2-4-9 - sunappleus

[ArchivalUser]

A previously healthy 67-year-old woman is brought to
the emergency
department by paramedics 40 minutes after the sudden
onset of shortness of
breath while shopping. She is unable to provide
additional medical
history. She is in severe respiratory distress. Her
temperature is 37 C
(98.6 F), blood pressure is 90/60 mm Hg, pulse is
120/min and regular,
and respirations are 24/min. Examination shows marked
jugular venous
distention. Diffuse crackles are heard throughout all
lung fields.
Cardiac examination shows an enlarged point of maximal
impulse and normal
S1 and S2; there is an S3. Abdominal examination
shows no
abnormalities. There is no edema of the lower
extremities. Laboratory studies
show:


Hematocrit 38%
Leukocyte count 12,000/mm3
Platelet count 350,000/mm3


Arterial blood gas analysis on 5 L/min of oxygen:


pH 7.5
PCO2 16 mm Hg
PO2 64 mm Hg

A
) Acute gastrointestinal bleeding

B
) Adrenal insufficiency

C
) Aortic valve rupture

D
) Cardiac tamponade


E
) Congestive heart failure

F
) Pneumonia

G
) Pulmonary embolism

H
) Sepsis

[ArchivalUser]

E. raise JVP< Diffuse crackels, S3

[ArchivalUser]

BP is low
pulse high
jvp: markedly distended
chest: diffuse crackles at lung base
heart: enlarged point of maximal impulse(cardiomegaly?)
alkalosis
pco2: decrease, hyperventilation
po2: low
abdomen: clear

A.Acute gastrointestinal bleeding: patient has no abdominal symptoms, y wuld there be raised jvp

B.Adrenal insufficiency: no cutaneous signs plus this is sudeen, plus no h/o of drug intake

C.Aortic valve rupture: no murmurs

D.Cardiac tamponade: no distant heart sounds, although jvp is raised, but becks triad is not there? hmm

E.Congestive heart failure

F. Pneumonia..no fever?

G.Pulmonary embolism..y wuld there be cardiomegaly???

H
) Sepsis

[ArchivalUser]

so i guess chf

[ArchivalUser]

chf

[ArchivalUser]

the only diff between Q8 ang Q9 is the S3 vs. S4. What does it tell us?