每日一题_2022.4.9

A 24-year-old man is involved in a motor vehicle collision. He is following commands. Head and cervical spine CT is negative, chest radiograph is normal, focused assessment with sonography in trauma (FAST) and extended FAST examinations are normal. Hemoglobin is 9.1 g/dL, base deficit is -8 mmol/L, and lactic acid level is 4.5 mmol/L. He is transferred to the ICU, where his mean arterial pressure is 51 mm Hg. On focused echocardiography, his inferior vena cava is 1.4 cm with greater than 50% collapsibility and left ventricular walls are touching on parasternal long-axis view.

Which of the following is the most likely cause of shock?

A. Heart failure

B. Infection

C. Hypovolemia

D. Spinal cord injury

答案解析：

近年来，超声检查，特别是超声心动图，因其便携性、无创性和必要时可重复多次而在重症监护医师中变得更加流行。缺点包括操作者依赖性和需要大量培训，因为结果低估或高估可能导致错误治疗。

在该患者中，超声心动图结果反对心力衰竭，因为他保留了收缩力。考虑到临床情况，不太可能发生感染。他的血流动力学和超声心动图结果显示血容量减少。考虑到创伤检查和胸片中超声检查的正常重点评估，可能的出血来源包括腹膜后血肿或长骨骨折失血。

正确答案：C