PACULit Literature Updates September 2025: Emergency Medicine & Critical Care Quiz

Question 1 of 10

1. Question

John is a 62-year-old male admitted to the ICU with acute coronary syndrome and congestive heart failure. His medical history includes hypertension and type 2 diabetes. He is currently on multiple medications including aspirin, lisinopril, metformin, and furosemide. The ICU pharmacist is considering the use of a structured medical record model to optimize medication review and reduce drug-related problems during his stay.
Question: Based on evidence from the DAM model study, what is the most significant benefit of using a drug-related problem (DRP) oriented medical record in John’s ICU care?

Reduction in length of hospital stay and mortality rates
Improved patient satisfaction scores
Decreased need for mechanical ventilation
Elimination of all adverse drug reactions

Question 2 of 10

2. Question

Maria is a 65-year-old female admitted to the ICU with acute coronary syndrome complicated by cardiogenic shock. She has no prior history of diabetes. Her admission labs reveal a blood glucose of 180 mg/dL and an estimated average glucose of 120 mg/dL, resulting in an SHR of approximately 1.5. The ICU team uses OASIS and SAPSII scores for mortality risk prediction and asks if SHR should be incorporated.
Question: What is the best pharmacist advice regarding the addition of SHR to conventional severity scores for mortality risk prediction in Maria’s case?

Recommend adding SHR to OASIS and SAPSII scores to improve short-term mortality prediction, especially in-hospital and 28-day outcomes.
Advise against adding SHR as it does not improve predictive accuracy for any mortality time points.
Suggest using SHR only for predicting 90-day and 365-day mortality, not short-term outcomes.
Recommend replacing OASIS and SAPSII scores entirely with SHR for mortality prediction.

Question 3 of 10

3. Question

David, a 55-year-old male with severe TBI, is admitted to the ICU. Initial labs reveal hypochloremia (serum chloride 95 mEq/L) and hypocalcemia (serum calcium 7.8 mg/dL). The ICU team is concerned about the impact of these imbalances on mortality risk and requests pharmacist guidance on monitoring and management.
Question: Which statement best reflects the pharmacist’s evidence-based advice regarding hypochloremia and hypocalcemia in severe TBI patients?

Hypochloremia is linked to higher mortality in severe TBI and should be closely monitored and corrected alongside hypocalcemia to reduce mortality risk
Hypochloremia has no significant impact on mortality and does not require correction in severe TBI
Only hypocalcemia correction is necessary as hypochloremia is not associated with outcomes
Electrolyte imbalances should be ignored initially as they reflect injury severity rather than modifiable risk factors

Question 4 of 10

4. Question

A 35-year-old female with a history of mild asthma presents to the pharmacy. She has been using albuterol inhaler as needed but reports two recent episodes of worsening symptoms requiring oral corticosteroids. She is currently not on any inhaled corticosteroids. She has no known drug allergies and is insured with moderate copayments. She expresses concern about frequent steroid use and wants to avoid exacerbations.
Question: Based on the BATURA trial findings, which of the following is the most appropriate recommendation for this patient to reduce her risk of severe asthma exacerbations?

Continue as-needed albuterol alone and monitor symptoms closely
Switch to as-needed albuterol-budesonide fixed-dose combination inhaler
Start daily low-dose inhaled corticosteroid and continue as-needed albuterol
Add a leukotriene receptor antagonist to current albuterol therapy

Question 5 of 10

5. Question

John is a 62-year-old male admitted to the ICU after experiencing an in-hospital cardiac arrest 8 hours ago. He is mechanically ventilated and has a baseline lactate level of 6.2 mmol/L. His medical history includes hypertension and type 2 diabetes. Current medications include metoprolol 50 mg daily and insulin glargine. The ICU team is considering adjunctive therapies to improve his metabolic status.
Question: Based on the recent evidence from Berg et al. (2024), what is the most appropriate pharmacist recommendation regarding intravenous thiamine administration in John’s case?

