Surgery>>>>>Shock
Question 9#

A patient has a blood pressure of 70/50 mm Hg and a serum lactate level of 30 mg/100 mL (normal: 6-16). His cardiac output is 1.9 L/min, and his central venous pressure is 2 em H₂O. The most likely diagnosis is:

A. Congestive heart failure
B. Cardiac tamponade
C. Hypovolemic shock
D. Septic shock

Correct Answer is C

Comment:

The findings given in the question are characteristic of hypovolemic shock, which can be defined as inadequate tissue perfusion secondary to an extracellular fluid loss. The high lactate level is a result of anaerobic metabolism due to decreased blood flow to tissues. The hemodynamic measurements indicate both low blood flow and low venous return. The total combination is most consistent with a diagnosis of hypovolemic shock. Pulmonary embolus, congestive heart failure, and cardiac tamponade are all associated with a high central venous pressure. Septic shock, particularly in its early phases, is usually hyperdynamic, and affected patients have a greater-than-normal cardiac output. Complete hemodynamic monitoring is vital in hypovolemic shock so that prompt diagnosis and rational therapy can be expeditiously carried out.