A 68-year-old man with a history of hypertension, diabetes, and urinary retention awoke feeling nauseated and light-headed. He did not respond to questions from his wife. When the emergency medical technicians arrived, his blood pressure was 60 by palpation. IV fluids and oxygen were administered. Vital signs obtained in the ERwere blood pressure 60, heart rate 120 and regular, temperature 38.9C (102F), and respiratory rate 30. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds. An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. Chest x-ray revealed bilateral interstitial infiltrates; ECG was unremarkable except for sinus tachycardia. Antibiotics were administered, and the patient was transferred to the ICU, where a right heart catheterization was performed. Pulmonary capillary wedge pressure was 28 mmHg. Cardiac output was 1.9 L/min. Right atrial mean pressure was 10 mmHg. The most likely cause of this man’s hypotension was (A) left ventricular dysfunction (B) right ventricular infarction (C) gram-negative sepsis (D) gastrointestinal bleeding (E) pulmonary emboli
Posted on: Sat, 12 Jul 2014 01:00:25 +0000
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