Chapter 5 of 616% of exam

Multisystem

Multisystem problems affect several organs at once: sepsis and shock, burns, toxic exposures, acid-base and electrolyte disorders, massive hemorrhage and end-of-life care. Sepsis questions follow the current Surviving Sepsis Campaign guideline, updated in 2026.

Sepsis and septic shock

Early recognition, cultures, antimicrobials and hemodynamic support remain the core of sepsis care. The 2026 guideline kept several familiar targets and changed others, such as the preferred screening tools and fluid type.

Screening

Use NEWS, NEWS2, MEWS or SIRS rather than qSOFA alone to screen acutely ill inpatients.

Surviving Sepsis Campaign 2026

Cultures and antimicrobials

Draw blood cultures as soon as possible, ideally before antimicrobials; in septic shock give antimicrobials immediately, ideally within 1 hour.

Surviving Sepsis Campaign 2021 and 2026

Fluids

Balanced crystalloids are suggested over 0.9% saline; dynamic measures guide further fluid.

Surviving Sepsis Campaign 2026

Pressure target and first vasopressor

Initial MAP of 65 mm Hg (60–65 in patients 65 and older); norepinephrine first-line.

Surviving Sepsis Campaign 2026

Anaphylaxis, burns and trauma hemorrhage

Each of these conditions has a first-line intervention that should never be delayed by second-line drugs. Burn resuscitation is calculated from weight and burn size. Trauma resuscitation focuses on stopping bleeding and preventing the lethal triad.

Anaphylaxis

IM epinephrine 0.01 mg/kg (maximum 0.5 mg in adults) into the anterolateral thigh, repeated every 5–15 minutes as needed.

World Allergy Organization Anaphylaxis Guidance 2020

Burn fluids

Lactated Ringer's 2–4 mL/kg per %TBSA over 24 hours in adults; in the Parkland convention half is given in the first 8 hours.

Nurs Open 2026 burn fluid review (ABLS range)

Burn depth

Partial-thickness burns are painful and blistered; full-thickness burns look white or charred and may be numb.

MedlinePlus (NLM), Burns

Lethal triad

Hypothermia, acidosis and coagulopathy reinforce one another in bleeding trauma patients.

World J Emerg Surg 2025

Balanced transfusion

A 1:1:1 plasma:platelet:red cell ratio achieved hemostasis more often and reduced early deaths from exsanguination.

PROPPR, JAMA 2015

Toxic ingestions

Poisonings are managed with supportive care plus specific antidotes or strategies. Some toxins look benign early and are dangerous later.

Salicylates

Mixed respiratory alkalosis and metabolic acidosis; avoid sedation or intubation that reduces ventilation, and alkalinize.

Cureus 2025 salicylate review

Calcium channel blockers

First-line therapy includes IV calcium, high-dose insulin and vasopressors.

CCB Poisoning Expert Consensus, Crit Care Med 2017

Acetaminophen

Symptoms may not appear for 12 hours or more; N-acetylcysteine is the antidote and works best early.

MedlinePlus (NLM), Acetaminophen overdose

Opioids

Small pupils and slow breathing respond to naloxone, which may wear off first.

MedlinePlus (NLM), Opioid intoxication

Acid-base, electrolytes, nutrition and end of life

Interpret the pH first, then decide whether the carbon dioxide or bicarbonate explains it. Refeeding can cause dangerous shifts in phosphate and other electrolytes. Palliative care is compatible with ongoing treatment.

Metabolic alkalosis

High pH and bicarbonate, often from vomiting or gastric suction (chloride loss) or diuretics (potassium loss).

MedlinePlus (NLM), Alkalosis

Rhabdomyolysis

Tea-colored urine, heme-positive dipstick with few red cells, and CK above five times normal.

Crit Care 2016 rhabdomyolysis review

Refeeding syndrome

A fall in phosphorus, potassium or magnesium within 5 days of starting nutrition.

ASPEN 2020 consensus (via Nutrients 2026)

Palliative care

Can start at diagnosis and run alongside disease-directed treatment; hospice applies when that treatment stops.

National Institute on Aging

Keep going: the full CCRN (Adult) — Acute/Critical Care Nursing Certification Exam guide covers every section of the exam. CCRN (Adult) Study Guide — 2026 Edition — PDF + EPUB, $24.99 · 14-day refund →

Practice this topic →← All chapters

Studying in order?

Practice stays free. The full CCRN (Adult) — Acute/Critical Care Nursing Certification Exam study guide is the material itself, taught start to finish — a downloadable PDF + EPUB you keep.

Get the book — $24.99