Common Causes of Ward Emergencies

Question 1

What can cause hypotension?

Answer 1

Hypovolemia (iatrogenic, hemorrhage); sepsis; MI; cardiac dysrhythmia, hypoxia, false reading (e.g. wrong cuff size, arterial line twist or clot), PTX, PE, cardiac tamponade, medications (e.g. morphine)

Question 2

How do you act in the setting of hypotension?

Answer 2

ABCs, examine, recheck BP, IV access, IV bolus, labs (e.g. Hct), EKG, vital signs monitoring, CXR, supplemental O2, check medications/history, give IV antibiotics if sepsis likely, compress all bleeding sites

Question 3

What are the common causes of postoperative hypertension?

Answer 3

Pain (from catecholamine release), anxiety, hypercapnia, hypoxia (which may also cause hypotension), preexisting condition, bladder distention

Question 4

What can cause hypoxia or SOB?

Answer 4

Atelectasis, pneumonia, mucous plug, PTX, PE, MI, dysrhythmia, venous blood in ABG syringe, SAT% machine malfunction or probe malposition, iatrogenic (wrong ventilator settings), severe anemia, hypovolemia, low cardiac output, CHF, ARDS, fluid overload

Question 5

How do you act in the setting of hypoxia?

Answer 5

ABCs, physical exam, vital signs monitoring, supplemental O2, IV access, ABG, EKG, CXR

Question 6

What can cause mental status changes?

Answer 6

Hypoxia (until ruled out), hypotension (e.g. cardiogenic shock), hypovolemia, iatrogenic (narcotics, benzodiazepines), drug reaction, alcohol withdrawal, drug withdrawal, seizure, ICU psychosis, CVA, sepsis, metabolic derangements, intracranial bleeding, urinary retention in the elderly

Question 7

What are the signs of alcohol withdrawal?

Answer 7

Confusion, tachycardia, autonomic instability, seizure, hallucinations

Question 8

What are the causes of tachycardia?

Answer 8

Hypovolemia, third-spacing, pain, alcohol withdrawal, anxiety/agitation, urinary retention, cardiac dysrhythmia (e.g. sinoventricular tachycardia, AFib with rapid rate), MI, PE, beta-blocker withdrawal, anastomotic leak

Question 9

What are the causes of decreased urine output?

Answer 9

Hypovolemia, urinary retention, Foley catheter malfunction, cardiac failure, MI, ATN, ureteral or urethral injury, abdominal compartment syndrome, sepsis

Question 10

How do you act initially in a case of decreased urine output?

Answer 10

Examine, vital signs, check or place Foley catheter, irrigate Foley catheter, IV fluid bolus