Aashi
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A previously healthy 21-year-old woman comes to the local college clinic because of a headache and low-grade fevers. She is sent home with acetaminophen and advised to return if she does not improve. Approximately three hours later her roommate calls 911 reporting that her friend is unconscious and not arousable. On arrival the paramedics find a lethargic, febrile female lying on the floor and unresponsive. The patient is stabilized and she is rushed emergently to the local hospital where an abdominal CT scan shows bilateral adrenal hemorrhages. The patient is transported to the intensive care unit where a pulmonary artery catheter is inserted via a right internal jugular vein. Her temperature is 39.3 C (102.8 F), blood pressure is 85/40 mm Hg, and pulse is 140/min. An electrocardiogram demonstrates sinus tachycardia. Her extremities are warm to the touch and appear pink. A cardiac output (CO), systemic vascular resistance (SVR), pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) are obtained. The data acquired from her PA-line is most likely to be
A. CO 5.0 L/min, SVR 800 dynes-sec/cm5, PCWP 12 mm Hg, CVP 4 mm Hg
B. CO 9.5 L/min, SVR 210 dynes-sec/cm5, PCWP 8 mm Hg, CVP 6 mm Hg
C. CO 2.3 L/min, SVR 1500 dynes-sec/cm5, PCWP 30 mm Hg, CVP 10 mm Hg
D. CO 3.0 L/min, SVR 1500 dynes-sec/cm5, PCWP 8 mm Hg, CVP 1 mm Hg
E. CO 9.5 L/min, SVR 1210 dynes-sec/cm5, PCWP 12 mm Hg, CVP 6 mm
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| CocaCola
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The patient is septic... most likely from Meningococcal infection... ledaing to waterhouse frederickson syndrome
D - low CO, low PCWP, and low CVP
not sure about the SVR
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| prathapdoctor
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suspecting adrenal crisis because of waterhouse fredirichson syn,i will go for option A,because of lack of production of steroids leads to decreased peripheral vascular resistance because vessels are no more responsive to pressors.
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| webjeee
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b
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| Aashi
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The correct answer is B.
CO 9.5 L/min, SVR 210 dynes-sec/cm5, PCWP 8 mm Hg, CVP 6 mm Hg
The patient likely has septic shock that is characterized by high cardiac output, low systemic resistance, and a relatively normal contractile function (PCWP) and filling pressures (CVP).
(choice A) is a profile of a normal, healthy person.
(choice C) is a profile of cardiogenic shock. This patient has a depressed cardiac output, a markedly elevated PCWP reflecting failure, and an appropriately high peripheral vasoconstrictive response to maintain blood pressure.
(choice D) reflects hypovolemic shock with a low output, an appropriately high peripheral resistance but very low filling pressures.
(choice E) is representative of a healthy person undergoing vigorous exercise, with augmented cardiac output, normal systemic resistance and filling pressures.
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| tongsaa
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Very useful. Thank you
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| cirus
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I knew the pathophisiol but i don't know the normal values, so i guess i would have missed it, thanx Aashi, really good one
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