Adult Critical Care Specialty (ACCS) Practice Exam

In a patient with Crohn's disease presenting with hypotension and tachycardia, what is the most appropriate initial intervention?

1. Administer dobutamine HCl (Dobutrex)

2. Administer norepinephrine

3. Initiate rapid infusion of normal saline

4. Initiate renal dialysis

The correct answer is: Initiate rapid infusion of normal saline

In a patient with Crohn's disease presenting with hypotension and tachycardia, initiating a rapid infusion of normal saline is the most appropriate initial intervention. This approach is primarily aimed at addressing potential hypovolemia or dehydration, which can be prevalent in patients with Crohn's disease due to conditions such as diarrhea or malabsorption. By administering normal saline, the goal is to restore intravascular volume, improve circulation, and stabilize blood pressure. Hypotension often indicates an inadequate volume status, and the immediate correction of this with intravenous fluids can help to adequately perfuse vital organs and alleviate symptoms such as tachycardia, which is a compensatory response to low blood volume or hypotension. This intervention aligns with standard emergency protocols for managing shock or fluid deficit. Other interventions, such as administering dobutamine, norepinephrine, or initiating renal dialysis, are typically more aggressive and would be considered in specific scenarios after initial fluid resuscitation is undertaken. Dobutamine is primarily used for heart failure or cardiogenic shock, norepinephrine is indicated for severe hypotension resistant to fluid therapy, and renal dialysis is not appropriate in this acute setting without prior assessment and unless there is significant renal failure. Thus, the rapid infusion