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15 Posts

chinda11
Forum Junior

Topics: 19
Posts: 48

05/05/07 - 08:46 AM

Five days after undergoing appendectomy for a perforated appendicitis, a 47 year old lady has abdominal pain, nausea and vomiting. She appears pale and diaphoretic. Her temp is 39 BP is 84/44, pulse 115 and resp are 18/min. No JVD and lungs are clear to auscultation. Abdominal examination shows mild distension and tenderness in theright lower quadrent. Both upper and lower extremeties are warm. Rectal exam shows a tender mass on pelvic examination just extrinsic to the rectum. Which of the following is the most likely set of hemodynamic findngs in this patient.

Pre load cardiac contractility after load

A) Decrease decrease decrease

B) decrease increase decrease

C) decrease decrease increase

D) increase decrease increase

E) increase increase decrease

F) increase increase increase

ManuNastai
Transilvanian..
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05/05/07 - 09:57 AM

B?

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chinda11
Forum Junior

Topics: 19
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05/05/07 - 10:16 AM

thats what I answered. THis is septic shock. so the preload and afterload should decrease because of blood pooling in the veins. Now cardiac output increases initially in septic shock.. so I am thinking increased cardiac contractility. can any one else try answering.

usmle12
Forum Senior

Topics: 19
Posts: 194

05/08/07 - 07:28 AM

Yeah systemic vasodialation causes decrease in preload n afterload...plus heart tries to compensate by increasing contractility...

klimt
Forum Guru

Topics: 27
Posts: 605

06/04/07 - 12:46 PM

I go with E.

in septic shock cardiac output is increased because the venous return is increased

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radonc
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06/04/07 - 10:08 PM

Answer is B.

Justice
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06/06/07 - 10:37 AM

klimt wrote:
I go with E.

in septic shock cardiac output is increased because the venous return is increased

How does this explain then this 84/44 BP?
I think this is B

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wywywy2006
Forum Elite

Topics: 43
Posts: 166

06/06/07 - 02:02 PM

hi,
how about answer A ?
If LVEDV is decreased, why the contractility can be increased ?

drgoldfinger
Forum Newbie

Topics: 1
Posts: 5

06/27/07 - 12:21 PM

ans should be A- hyperdynamic septic shock- fever and warm extrimities
vasodiln due to inflmm mediators- so dec afterload and dec preload as pooling,
the inc CO is just due to hyperdynamic state and i dont think there is positive inotropy so contractility should be decreased

dr in trouble
Forum Guru
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Topics: 60
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07/08/07 - 07:58 PM

#10

it shud b B as vasodilation leads to decrease preload and afterload.

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haduytu7
Forum Newbie

Topics: 2
Posts: 24

07/31/07 - 05:59 PM

#11

This is a sepsis shock, so decrease preload and afterload.
Look for Both upper and lower extremeties:
- If warm then increase cardiac contractility (early stage)
- If cold then decrease cardiac contractility (late stage)
grin

coolmavs
Forum Elite
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Topics: 21
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08/09/07 - 06:39 AM

#12

SO the final answer is B....decreased preload & afterload and increased contarctility!

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liliaeliz
Forum Elite

Topics: 26
Posts: 237

08/23/07 - 05:55 PM

#13

radonc
Forum Senior

Topics: 5
Posts: 171

02/12/08 - 07:00 AM

#14

I think the answer is A.

Cardiac contractility is decreased in sepsis due to the release of inflammatory factors in the blood. Google "sepsis contractility".
Preload and afterload are reduced.

solitarius
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Topics: 6
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03/01/08 - 06:41 PM

#15

I think the answer is B. cuz you can rule out options with high afterloads right after looking at BP wink

,and in shock there is decreased preload always and pulse rate is high as well...so find the combination of the 3... grin

(maybe wrong logic..but could work)

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