Vol 2:5 Answer

The Question
The answer is c.
This patient is in cardiogenic shock from decreased cardiac output producing inadequate tissue perfusion. Support for this diagnosis includes an older patient with a history of coronary artery disease, with new mental status changes coupled with signs of volume overload. Common causes of cardiogenic shock include acute myocardial infarction, pulmonary embolism, COPD exacerbation, and pneumonia. This patient should be stabilized with intravenous pressors since there is already pulmonary congestion evident on exam. A rapid workup including ECG, CXR, laboratory tests, echocardiogram, and hemodynamic monitoring should help confirm the etiology and direct specific treatment of the underlying cause.

Hypovolemic shock (a) occurs when there is inadequate volume in the circulatory system, resulting in poor oxygen delivery to the tissues. Neurogenic shock (b) occurs after an acute spinal cord injury, which disrupts sympathetic innervation resulting in hypotension and bradycardia. Anaphylactic shock (d) is a severe systemic hypersensitivity reaction resulting in hypotension and airway compromise. Septic shock (e) is a clinical syndrome of hypoperfusion and multi-organ dysfunction caused by infection.

Don't forget to give this week's VizD a try.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training. For more information please refer to the following link.