Which of the following physiologic changes caused by aging is the ...

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Which of the following physiologic changes caused by aging is the most likely contributor to the high mortality rate in older trauma patients compared with younger trauma patients?
 
  a. Deterioration of cerebral and motor skills
  b. Poor vision and hearing
  c. Diminished pain perception
  d. Limited cardiovascular physiologic reserve in the elderly

Question 2

A patient with multisystem trauma has been in the ICU for 6 days after sustaining a closed head injury, a right-sided pneumothorax, right rib fractures, a grade IV liver laceration, a pancreatic contusion, and a right acetabular fracture
 
  The patient is still intubated and mechanically ventilated and has a chest tube, Foley catheter, and two abdominal drains. The patient's hemodynamic assessment reveals the following values: BP, 94/66 mm Hg; HR, 118 beats/min; T, 38.7  C; CVP, 5 cm H2O; wedge pressure, 6 mm Hg; cardiac index, 6.1; and systemic vascular resistance, 450 dynes/sec. What is the most likely cause of this hemodynamic picture?
 
  a. Septic shock
  b. Hemorrhagic shock
  c. Cardiogenic shock
  d. Neurogenic shock

[duy1981999]

Answer to Question 1

D
Older adults have limited ability to increase their heart rate in response to blood loss, obscuring one of the earliest signs of hypovolemiatachycar dia. Loss of physiologic reserve and the presence of pre-existing medical conditions are likely to produce further conflicting hemodynamic data. An older patient's lack of physiologic reserve makes it imperative that early nutritional support is initiated.

Answer to Question 2

A
The patient with multiple injuries is at risk for overwhelming infections and sepsis. The source of sepsis in the trauma patient can be invasive therapeutic and diagnostic catheters or wound contamination with exogenous or endogenous bacteria. The source of the septic nidus must be promptly evaluated. Gram stain and cultures of blood, urine, sputum, invasive catheters, and wounds are obtained.

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Correct answers!

[duy1981999]

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