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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

  1. 1. Case presentation by : dr.Maria al-hosni R5
  2. 2. <ul><li>62 yr old woman with abdominal pain & diarrhea .seen in triage on Monday afternoon . </li></ul><ul><li>initial vitals : </li></ul><ul><li>Bp:100/50 mm Hg </li></ul><ul><li>Pr:77/min </li></ul><ul><li>Spo2:97% RA </li></ul>
  3. 3. <ul><li>kept in waiting area till provide a bed for her . </li></ul>
  4. 4. <ul><li>While waiting …………………….. </li></ul><ul><li>She collapses and became unresponsive </li></ul>
  5. 5. <ul><li>Taken quickly to resuscitation room </li></ul>
  6. 6. 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.
  7. 7. 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
  8. 8. <ul><li>General : unresponsive & warm </li></ul><ul><li>A :patent </li></ul><ul><li>B :no spontanous breathing </li></ul><ul><li>AMBU bag on going …….. </li></ul><ul><li>C :no femoral or carotid pulses </li></ul><ul><li>CPR initiated </li></ul><ul><li>Cardiac monitor </li></ul>
  9. 9. <ul><li>Wide complex regular tachycardia at 170BPM , tall t-wave . </li></ul>
  10. 10. <ul><li>V.Tach </li></ul>
  11. 11. Action….. <ul><li>Defib with 200J >>>> with sinus rhythm with wide QRS , weak carotid pulse. </li></ul><ul><li>Intubated( 7.5 ETT) </li></ul><ul><li>IV line initiated CBC, UE1, Ca, Mg, Phos, trop., VBG. </li></ul><ul><li>D x:7.2 mmol/l </li></ul>
  12. 12. <ul><li>Ca gluconate … </li></ul><ul><li>Insulin & glucose iv </li></ul><ul><li>NaHCO3 iv…. </li></ul><ul><li>BP:78/42 </li></ul><ul><li>PR:130/min </li></ul>
  13. 13. 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
  14. 14. S A M P L E <ul><li>S :1day h/o crampy abd. Pain ,watery , non bloody diarrhea X10 times over the Sunday night only . </li></ul><ul><li>No fever </li></ul><ul><li>No chills </li></ul><ul><li>No vomiting </li></ul>
  15. 15. <ul><li>A .nill </li></ul><ul><li>M .aspirin , lisinopril ,atenolol, amlodipine ,isosorbide mononitrate. </li></ul><ul><li>P .HTN , ESRD on hemodialysis 3X/week (Monday ,Wednesday,Friday).stable angina. </li></ul><ul><li>L .had her lunch and a juice while waiting in waiting room. </li></ul><ul><li>E .she used to be compliant with her Rx but she miss this Monday dialysis sett </li></ul><ul><li>setting. </li></ul>
  16. 16. <ul><li>Her 2 yrs old grandson was having gasteroenteritis 2 days before her symptoms start. </li></ul>
  17. 17. inves <ul><li>VBG:ph:7.30 ,pco2:32 , hco3:14 , po2:90 . </li></ul><ul><li>UE1:urea:33, Cr:977 , K:7.8 , Na:129 </li></ul><ul><li>CBC :HB :9.2 , wbc:16,000 </li></ul>
  18. 18. ACLS <ul><li>2005 ) New ): To treat cardiac arrest </li></ul><ul><li>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 ). </li></ul>
  19. 19. ACLS <ul><li>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 . </li></ul>
  20. 20. ACLS <ul><li>)2005 New ): The initial selected shock dose for adults is 150 J to 200 J for a biphasic waveform . </li></ul><ul><li>The second dose should be the same or higher ( Class IIa ). </li></ul>
  21. 21. ACLS
  22. 22. case1 <ul><li>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 : </li></ul><ul><li>A.metabolic alkalosis. </li></ul><ul><li>B.anion gap MA. </li></ul><ul><li>C. non-anion-gap MA. </li></ul><ul><li>D.respiratory acidosis. </li></ul><ul><li>E.respiratory alkalosis. </li></ul>
  23. 23. case 2 <ul><li>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 ? </li></ul><ul><li>A. epinephrine </li></ul><ul><li>B.lidocaine </li></ul><ul><li>C.electrical defibrillation </li></ul><ul><li>D.atropine </li></ul><ul><li>E.amiodarone </li></ul>

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