Common Causes of Ward Emergencies, C23 P156-158

Question 1

What can cause hypotension?

P156

Answer 1

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

Question 2

How do you act?

P157

Answer 2

ABCs, examine, recheck BP, IV access, IV bolus, labs (e.g., HCT), EKG, pulse ox/vital signs monitoring, CXR, supplemental oxygen, check medications/history, give IV antibiotics “stat” if sepsis likely, compress all bleeding sites

Question 3

What are the common causes of postoperative hypertension?

P157

Answer 3

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

Question 4

What can cause hypoxia/shortness of breath?

P157

Answer 4

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

Question 5

How do you act?

P157

Answer 5

ABCs, physical exam, vital signs/pulse oximetry monitoring, supplemental oxygen, IV access, ABG, EKG, CXR

Question 6

What can cause mental status change?

P157

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?

P157

Answer 7

Confusion, tachycardia/autonomic instability, seizure, hallucinations

Question 8

What are the causes of tachycardia?

P157

Answer 8

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

Question 9

What are the causes of decreased urine output?

P158

Answer 9

Hypovolemia, urinary retention, Foley catheter malfunction, cardiac failure, MI, acute tubular necrosis (ATN),
ureteral/urethral injury, abdominal compartment syndrome, sepsis

Question 10

How do you act initially in a case of decreased urine output?
P158

Answer 10

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