Confused, elderly, and hypotensive in the ER.... - USMLE Forums
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  #1  
Old 07-03-2011
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ER Confused, elderly, and hypotensive in the ER....

An 88-year-old woman presents from a nursing home presents to the emergency room. She is confused and does not follow commands. The nursing home reveals that this is her normal baseline mental status. She was in pain after she fell out of her bed 2 hours prior to presentation. Her past medical history includes chronic obstructive pulmonary disease, diabetes, dementia, and glaucoma. A medication list sent in by the nursing home includes prednisone, albuterol, insulin, fluticasone propionate (Flovent), salmeterol xinafoate (Serevent), and topical medication for her glaucoma. Vital signs are heart rate 102 beats/min, respiratory rate 18 breaths/min, oxygen saturation 92% on room air, and blood pressure of 101/66 mm Hg. On exam her right leg is shorter than the left and her hip is internally rotated. X-rays of the hip reveal an intertrochanteric fracture of the right hip and severe osteopenia. After she returns from x-ray her blood pressure is found to be 80/55 mm Hg. Hemoglobin is found to be 12 g/dL. Electrocardiogram does not show any ischemic changes. What is the best treatment for her hypotension?

Answer Choices
A. Epinephrine
B. Intravenous fluid bolus
C. Methylprednisolone sodium succinate
D. Norepinephrine
E. Red blood cell transfusion
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Old 07-03-2011
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i think its b..better to start with iv fluid..not sure
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Quote:
Originally Posted by confident View Post
i think its b..better to start with iv fluid..not sure
she is old with unknown cardiac conditions
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Old 07-04-2011
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Yes. Fluid resuscitation. C
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I meant B. Sorry!
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Quote:
Originally Posted by miss patho View Post
she is old with unknown cardiac conditions
what is the answer please..
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Old 07-04-2011
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a??? answer...??
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B. Intravenous fluid bolus
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C. Methylprednisolone sodium succinate the answer

The patient needs stress dose steroids. She is on prednisone, and now has had a significant stressor.

I can't post the whole answer because admin send me message because the copyright issue of q bank
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Quote:
Originally Posted by miss patho View Post
C. Methylprednisolone sodium succinate the answer

The patient needs stress dose steroids. She is on prednisone, and now has had a significant stressor.

I can't post the whole answer because admin send me message because the copyright issue of q bank

I got a similar question, a very difficult question if you are not aware of the prednisone.
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