Group 4 Scenario: Mr. MI has been admitted to the ICU after arriving to the ED...

Group 4 Scenario:

Mr. MI has been admitted to the ICU after arriving to the ED complaining of severe gastric pain for three days. He has a history of HTN, CAD, and GERD. He attempted to get relief from his symptoms by eating two rolls of TUMS per day. His wife talked him into coming to be seen this morning after he woke up sweating profusely and had SOB.

He was immediately moved to a room in the ED and a STEMI was found on EKG. 100% blockage was found in three vessels per heart catheterization. Angioplasty was unable to be performed due to the instability of the patient. Appropriate assessment was done and tPa was administered pending possible surgical intervention for a CABG.

Three hours after admission, the vital signs change to the following values:

BP 92/48 P 124 RR 26 T 99.0 Sat 93% Pain level 3/10

Norepinephrine is ordered at 4mcg/kg/min. Mr. MI has been weighed at 254 lbs.

Question 1: What form of shock is developing in your patient and what is your rationales?

Question 2: What is the pathophysiology of this type of shock? What anatomical structure do you suspect is involved?

Question 3: What other symptoms would you suspect with the process? Why would they occur?

Question 4: Besides CABG and PCI, what interventions would be considered for your patient?

Question 5: What is the pump setting you would need to provide the dosage ordered for the norepinephrine?

Solutions

Expert Solution

1.The patient is experiencing cardiogenic shock because the symptoms like profuse sweating , shortness of breath, tachycardia with hypotension, complete blockage

2.The anatomical structure which is involved is the heart or the cardiovascular system. The pathiophysiology of this type of shock is

Blockage of the blood vessels >>stops the blood supply to cardiac muscle >>decrease the function of the left ventricle >> low blood pressure ,tachycardia ,strain on heart>>death if untreated.

3.The other symptoms which can be expected are

Loss of consciousness,confusion ,dizziness due to decreased blood supply to brain
Decreased or not urine output die to no blood supply
The decreased blood supply can lead to loss of energy and bust temperature at the hands and feet making them cold to touch

4.The other interventions which is required are

MRI Brain to rule out any block in brain
Liver profile
Renal profile
Cardiac markers

Nightingale answered 1 year ago

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