Critical Care Medicine Fluid Resuscitation: Review Questions Dennis R. Pyszczynski, MD Dr. Pyszczynski is an associate professor of medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO. Choose the single best answer for each question.
	Questions 1 and 2 refer to the following case. A 65-year-old man who resides in a skilled nursing facility becomes febrile, tachycardic, dyspneic, and hypotensive 90 minutes after bladder catheterization. His past medical history is notable for Alzheimer’s disease, renal insufficiency, and anemia. His heart rate is 115 bpm, and his blood pressure is 85/55 mm Hg. 1. What is the first step in the management of this patient? Administer 6% hetastarch in a 500 mL 0.9% sodium chloride injection Administer 20 mL of albumin (human) 25% through a large-bore IV line Rapidly administer 500 mL of normal saline through a large-bore intravenous (IV) line Transfuse 1 U of packed red blood cells Click here to compare your answer. 2. The patient becomes more dyspneic. Chest radiography reveals bilateral infiltrates. The patient progresses to respiratory failure and requires intubation. He is placed on mechanical ventilation with a fractional concentration of oxygen in inspired gas (Fio2) of 100% and positive end-expiratory pressure of 8 cm H2O to maintain an oxygen saturation of 90%. He continues to be hypotensive. What is the next step in the management of this patient? Administer an additional 6% hetastarch in a 500 mL 0.9% sodium chloride injection Administer another 500 mL bolus of normal saline Administer another 20 mL of albumin (human) 25% Transfuse an additional unit of packed red blood cells Click here to compare your answer.		3. What are the target hemodynamic parameters to minimize the duration of mechanical ventilation in the presence of acute respiratory distress syndrome? Fluid therapy to maintain a central venous pressure (CVP) of 10 to 14 mm Hg and a pulmonary artery occlusion pressure (PAOP) of 14 to 18 mm Hg Fluid therapy to maintain a CVP of less than 4 mm Hg and a PAOP of less than 8 mm Hg Fluid therapy to maintain a CVP of 8 to 12 mm Hg Fluid therapy to maintain a CVP of 12 to 15 mm Hg Click here to compare your answer. 4. What is the ideal hematocrit in fluid resuscitation in the absence of acute myocardial disease? 21% to 27% 24% to 30% 30% to 36% 42% to 45% Click here to compare your answer.
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