prathapdoctor
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A 40yr old man is brought to the emergency dept 1hr after a high speed motor vehicle colllision.on arrival,he is awake and alert but has severe pain over the sternum.His systolic BP is 80 mm hg,pulse 80/min and respirations are 10/min. ECG shows multifocal premature ventricular contractions but no ST segment changes.Po2 is 100mm hg.after 1 lr of lactated ringers solution is administered his PO2 decreases to 60 mm hg while breathing 4L/min of oxygen by nasal cannula.Pulmonary capillary wedge pressure has increased from 14 to 24 mm hg,which of the following is the most likely explanation for the patients poor response to fluid resuscitation.
A. Inadequate administration of fluids
B.Myocardial contusion
C.Myocardial infarction
D.Pulmonary contusion
E. Traumatic rupture of the aorta
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| CocaCola
Forum Guru
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b - Myocardial contusion
pain over the sternum, arrythmia, and increase left atrial pressure...
Edited by CocaCola on 01/21/07 - 01:27 PM
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| chemamr
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B?
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| sarika
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B.Myocardial contusion ...these are sensitive to fluid administration.
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| nida
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Agree B)
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| ndspider
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Ok Sarika using your knowledge, then why can't the answer be A. Inadequate administration of fluid? Which made the contusion worst? In additoin. P02 decreased from 100 to 60 suggesting a lung issue from fluid overload. An increase in wedge pressure (anything over 20) will give you pull. congestion.
So I am thinking it is A.
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