Case Case presentationpresentation

Case Case presentationpresentation

by : dr.Maria al-hosniby : dr.Maria al-hosni

R5R5

• 62 yr old woman with abdominal pain & diarrhea .seen in triage on Monday afternoon .

initial vitals :Bp:100/50 mm HgPr:77/min Spo2:97% RA

kept in waiting area till provide a bed for her .

While waiting ……………………..

She collapses and became unresponsive

Taken quickly to resuscitation room

S

A

M

P

L

e

2ry1ryWhat do I see in

front of me?

ABCDE

P(p-ox) I(IV) O (O2) M (monitor)

BPHRRRTempO2 satGlucose

ECG

Physical exam (head to toe )

Labs

CBCUE1,etc…Xrays

Disposition by problem list1.2.3.4.5.6.

1ryWhat do I see in

front of me?

ABCDE

P(p-ox) I(IV) O (O2) M (monitor)

BPHRRRTempO2 satGlucose

ECG

• General : unresponsive & warm • A:patent• B:no spontanous breathing• AMBU bag on going ……..

• C:no femoral or carotid pulsesCPR 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.• Dx:7.2 mmol/l

• Ca gluconate …• Insulin & glucose iv • NaHCO3 iv….

• BP:78/42• PR:130/min

S

A

M

P

L

e

2ry1ryWhat do I see in

front of me?

ABCDE

P(p-ox) I(IV) O (O2) M (monitor)

BPHRRRTempO2 satGlucose

ECG

Labs

CBCUE1,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