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Old 08-15-2011
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Default sepsis

Overnight, an otherwise healthy patient with lower extremity cellulitis becomes increasingly hypotensive. Your attending is concerned for sepsis and requests an arterial blood gas which shows: pH 7.33, PaCO2 55 mmHg, and PaO2 75 mmHg. CXR shows normal lung fields. One factor contributing to this patientís hypoxia is
A. Progressive airway reactive disease requiring mechanical ventilation.
B. Unrecognized pulmonary embolism causing increased shunting.
C. Pulmonary toxicity from antibiotic over dosage
D. Increased alveolar dead space due to hypotension
E. Worsening pneumonia
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Old 08-15-2011
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Quote:
Originally Posted by ricko335 View Post
Overnight, an otherwise healthy patient with lower extremity cellulitis becomes increasingly hypotensive. Your attending is concerned for sepsis and requests an arterial blood gas which shows: pH 7.33, PaCO2 55 mmHg, and PaO2 75 mmHg. CXR shows normal lung fields. One factor contributing to this patientís hypoxia is
A. Progressive airway reactive disease requiring mechanical ventilation.
B. Unrecognized pulmonary embolism causing increased shunting.
C. Pulmonary toxicity from antibiotic over dosage
D. Increased alveolar dead space due to hypotension
E. Worsening pneumonia
seems to be B the right option to me ...
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Old 08-15-2011
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Originally Posted by ricko335 View Post
Overnight, an otherwise healthy patient with lower extremity cellulitis becomes increasingly hypotensive. Your attending is concerned for sepsis and requests an arterial blood gas which shows: pH 7.33, PaCO2 55 mmHg, and PaO2 75 mmHg. CXR shows normal lung fields. One factor contributing to this patientís hypoxia is
A. Progressive airway reactive disease requiring mechanical ventilation.
B. Unrecognized pulmonary embolism causing increased shunting.
C. Pulmonary toxicity from antibiotic over dosage
D. Increased alveolar dead space due to hypotension
E. Worsening pneumonia
is it D???????????????
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Old 08-15-2011
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i would go with B) Pulmonary embolism. .. it is possible that the patient was immobilized for a long period of time & developed DVT ?
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Old 08-15-2011
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i would go with B) Pulmonary embolism. .. it is possible that the patient was immobilized for a long period of time & developed DVT ?
yup u are rght its septic shoch so it will basically result in DIC so dvt can b its complication and pulmoary embolism also ...
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Old 08-15-2011
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arnt the pts wid septic shock mor prone to develop ARDS then PE...making A). a possible ans.??
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Old 08-15-2011
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arnt the pts wid septic shock mor prone to develop ARDS then PE...making A). a possible ans.??
yup i was double minded between a and b.. so not sure about whats the correct among them but anyways this is septic shock thesee petients also have ARDS and DIC(can cause pulmonary embolism) it can be confirmed by calculating A-a gradient and actually forget the formula to calculate A-a gradient .. it A-a gradient is increased then its gonna b A the right option .. so i havnt checked it properly ..
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Old 08-15-2011
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I exclude b) as CXR is normal, my guess is A)
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Old 08-15-2011
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pulmonary embolism causes shunting?
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B. Unrecognized pulmonary embolism causing increased shunting.
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Old 08-16-2011
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The correct answer is D.
The likely contributing factor to this patientís hypoxemia is increased alveolar dead space resulting from septic hypotension. Alveolar dead space is defined as alveoli that are adequately ventilated but underperfused. Hypotension is often a culprit of increased alveolar dead space, since decreased cardiac output results in decreased perfusion of alveoli. 

Pulmonary embolism is a dead space event; the answer of increased shunting is therefore inaccurate. The normal CXR rules out pneumonia and ARDS (bilateral fluffy infiltrates).
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