Stage Presentation
Transcript: May, 8, 2017 Picking Up the Pace Montreal General Case Presentation 12:25 , March 27, 2017 Daughter called Mother c/o dizziness & weakness Patient Vital Signs Vital Signs BP: 116/77 O2 Saturation 99% RA RR: 26/min HR: 24bpm Upon arrival of paramedics BGL: 7.1 Vital Signs BP: 97/58 O2 Saturation 97% HC RR: 24/min HR: 28bpm In the Trauma Room BGL: 7.0 ER Vital Signs Patient's History Diabetes Mellitus II Chronic Renal Injury Hyperlipidemia Hypertension Upon arrival of paramedics History Patient's Allergies Naproxen Pantoprazole Acetaminophen Codeine & oxycodone Upon arrival of paramedics Allergies Past Surgeries Dialysed Oophorectomy Hysterectomy Upon arrival of paramedics Medical HX Pathophysiology Symtomatic Sinus Bradycardia with Atrial Fibrillation Pathophysiology Natural Pacemakers (SA, AV, Bundle of His, L & R branch, Purkinje fibers) Disruption of the normal electrical rhythm controlling HR Weakness, dizziness, diaphoresis, syncope Dependent on the underlying cause and is usually a secondary finding Hospital Hospital Treatment Ensure the stability of the patient's condition Unstable: ET intubation & transcutaneous (pads) or tranvenous pacing (drugs) Stable: Know the underlying cause of the symptoms and treat. Pathophysiology Pathophysiology A-Fib is a rapid, irregular heart rhythm Usually the result from multiple electrical discharges communicating with the AV node causing an inconsistent and irregular ventricular depolarization. A-fib is when the atrias are not contracting in relation to the ventricles due to the numerous reentry of electrical impulses within the atrias. Palpitations, weakness, dyspnea, light-headedness, For some, it may be asymptomatic. Hospital Treatment Hospital Treatment Brought to the ED. Blood sample was taken which revealed high levels of troponin, very high levels of potassium, low chloride, bicarb and hemoglobin levels. They went straight to transcutaneous pacing because it was a Type II second degree AV block. Drugs will not work. They administered Isuprel, calcium chloride, sodium bicarbonate, ventolin and insulin. The staff then brought her to the EP lab where the patient received a portable pacemaker. Pre-Hospital Treatment APP. MED. 1 MED. 2 MED. 3 MED. 5 MED. 15 MED. 16 MED. 17 REA. 1 REA. 7 TECH. 6 TECH. 9 TECH. 10 TECH. 11 Pre-Hospital