Recommend initiating high-dose IV thiamine 500 mg every 12 hours for 3 days to reduce lactate levels
Advise against routine thiamine administration due to lack of demonstrated benefit and potential harm in patients with high baseline lactate
Suggest thiamine only if the patient shows clinical signs of thiamine deficiency
Recommend switching to oral thiamine supplementation to improve metabolic outcomes

Question 6 of 10

6. Question

Maria is a 72-year-old female with sepsis secondary to urinary tract infection. She has chronic kidney disease stage 3 and is currently hemodynamically unstable. The emergency department team is preparing to initiate fluid resuscitation. Maria weighs 65 kg. The pharmacist is consulted to advise on the timing of fluid administration to maximize survival benefit.
Question: What timing strategy for administering the initial 30 mL/kg fluid bolus should the pharmacist recommend based on current evidence?

Complete the 30 mL/kg fluid bolus within 1 to 3 hours of sepsis diagnosis
Administer the fluid bolus slowly over 6 to 8 hours to prevent overload
Delay fluid resuscitation until lactate levels normalize
Administer fluids only after vasopressor therapy is initiated

Question 7 of 10

7. Question

Liam is a 5-year-old boy admitted to the pediatric intensive care unit (PICU) with severe pneumonia requiring mechanical ventilation. His medical history is unremarkable, and he has no known drug allergies. Currently, he is sedated with intravenous midazolam 0.1 mg/kg/hr. The clinical team is considering alternative sedation strategies to optimize recovery and minimize opioid use.
Question: Based on the IsoCOMFORT trial findings, what is the most appropriate pharmacist recommendation regarding sedation management for Liam?

Continue intravenous midazolam as it is superior to inhaled isoflurane for sedation efficacy
Switch to inhaled isoflurane sedation as it is non-inferior to midazolam and may reduce opioid and muscle relaxant requirements
Discontinue all sedatives and rely solely on opioid analgesics for sedation
Add dexmedetomidine to midazolam to improve sedation depth

Question 8 of 10

8. Question

John is a 72-year-old male presenting to the emergency department with acute respiratory failure secondary to COPD exacerbation. His medical history includes hypertension and mild cognitive impairment. On assessment, his Glasgow Coma Scale (GCS) score is 13, heart rate is 120 bpm, and he exhibits increased work of breathing with use of accessory muscles. He was started on non-invasive ventilation (NIV) in the ED. The pharmacist is reviewing his clinical status and monitoring parameters.
Question: Which of the following clinical findings most strongly indicates John is at high risk for early clinical deterioration under NIV within the first hour?

GCS score of 13
Heart rate of 100 bpm
Absence of accessory muscle use
Normal respiratory rate

Question 9 of 10

9. Question

David is a 70-year-old male with septic shock treated with stress dose hydrocortisone for 5 days. The ICU team is debating whether to taper or abruptly stop hydrocortisone. They want to understand the impact of tapering on ICU length of stay and mechanical ventilation duration to inform their decision.
Question: According to recent evidence, what are the expected effects of hydrocortisone tapering on ICU length of stay and mechanical ventilation duration?

Tapering decreases both ICU length of stay and mechanical ventilation duration
Tapering has no significant effect on ICU length of stay or ventilation duration
Tapering increases ICU length of stay and mechanical ventilation duration
Tapering decreases ICU length of stay but increases ventilation duration

Question 10 of 10

10. Question

Maria is a 68-year-old Hispanic female with no known cardiac history presenting to the ED with palpitations. She is uninsured and does not have a primary care provider. Continuous ECG monitoring reveals paroxysmal atrial fibrillation lasting 45 seconds. Her CHA2DS2-VASc score is 3. She is discharged without AF documentation or anticoagulation therapy.
Question: Considering the study’s findings on demographic disparities, what is a key pharmacist intervention to improve Maria’s care?

Provide education on AF and stroke risk and facilitate referral to cardiology and primary care
Advise her to avoid anticoagulation due to lack of insurance coverage
Recommend over-the-counter supplements to manage palpitations
Suggest follow-up only if symptoms worsen