Supportive and Preventive Medicine

ducing hypochlorhydria and increasing the host

susceptibility to infections.

shown that the risk of CDI is associated with

PPI use.

CDI risk.

the same definition of CDI and implemented

the same infection control practices.

A 50-year-old woman (weight 70 kg) is admitted

to the ICU for worsening mental status. Her medi-

cal history is significant for hypertension, tobacco

use, and osteoporosis. The next morning, she is

intubated and stabilized on a ventilator. An NGT is

placed. Her current medications include ceftriaxone

2 g intravenously every 12 hours, vancomycin 1250

mg intravenously every 12 hours, acyclovir 800 mg

intravenously every 8 hours, famotidine 20 mg by

NGT twice daily, and a bowel regimen. Serum cre-

atinine (SCr) is normal. Which would be the most

appropriate VTE prophylaxis for this patient?

maintain a therapeutic activated partial throm-

boplastin time (aPTT).

A 34-year-old woman (weight 65 kg) is admitted

to the ICU with several upper extremity fractures,

a closed-head injury, and a grade 4 liver laceration

after a motor vehicle collision. Her medical his-

tory is nonsignificant. She is admitted to the ICU

on a ventilator after surgery. Her current laboratory

values are as follows: sodium (Na) 145 mEq/L,

potassium (K) 3.1 mEq/L, chloride 97 mEq/L, car-

bon dioxide 18 mEq/L, blood urea nitrogen (BUN)

70 mg/dL, and SCr 3.5 mg/dL. Which would be the

most appropriate VTE prophylaxis on the day of

admission for this patient?

devices.

12 hours.

A 34-year-old man (weight 70 kg) is admitted to the

surgical ICU for acute respiratory failure from pan-

creatitis. He has no pertinent medical history. His

current medications include norepinephrine at 0.07

mcg/kg/minute, dexmedetomidine at 0.7 mcg/kg/

hour, ampicillin/sulbactam 3 g intravenously every

6 hours, famotidine 20 mg intravenously twice daily,

and heparin 5000 units subcutaneously three times

daily. On day 3 of his ICU admission, the team sus-

pects heparin-induced thrombocytopenia (HIT). His

platelet count (Plt) was 360,000/mm3 on admission

and is 180,000/mm3 today. The 4Ts score is used to

determine the probability of HIT. This patient’s 4Ts

score is 3 (equating to a low probability of HIT).

The team would like to send the heparin–platelet

factor 4 (PF4) immunoassay and initiate argatroban.

Which is the most appropriate response?

tiate argatroban.

argatroban.

tinue low-dose unfractionated heparin (LDUH)

until the results return.

continue LDUH.

Which would be the most important group of con-

siderations in a critically ill patient approaching the

end of life?

and control of secretions.

of unnecessary medications, and control of

secretions.

discontinuation of unnecessary medications.

insertion of a Foley catheter, and treatment of

nausea and vomiting.