A confused 90 year old female is supine in bed. She answers questions inappropriately. The room is very warm and her skin is hot and dry. She has been incontinent of urine and has poor skin turgor. Vital signs are BP 82/30, P 110, R 18, SpO2 97%. What should you do?

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Multiple Choice

A confused 90 year old female is supine in bed. She answers questions inappropriately. The room is very warm and her skin is hot and dry. She has been incontinent of urine and has poor skin turgor. Vital signs are BP 82/30, P 110, R 18, SpO2 97%. What should you do?

The main idea is that this patient is in hypovolemic shock from volume depletion due to dehydration. Signs like hot, dry skin, poor skin turgor, incontinence, and especially the very low blood pressure with tachycardia point to reduced intravascular volume and poor perfusion. In this situation the priority is to restore circulating volume quickly with an IV fluid bolus using isotonic crystalloids (for example normal saline), and to reassess frequently. Administering an IV fluid bolus helps increase preload, improve cardiac output, and raise blood pressure, addressing the root cause of the shock. In a 90-year-old, you’d typically give a crystalloid bolus and monitor response, adjusting as needed and watching for signs of fluid overload or underlying conditions. Delirium tremens isn’t the most likely cause given the presentation (no tremors or other DT features described) and would not be addressed by fluids alone. Cooling measures are for overheating or heat stroke and aren’t indicated here without evidence of hyperthermia. Antibiotics would treat infection but won’t rapidly correct the shock from dehydration.

The main idea is that this patient is in hypovolemic shock from volume depletion due to dehydration. Signs like hot, dry skin, poor skin turgor, incontinence, and especially the very low blood pressure with tachycardia point to reduced intravascular volume and poor perfusion. In this situation the priority is to restore circulating volume quickly with an IV fluid bolus using isotonic crystalloids (for example normal saline), and to reassess frequently.

Administering an IV fluid bolus helps increase preload, improve cardiac output, and raise blood pressure, addressing the root cause of the shock. In a 90-year-old, you’d typically give a crystalloid bolus and monitor response, adjusting as needed and watching for signs of fluid overload or underlying conditions.

Delirium tremens isn’t the most likely cause given the presentation (no tremors or other DT features described) and would not be addressed by fluids alone. Cooling measures are for overheating or heat stroke and aren’t indicated here without evidence of hyperthermia. Antibiotics would treat infection but won’t rapidly correct the shock from dehydration.

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