robin082006
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4) A 57-year-old woman presents with progressive shortness of breath over the past 2 days. The woman was admitted to the medical service 6 days ago after a fall and has been on bed rest for a nondisplaced pubic ramus fracture. She has been on deep vein thrombosis prophylaxis with subcutaneous heparin. Her past medical history is significant for type 2 diabetes and dialysis-dependent renal failure secondary to diabetic nephropathy. She makes no urine at baseline. Her last dialysis run was 4 days ago, though she usually undergoes dialysis 3 times per week. She has no chest pain. On physical examination, she appears anxious. Her blood pressure is 160/105 mm Hg, pulse is 110/min, and respirations are 22/min. Her oxygen saturation is 80% on room air, and she appears cyanotic. She has a jugular venous pressure of 10 cm and inspiratory crackles half way up from the bases on auscultation of the lungs. An ECG reveals a rate-related right bundle branch block but no ischemic changes. A chest x-ray film obtained yesterday revealed interstitial edema and vascular redistribution to the apices. Which of the following is the most appropriate initial therapy?
A. An anti-hypertensive agent to decrease her blood pressure to normal
B. A beta blocker to better control her pulse
C. IV morphine to decrease her respirations to normal
D. Oxygen by endotracheal intubation to maximize the oxygen concentration
E. Oxygen by face mask to increase her oxygen saturation
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| ssrpk
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E. Oxygen by face mask to increase her oxygen saturation
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| ssrpk
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hey robin wht is the source of these questions?
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| mazinger
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good point ssprk, O2 its always the first step in the management... but I have my doubts about the diagnosis, it may look like a pulmonary embolus or is that it may be a congestive heart failure?
In short whats your diagnosis?
Regards
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| ssrpk
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last dialysis four days ago....so this is volume overloaded status....she basically needs an urgent dialysis!
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| mazinger
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| ssrpk
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lets expand this further 
wht are the other indications for urgent dialysis?
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| mazinger
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first of all hyperkalemia..
Sxs of fluid overload
Met Acidosis
Pericarditis
Uremia <- encephalopathy
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| aml
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Renal failure, drug overload, poisoning
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