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+--- Thread: nbme 1;1;3 - samomcos (/showthread.php?tid=502456)
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nbme 1;1;3 - samomcos - ArchivalUser - 04-27-2010
3. A 40-year-old man is brought to the emergency department 1 hour after a high-speed motor vehicle collision. On arrival, he is awake and alert but has severe pain over the sternum. His systolic blood pressure is 80 mm Hg, pulse is 80/min, and respirations are 10/min. An ECG shows multifocal premature ventricular contractions but no ST-segment changes. His PO2 is 100 mm Hg. After 1 L of lactated Ringer's solution is administered, his PO2 decreases to 60 mm Hg while breathing 4 L/min of oxygen by nasal cannula. Pulmonary capillary wedge pressure has increased from 14 mm Hg to 24 mm Hg (N=1“10). Which of the following is the most likely explanation for the patient's 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
0 - ArchivalUser - 04-27-2010
B
0 - ArchivalUser - 04-27-2010
B
0 - ArchivalUser - 04-27-2010
B.
0 - ArchivalUser - 04-27-2010
i think its D
because its getting worse after admin of fluids
0 - ArchivalUser - 04-27-2010
picked B too, key said C. thanks
0 - ArchivalUser - 04-27-2010
how do they rule out myocardial contusion?PVCs could be caused by both indeed..I guess if its non-STEMI both work..
0 - ArchivalUser - 04-27-2010
his po2 is 100 after RL its becoming 60, why dont we consider D?
0 - ArchivalUser - 04-27-2010
in pulmonary contusion you have more pulmonary symptoms rapid breathing,cough,wheezing.. plus we have premature contractions here,which are sign of myocardial problem
0 - ArchivalUser - 04-27-2010
oh ok. thank u jamesking. i never even considered PVC. was always going in for that one line that says give fluids and abg deteriorates..
thanks, now i get it.