MultisystemDifficulty 3/5
A patient has warm extremities, a wide pulse pressure, systemic vascular resistance of 480 dynes/sec/cm-5, a cardiac index of 4.8 L/min/m2 and a rising lactate. Which intervention is most appropriate?
- AStart an inotrope to improve a failing cardiac output
- BFluid resuscitation and a vasopressor to restore perfusion pressure
- CGive a diuretic to relieve vasodilation and reduce preload
- DStart a beta blocker to control the compensatory tachycardia
Show answer and rationale
Correct: B. This is distributive shock: low systemic vascular resistance with a high cardiac index and tissue hypoperfusion. Treatment restores intravascular volume and vascular tone; the pump is not the problem.
- A — Cardiac index is already high, so inotropy is not the deficit.
- C — Diuresis worsens hypoperfusion in a vasodilated patient.
- D — Beta blockade removes a compensatory mechanism and worsens shock.