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An 82 yo F is admitted to the ICU following an open AAA repair using suprrenal aortic cross clamping. In the first hour of ICU admission, her urine output is only 10 mL. After administration of furosemide, urine output increases to 100 mL/hr. Urine sodium concentration is 45 mEq/L and urine osmolality is 210 mOsm/L. The most likely cause of the initial oliguria is:
Fluoride toxicity
Mechanical obstruction of the urinary catheter
ATN
Increased ADH
Impossible to differentiate
Oliguria associated with urine sodium concentrations > 40mEq/L and urine osmolality < 400 mOsm/L strongly suggests intrinsic renal disease (ATN), whereas prerenal causes typically have urine sodium concentrations < 20 mEq/L and urine osmolality > 400 mOsm/L
Fluoride may hypothetically be seen with Sevo
A 42 yo F is admitted to the ICU with septic shock. BP = 90/45. PA catheter reads 25/10. CO is 11. PA occlusion pressure is 10. CVP is 5.
SVR is equal to which of the following?
0.3 Wood units
3.6 Wood units
5 Wood units
5.5 Wood units
SVR = (MAP - CVP)/CO
MAP = (90 + 2*45)/3 = 60
(60-5) / 11 = 5
A 74 yo M is admitted for elective AAA. BP = 170/110. PA pressure = 36/12. PA occlusion pressure = 15. CO is 4. CVP is 10.
What is his PVR and SVR?
PVR = 1.25, SVR = 15
PVR = 1.25, SVR = 30
PVR = 1.25, SVR = 32.5
PVR = 5.25, SVR = 30
PVR = (PA mean - LAP)/CO
LAP is approximately PAOP
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