Dr Maria Case Presentaion March 2nd
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Dr Maria Case Presentaion March 2nd

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march 2nd

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Dr Maria Case Presentaion March 2nd Dr Maria Case Presentaion March 2nd Presentation Transcript

  • Case presentation by : dr.Maria al-hosni R5
    • 62 yr old woman with abdominal pain & diarrhea .seen in triage on Monday afternoon .
    • initial vitals :
    • Bp:100/50 mm Hg
    • Pr:77/min
    • Spo2:97% RA
    • kept in waiting area till provide a bed for her .
    View slide
    • While waiting ……………………..
    • She collapses and became unresponsive
    View slide
    • Taken quickly to resuscitation room
  • S A M P L e 2ry 1ry What do I see in front of me? A B C D E P(p-ox) I(IV) O (O2) M (monitor) BP HR RR Temp O2 sat Glucose ECG Physical exam (head to toe ) Labs CBC UE1,etc… Xrays Disposition by problem list 1. 2. 3. 4. 5. 6.
  • 1ry What do I see in front of me? A B C D E P(p-ox) I(IV) O (O2) M (monitor) BP HR RR Temp O2 sat Glucose ECG
    • General : unresponsive & warm
    • A :patent
    • B :no spontanous breathing
    • AMBU bag on going ……..
    • C :no femoral or carotid pulses
    • CPR initiated
    • Cardiac monitor
    • Wide complex regular tachycardia at 170BPM , tall t-wave .
    • V.Tach
  • Action…..
    • Defib with 200J >>>> with sinus rhythm with wide QRS , weak carotid pulse.
    • Intubated( 7.5 ETT)
    • IV line initiated CBC, UE1, Ca, Mg, Phos, trop., VBG.
    • D x:7.2 mmol/l
    • Ca gluconate …
    • Insulin & glucose iv
    • NaHCO3 iv….
    • BP:78/42
    • PR:130/min
  • S A M P L e 2ry 1ry What do I see in front of me? A B C D E P(p-ox) I(IV) O (O2) M (monitor) BP HR RR Temp O2 sat Glucose ECG Labs CBC UE1,etc… Xrays
  • S A M P L E
    • S :1day h/o crampy abd. Pain ,watery , non bloody diarrhea X10 times over the Sunday night only .
    • No fever
    • No chills
    • No vomiting
    • A .nill
    • M .aspirin , lisinopril ,atenolol, amlodipine ,isosorbide mononitrate.
    • P .HTN , ESRD on hemodialysis 3X/week (Monday ,Wednesday,Friday).stable angina.
    • L .had her lunch and a juice while waiting in waiting room.
    • E .she used to be compliant with her Rx but she miss this Monday dialysis sett
    • setting.
    • Her 2 yrs old grandson was having gasteroenteritis 2 days before her symptoms start.
  • inves
    • VBG:ph:7.30 ,pco2:32 , hco3:14 , po2:90 .
    • UE1:urea:33, Cr:977 , K:7.8 , Na:129
    • CBC :HB :9.2 , wbc:16,000
  • ACLS
    • 2005 ) New ): To treat cardiac arrest
    • associated with VF or pulseless VT, the 2005 guidelines recommend delivery of single shocks followed immediately by a period of CPR, beginning with chest compression ( Class IIa ).
  • ACLS
    • 2005 ( New ): The recommended dose for initial and subsequent shocks using monophasic waveform for treatment of VF/pulseless VT in adults is 360 J . For manual defibrillation .
  • ACLS
    • )2005 New ): The initial selected shock dose for adults is 150 J to 200 J for a biphasic waveform .
    • The second dose should be the same or higher ( Class IIa ).
  • ACLS
  • case1
    • A previously healthy 17 yrs old boy present to ED after 5 days of profuse watery diarrhea .which primary acid-base abnormalty would U expect :
    • A.metabolic alkalosis.
    • B.anion gap MA.
    • C. non-anion-gap MA.
    • D.respiratory acidosis.
    • E.respiratory alkalosis.
  • case 2
    • A 77 yr old pt in ED complains of episodes of palpitations & lightheadedness .she is triaged to a room , seen by the nurse , placed on oxygen & cardiac monitor , & is undergoing IV placement when suddenly becomes unresponsive .the monitor shows QRS complex that is regular at 150-200 bpm . U R unable to feel femoral or carotid pulse .which of the following is the first –line intervention ?
    • A. epinephrine
    • B.lidocaine
    • C.electrical defibrillation
    • D.atropine
    • E.amiodarone
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