Under Pressure
Multisystem Processes & Disorders
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M13_F1.jpg"}},{"insert":"\n\n"},{"insert":"The ER has its highs and lows. Today seems to be an in-between. Not too busy, and not too quiet. Just the right amount of work to keep you occupied and interested.\n\nFeeling like a medical Goldilocks, you take a look at the next patient.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M13_F2.jpg"}},{"insert":"\n\n"},{"insert":"Sixty-five year old Mr. Banks has a history of hypertension, depression, and chronic pain from failed back surgeries for lumbar radiculopathies.\n\nHis wife (who is a nurse) found him lying unresponsive by the side of his bed, about 20 minutes ago, soon after she returned from her night shift.\n\nShe checked his ABCs and thought that she noted a faint pulse and shallow breaths.\n\nShe immediately called emergency services, and went back to her husband.\n\nAt this point, she felt that he didn\u0027t have a pulse and was becoming slightly cyanosed.\n\nThus, she started CPR with 30 compressions and two breath cycles.\n"}]}
2
{"ops":[{"insert":"The emergency team arrived quickly and took over, starting bag and mask ventilation.\n\nThey noted a faint pulse of about 120 beats per minute. His respiratory rate was very low, so they continued bagging to keep the oxygen saturation above 95%.\n\nHis systolic blood pressure was 68 mmHg, and both pupils were normal and reactive to light.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M13_F4.jpg"}},{"insert":"\n\n"},{"insert":"The paramedics also secured his spine, and started IV fluids en-route. His capillary glucose was found to be 78 mg\/dL.\n\nThey also noted that he was responsive to pain, but not to verbal commands.\n\nAlthough obviously distressed, Mrs Banks tries to maintain her composure and provides her husband\u0027s medical history and medication list.\n\nHe is on Hydrocodone + Acetaminophen 10\/325 mg QID, Morphine ER 30mg BID, Lisinopril 40 mg daily, Duloxetine 60 mg BID, and Ranitidine 150 mg prn.\n\nThere is no history of diabetes, recent changes in his medication, or suicidal ideation.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M13_F5.jpg"}},{"insert":"\n\n"},{"insert":"Currently, Mr. Banks is still being bagged, but has good color.\n\nHis vitals are as follows: temperature: 37.8 \u02daC (100.2 \u02daF), pulse 100 bpm, blood pressure 80\/50 mm Hg, O2 saturation 98%.\n\nExamination shows a older man with an average build who is obtunded while being bagged.\n\nHis heart exam shows a normal rhythm, without murmurs or gallops, and no edema in the extremities. His lungs sound clear bilaterally, and the abdomen is nontender.\n"}]}
5
{"ops":[{"insert":"What do you do now?\n"}]}
1. Put the patient on a ventilator, and get a chest x-ray
2. Give Naloxone 1 mg IV
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