperature of 40.0°C (104.0°F) and a heart rate of 135/min. In the past 3 hours his mean arterial blood pressure has dropped to 58 mm Hg despite three 1-L boluses of normal saline; urine output was only 15 mL in the past hour. The patient's oxygen saturation is 85% on 100% oxygen by non-rebreather mask. Platelet count is 42,000/μL (42 × 109/L) and random glucose is 148 mg/dL (8.2 mmol/L).
A portable chest radiograph shows bilateral alveolar infiltrates. A central venous catheter is placed; invasive mechanical ventilation and broad-spectrum antibiotic therapy are begun.
Which of the following is most likely to improve survival of this patient?
(A) Activated protein C
(B) Colloid fluid infusion
(C) Insulin drip
(D) Low-dose dopamine
A 67-year-old man is evaluated in the surgical intensive care unit. He underwent laparotomy and diverting colostomy for a ruptured diverticulum 72 hours ago, and now has a temperature of 40.0°C (104.0°F) and a heart rate of 135/min. In the past 3 hours his mean arterial blood pressure has dropped to 58 mm Hg despite three 1-L boluses of normal saline; urine output was only 15 mL in the past hour. The patient's oxygen saturation is 85% on 100% oxygen by non-rebreather mask. Platelet count is 42,000/μL (42 × 109/L) and random glucose is 148 mg/dL (8.2 mmol/L).
A portable chest radiograph shows bilateral alveolar infiltrates. A central venous catheter is placed; invasive mechanical ventilation and broad-spectrum antibiotic therapy are begun.
Which of the following is most likely to improve survival of this patient?
(A) Activated protein C
(B) Colloid fluid infusion
(C) Insulin drip
(D) Low-dose dopamine
Last edited by a moderator: