tailieunhanh - Tình huống sản khoa - Tình huống 6

Tham khảo tài liệu 'tình huống sản khoa - tình huống 6', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 5 A 28-year-old woman is brought into the emergency room with a blood pressure of 60 40. The patient s husband states that she had 2 days of nausea and vomiting fever to 102 F and myalgias. On examination the patient appears lethargic and has mental confusion. Her skin has a sunburn-like rash diffusely. Auscultation of her heart reveals tachycardia. The lung examination demonstrates slight crackles at the lung bases. The abdomen is slightly tender throughout without any discernible masses. The uterus is nontender and the adnexa are normal to palpation. The laboratory evaluation reveals a hemoglobin level of 15 g dL. and a scrum creatinine of mg dL. What is the most likely diagnosis What is the next step in therapy 5 S CASE 1 I í i s OBSTETRICS AND I Y I I H I ANSWERS TO CASE 5 Toxic Shock Syndrome Suinuiurv A 28-year-okl woman has fever to 102 F myalgias vomiting hypotension confusion and a sunburn-like rash. She has evidence of hemoconcentration and renal insufficiency. Most likely diagnosis Toxic shock syndrome. Next step in therapy Isotonic intravenous fluids intravenous nafcillin monitor urine output and blood pressure and support blood pressure with dopamine if needed. Analysis Objectives 1. Recognize the manifestations of shock. 2. Understand that Staphylococcus aureus acting through an exotoxin causes toxic shock syndrome TSS . 3. Understand that aggressive fluid resuscitation and intravenous nafcillin or vancomycin arc fundamental in the treatment of TSS. Considerations The most significant issue for this patient is the hypotension since her blood pressure is 60 40. I ler mean arterial pressure is 47 mm Hg which is insufficient to maintain cerebral perfusion. Regardless of the etiology the blood pressure needs to be supported immediately. Because the patient has a fever of 102 E with the hypotension and no history of hemorrhage or pregnancy ectopic septic shock is the most likely diagnosis. rhe first step in resuscitation should therefore be .

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