Asuncion Assign 11 : Short Answer Questions: (50 points)

Case 1 :

12 year old female who was brought to the ER because of 5 days of vomiting and abdominal pain not able to take fluids for the past 2 days. Her review of system was unremarkable except for a weight loss of > 8 lbs for the past one month and have increased frequency of urination for the past 1 week. Denies any medical illness in past. Her vital signs are as follow: HR = 110/min , RR = 25-30/min , BP =110/58 , T = 98.5F , Pulse ox = 99% at Room air . A venous blood gas was obtained with following results : 7.21, pCO2 = 25, pO2 = 42 , HCO3 = 10 BE = - 12 and O2 sat = 70%. Dextrostix = 450. Developed an overall management plan based on the following questions:

  1. How do you interpret your blood gas ? (5 points)
  1. What are your differential diagnosis in this patient ?(5 points)
  1. Based on your differential diagnosis, what other clinical and diagnostic parameters do you requirefor your definite diagnosis ? (5 points)
  1. Outline your overall management plan for this patient (10 points)

Case 2 :

16 year old healthy male riding his ATV was hit by a moving car yesterday from pediatric trauma service. Trauma evaluation performed showed the following injuries: Multiple rib fractures, pulmonary contusion with bilateral pneumohemothoraces s/p bilateral chest tubes and a right femoral fracture s/p external fixation. CT scan of the head, spine, abdomen and pelvis did not reveal any fractures. He was intubated in the ER due to respiratory distress and remained intubated in the PICU due to severe chest injuries. Overnight, the patient have increased in oxygen and ventilatory requirements , decreasing urine output and hemodynamic instability

Review the PICU flow sheet and answer the following questions :

1)Define Shock Sates ? (5 pts)

2)Differentiate the different types of Shock by hemodynamic parameters and its management

(10 pts). Using the following :

I = increased D = decreased N = normal or no change

C O = cardiac output SVR = Systemic vascular resistance MAP = mean arterial pressure

CWP = capillary wedge pressure CVP = central venous pressure HR = heart rate

CO SVR MAP CWP CVP HR
Hypovolemic
Obstructive
Cardiogenic
Distributive
Early Sepsis
Late Sepsis
Neurogenic

3)What type of shock cause the patient’s deterioration overnight ? explain your reasoning

(5 points)

4)Outline your overall management plan for this patient – using organ system based: ( 15 points)

Patient D : Flow sheet