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هدية إن عصفوراً على الشجرة، قد يكون، خيراً من عشرة في اليد!! الفعاليات القادمة
استطلاع الرأي إلى أي مدى تعتبر أنّ الدراسة النظريّة للطبّ في كليتنا ستخدمك سريرياً في المستقبل؟ أعتبر أنّ الفائدة معدومة في ظل النظام التدريسيّ الحالي. 27% الفائدة كبيرة جداً، وهي أساس التميز العملي. 6% الأمر نسبي، يختلف من طالب لآخر، ومن مادة لأخرى. 67% عدد الأصوات: 241 أهلاً بك ! تفضل الإبحار |
 
.cardiology case.
dr.tabban - الخميس, 2007-03-01 01:06 |
الوصف الكامل Background: A 70-year-old man is found unresponsive at home. The emergency medical technicians note his blood pressure to be 70 mm Hg by palpation. His pulse is 120/min. He is brought to the emergency department, where his temperature is 39.5 C (103 F), and respirations are 30/min. He has rales halfway up his chest. Heart sounds are inaudible. His urine output is 10 mL/h. A chest x-ray film reveals fine costophrenic septal lines, and an electrocardiogram shows sinus tachycardia. He is given antibiotics and is taken to the intensive care unit, where a right-sided catheterization shows an elevated wedge pressure and diminished cardiac output. His right atrial pressure is not elevated.
الشكوى الرئيسية CC: القصة المرضية HPI: الأجهزة الأخرى ROS: السوابق المرضية الشخصية PMH: السوابق المرضية العائلية FMH: الوضع الصحي والاجتماعي SH: الفحص السريري Clinical Exam: التشخيص التفريقي DD: الاستقصاءات Investigations: التدبير Managment: كتابة حرة وطرح موضوع النقاش!: Which of the following is the most likely cause of this man's hypotension?
a.Gastrointestinal bleeding |
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I THINK D
i haven't reviewed cardiology yet, but i think it is b or c, i will choose C
left ventricle dysfunction can raise the pressure in left atrium and cause pulmonary edema
Gastrointestinal bleeding (choice A) would present with hypotension, tachycardia, and shock. Hypovolemia from a gastrointestinal bleed would cause a decrease in the wedge pressure as well.
Similarly, septic shock (choice B) would lead to hypotension and decreased wedge pressure. The cardiac output would be increased, and the systemic vascular resistance would be decreased. In the setting of fever, however, this diagnosis must be considered. Treatment would include supportive therapy with vasopressors and fluids, as well as antibiotics.
Pericardial tamponade (choice D) could produce elevated wedge pressures, but the obstruction to the right ventricular inflow should be associated with equally abnormal right atrial mean, right ventricular end diastolic, and pulmonary artery end-diastolic pressures.
A pulmonary embolus (choice E) would lead to decreased wedge pressure. The patient would be tachycardic, tachypneic, and hypotensive. Pulmonary edema would not be seen, however. Treatment would include administering a lytic agent and heparin.
nice one
keep going