100% solved
UponMyourMassessmentMofMyourMpatient,MwhoMhasMpancreatitis,MyouMfindMtheMfollowin
gMvalues:
tempM37.1C,MBPM98/64,MHRM110,MRRM28,MSpO2M88%MonM2LMNC.M
HerMlabsMareMWBCM19,000,MHgbM8.9,MHCTM39%,MNaM144,MKM3.1,MCaM7.7,MandMgluco
seM224.
YourMremainingMassessmentMrevealsMLLLMcracklesMofMtheMlungsMandMherMabdomenMw/
MCullen'sMsign.MBesidesMpancreatitis,MwhatMelseMdoMyouMthinkMyourMpatientMmayMhave
?
a)MSIRS,MhemorrhagicMpancreatitis,MMODsMandMneedingMfluids
b)MhemorrhagicMshock,MstressMhyperglycemia,Mhypoxemia,MandMneedingMblood
c)Mdehydration,MARDS,MstressMhyperglycemia,MandMneedsMintubation
d)MhypovolemicMshock,Mdiabetes,MsevereMsepsis,MandMneedingMantibioticsM-
MAnswerMa)MSIRS,MhemorrhagicMpancreatitis,MMODSMandMneedingMfluids
--
YourMpatientMhasMSIRSMbcMofMtheMincreasedMRR,MHR,MandMWBC.MDueMtoMtheMCullen'
sMsign,MyourMpatientMmostMlikelyMhasMhemorrhagicMpancreatitis,Mw/signsMofMMODSMby
MtheMlowMSpO2MandMtheMlowMBP.MFluidsMareMneededMr/tMtheMmassiveMfluidMshiftsMi
nMacuteMpancreatitis
--
ThisMptMdoesMnotMhaveMdiabetesMandMdoesMnotMneedMantibiotics.MHowever,MisMatMa
MhighMriskMofMARDSMbutMdoesMnotMhaveMbilateralMinfiltratesMorMrefractoryMhypoxemia
AMnewMpatientMjustMarrivedMtoMtheMhospitalMs/pMacuteMabdominalMtrauma.MTheMpatie
ntMisMnowMexperiencingMKehr'sMsign.MWhichMofMtheMfollowingMmayMbeMtheMcauseMof
MKehr'sMsign?
a)MdiaphragmaticMirritation
b)MliverMcontusion
c)MrupturedMkidney
d)MrupturedMbladderM-MAnswerMa)MdiaphragmaticMirritation
, --
TraumaMthatMcausesMsplenicMruptureMalsoMcausesMdiaphragmaticMirritationMandMsubsequ
entMreferredMpainMtoMtheMleftMshoulderM(Kehr'sMsign).MTheMotherMchoicesMdoMnotMca
useMKehr'sMsign.
YourMcoworkerMgoesMonMbreakMandMasksMyouMtoM"lookMout"MforMherMpatients.MHerM
ptMthenMcallsMyouMtoMtheMroomMw/aMcomplaintMofM"somethingMdoesn'tMfeelMrightMin
MmyMabdomen".MAfterMauscultatingMtheMpt'sMbowelMsounds,MwhichMofMtheMfollowingMi
sMpresentMinManMearlyMmechanicalMbowelMobstruction?
a)MnormalMbowelMsounds
b)MhypoactiveMbowelMsounds
c)MhyperactiveMbowelMsounds
d)MabsentMbowelMsoundsM-MAnswerMc)MhyperactiveMbowelMsounds
--
InMearlyMbowelMobstruction,MtheMbowelMsoundsMbecomeMhyperactive.MInMaMlateMbowel
Mobstruction,MbowelMsoundsMbecomeMhypoactiveMorMabsent.
YouMareMassistingMonMtheMadmissionMofMaMnewMpatientMintoMtheMICUMforMaMdiagnos
isMofMbleedingMesophagealMvariesMandMhypovolemicMshock.MWhichMofMtheMfollowingMcl
oselyMresemblesMcompensationMforMtheMhypovolemicMshock?
a)Mvasodilation
b)McapillaryMfluidMshiftMintoMtheMinterstitialMspace
c)MdecreaseMinMreninMsecretion
d)MincreaseMinMre-absorptionMofMsodiumMandMwaterM-MAnswerMd)ManMincreaseMinMre-
absorptionMofMsodiumMandMwater
--W/MvolumeMdepletion,MaldosteroneMisMreleasedMbyMtheMrenin-angiotensin-
aldosteroneMmechanisMwhichMwillMallowMextraMNaMandMwaterMtoMbeMreabsorbedMinMa
nMattemptMtoMincreaseMtheMvascularMvolume.MTheMotherMchoicesMareMnotMsignsMofMa
McompensatoryMresponse.