and abdominal pain. He is lethargic but can answer questions appropriately. His

Question

and abdominal pain. He is lethargic but can answer questions appropriately. His puise is 130 beats/min, blood pressure 70/30 mm Hg, and respiratory rate 28 breaths/min. On physical examination, he is noted to have dry mucous mentranes, poor caplay re and a distended abdomen with rebound tenderness. Arterial blood gas analysis reveals:pH 7.32, Pco2 28 mmHg, Po2 74 mm Hg, bicarbonate 13 mmol/L. Serum lactate is 8.0 mEa/L Which of the following findings has been shown to correlate with a worse prognosis in a patient with this picture? 13. A 75-year-old man with a history of hypertension is evaluated in the emergency department for nausea, vomiting, A. B. Acidemia on blood gas analysis C. Elevated serum lactic acid D. Tachypnea 14. A 65-year-old man is septic, with perlorated diverticulitis. He undergoes emergent colectomy with creation of a colostomy. Multile areas of punudonce are identified in the penitoneal cavity. Postoperatively, he continues to be febrile and hypotensive. Chest radiograph is clear. Central venous pressure is 18 mm Hg, and hemoglobin is 13 9/L. Which of the following vasoactive drugs is most appropriate to administer next? A Epinephrine B. Phenylephrine C. Norepinephrine D. Dobutamine 15. A 76-year-old woman with a history of congestive heart failure and hypertension is admitted with altered mental status and mild upper respiratory symptoms. According to family, her mental status has been gradually declining over the past three to four days. Because of generalized weakness and upper respiratory symptoms, she has had a limited amount of food and drink for the past 72 hours. Her home medications include metoprolol, lisinopril, and furosemide. Her family states that she has been compliant with these medications. On physical examination, vital signs are: heart rate 118 beats/min, blood pressure 96/53 mm Hg, respiratory rate 14 breaths/min, and oxygen saturaion 98% on room air. Other findigs iotded dry mucous membranes, poor skin turgor, and the absence of jugular venous distention. Pulmonary examination is clear on auscultation. She opens her eyes to mumbles incomprehensible sounds and has generalized weakness. She has a two-minute tonio-clonic selizure in voice, but which resolves without intervention. Pertinent laboratory results are: sodium 110 mEq. potassun 45 mEqL, dloride 80 mEgl, boat onato 26 meg L, blood urea nitrogen 57 mgd, creatinine 2 mgld, and gtucose 89 mgid. Which of the following is the most appropriate next step in management? A Free water restriction B. Hypertnic (3%) saine 100mL x 1 fr rapid early correction, with goal serum sodium of 118 mEqLin 24 hours rmal saine bols, 1 Lover 10 minutes, and repeat for goal serum sodium of 128 mEq L in 24 hours C. D. Oral tolvaptan, 15 mg x 1

Explanation / Answer

13. Hypotension -

Extreme hypotension can result in this life-threatening condition. Due to severe drop in the volume of liquid in the body, the heart cannot pump the blood properly, resulting in insufficient oxygen supply to the body which leads to the dangerous effect on heart and brain. Due to dehydration and low blood volume in the body results in elevated lactic acid and its coexisted with tachypnea and acidemia.

Related Questions

Navigate

• Browse (All)
• Browse A
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.