patient’s history and physical should be treated first. This patient has an AV
graft indicating that he has a history of renal disease. Since patients with
end-stage renal disease are at risk for hyperkalemiaand since hyperkalemia
can cause PEA, calcium gluconateshould be given first to stabilize the car-
diac membranes.
If the patient does not improve with calcium, sodium bicarbonate
(a) could be given to treat for metabolic acidosis and 50% dextrose (c) can
be given for suspected hypoglycemia. Cardiac tamponade is a possible eti-
ology in a patient with renal disease and pericardiocentesis (e) can be
attempted if the patient is not improving with the above treatments. A bed-
side ultrasound may also be helpful to look for right ventricular collapse or
other signs of tamponade. Pneumothorax is a less likely etiology in this
particular patient. It is treated with a (d)chest tube.
198.The answer is e.(Tintinalli, pp 231-237.)Septic shockis a clinical
syndrome of hypoperfusion, hypotension, and multiorgan dysfunction
caused by infection.This patient is clearly in shock with hypotension,
tachycardia, tachypnea, and acute mental status changes. He also has fever
and pus in his urine, making a urine infection the likely source of infection.
He requires immediate hydration, broad-spectrum antibiotics, possible
intubation, pressors, and admission to the intensive care unit. Remember,
elderly patients with comorbid conditions, such as diabetes are more prone
Shock and Resuscitation Answers 225PEA Etiologies and Treatments
H’s Tx T’s TxHypovolemia IV fluids Toxins Antidotes
Hypoxia Ventilation Tamponade (cardiac) Pericardiocentesis
Hydrogen ion Sodium Tension Tube thoracostomy
(acidosis) bicarbonate pneumothorax
Hypokalemia KCl, calcium Thrombosis Thrombolysis
and (coronary and
Hyperkalemia pulmonary)
Hypoglycemia Dextrose Trauma IV fluids
(hypovolemia and
increased ICP)
Hypothermia Warming