A patient is brought to the ED after being struck by a baseball to the chest. The physician suspects a cardiac tamponade based on hypotension muffled heart sounds, and distended jugular veins. What is the primary intervention for this patient?
Administer a stat fluid challenge
Place the patient in a prone position
Draw a stat CBC
Perform a stat pericardiocentesis
The Correct Answer is D
A. Administer a stat fluid challenge: This might temporarily improve cardiac output in tamponade, but it is not the primary intervention. The fluid challenge may be used as a temporary measure, but it does not address the underlying cause.
B. Place the patient in a prone position: This is incorrect and could worsen the patient's condition. The patient should be in a semi-recumbent position to decrease venous return and reduce pressure on the heart.
C. Draw a stat CBC: A CBC is not relevant to the immediate management of cardiac tamponade and does not address the urgent need to relieve the pressure on the heart.
D. Perform a stat pericardiocentesis: Pericardiocentesis is the definitive treatment for cardiac tamponade, as it removes the fluid from the pericardial space, relieving the pressure on the heart and allowing it to function properly.
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Related Questions
Correct Answer is C
Explanation
A. Decreases contractility: This is incorrect because ACE inhibitors do not directly affect myocardial contractility. They primarily work on the vascular system.
B. Increases preload: This is incorrect as ACE inhibitors do not increase preload. They may decrease preload by reducing fluid retention.
C. Decreased afterload: ACE inhibitors lower systemic vascular resistance (afterload) by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces the workload on the heart.
D. Increases sympathetic stimulation: This is incorrect because ACE inhibitors actually reduce sympathetic stimulation by preventing the vasoconstrictive and sodium-retaining effects of angiotensin II.
Correct Answer is A
Explanation
A. Pulmonary crackles/rales: Left-sided heart failure leads to a buildup of fluid in the lungs, causing pulmonary congestion and crackles/rales on auscultation.
B. Weight gain: This is more commonly associated with right-sided heart failure due to fluid retention, though it can be seen in both types of heart failure.
C. Hepatomegaly: Hepatomegaly is typically associated with right-sided heart failure due to congestion in the systemic circulation.
D. Jugular vein distention: JVD is a sign of right-sided heart failure, as it indicates increased central venous pressure.
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