An 8-year-old boy undergoes surgical repair of an atrial septal defect that was deemed too large to close in the cardiac catheterization lab. There are no intraoperative complications and he is transferred to the pediatric cardiac intensive care unit (PCICU) on minimal ventilatory and inotropic support. He is appropriately extubated the following day. Over the next 12 hours, the trend in his vital signs shows progressively worsening tachycardia and decreasing systolic blood pressure. The pressure reading from an indwelling central venous line is significantly higher than what it was upon his admission to the PCICU. His heart sounds are muffled, there are no murmurs present, and his neck veins appear to be distended. His peripheral pulses are 1+. A chest radiograph shows an enlarged cardiac silhouette and small bilateral pleural effusions. His vital signs are pulse 118 beats/min, respirations 30 breaths/min, blood pressure 86/68 mmHg, and central venous pressure 12 mmHg.Of the following, which is the best next step to improve this patient’s hemodynamics?

Atrial Septal defects are common, how does this happen?

After 6 hours, Rati was transferred to the surgical holding unit within ED, awaiting for surgical team's review. You noticed that she then became tachycardic (HR 100 bpm), hyperthermic (Temp 38.3) and hypotensive (98/65 mmHg). Explain why such vital signs arise.

An 83-year-old man is transferred to the hospital from his nursing home due to hypotension and confusion. He was previously well until yesterday morning, when the nursing staff observed that he seemed lethargic and spent the day in bed. Later that night, the staff tried to communicate with him but he was not oriented to place or time. His medical history is significant for hypertension, COPD, paroxysmal atrial fibrillation, and urinary incontinence requiring a urethral catheter. He is compliant with medications, has no recent medication changes, and has no sick contacts. On examination, his temperature is 35.4°C, his blood pressure is 68/44 mmHg, his heart rate is 88 beats per minute, and his respiratory rate is 18 breaths per minute. He is lethargic with flat neck veins; his cardiac examination is normal. His lungs are clear to auscultation, and there is no significant abdominal tenderness. His neurologic examination is normal, and his extremities are warm and well perfused. His laboratory values are significant for a leukocyte count of 13,500/mm3 and a serum lactate of 3.9 mmol/L (normal range 0.6 to 2.3 mmol/L). A urinalysis shows significant pyuria. A chest x-ray shows hyperinflated lungs but no focal opacities. Which of the following is the most appropriate next step in management?

A 45-year-old woman presented with exertional dyspnea. Fourteen years earlier the patient was diagnosed with arterial hypertension with a blood pressure of 170/105 mm Hg. Her blood pressure at presentation was 155/95 mm Hg. Physical examination was remarkable for lower-extremity edema, and abdominal enlargement due to ascites. Transthoracic echocardiogram showed left ventricular ejection fraction of 28% (reference range: 50-57%). Which of the following is the patterns of cardiac failure seen in this patient?

The first-line treatment for a patient with ventricular tachycardia with a pulse is:*1 pointa) Defibrillationb) Administering amiodaronec) Cardiac catheterizationd) Administering atropine