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Vern, suffering from cardiac arrhythmias, is brought into theemergency room of a hospital. In the emergency room he begins toexhibit tachycardia and as a result loses consciousness. Hisanxious wife asks you why he has lost consciousness. Explain to herwhat might be causing the tachycardia and what the consequencesmight be.

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Collen Von
Collen VonLv2
28 Sep 2019

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Related questions

CRITICAL CARE SERVICE
Dr. Sutton, emergency room physician, called in Dr. Elhart, the cardiologist on call from the local clinic, to provide critical care services to Linda Paulo. Code the services provided by Dr. Elhart in the following case.
LOCATION: Hospital Emergency Department
PATIENT: Linda Paulo
PHYSICIAN: Marvin Elhart, MD
The patient is a 23-year-old Hispanic female who took some medications to sleep tonight, including what sounds like amitriptyline and Hydrocodone. She called her husband, who came over at approximately 9:30 tonight. She slept for an hour until 10:30, and then she started having generalized seizures on and off four times, during which her husband called 911. Paramedics were on the scene in 4 to 5 minutes. The patient was immediately intubated. Monitor showed wide QRS (Q-wave, R-wave, S-wave) complexes. She received bicarbonate and was sent to the emergency room. I saw her with Dr. Sutton in the emergency room. She was actively seizing. She received multiple doses of Ativan, and then I gave her around 20 mg (milligram) of Versed and started a Versed drip. She was on a bicarbonate drip, and we gave her multiple amps of bicarbonate. Her QRS narrowed down. Unfortunately, this did not last long. The patient went bradycardic and then went into a junctional rhythm. Her blood pressure was dropping on occasion and then coming back up again. She eventually coded. We resuscitated her for more than 20 minutes. She had multiple rhythm problems including asystole, ventricular tachycardia, and pulseless electrical activity. She received multiple doses of epinephrine and multiple amps of sodium bicarbonate. She eventually recovered back in sinus rhythm after defibrillation for ventricular tachycardia.
Her ABGs (arterial blood gases) initially were pH (potential of hydrogen) 74.8 and PCO2 (partial pressure of carbon dioxide) 28. Oxygen was around 500 on 100% FiO2 (forced inspiration oxygen) with a bicarb of 18. Her bicarb went up to 23 at the end of the code when she was in sinus rhythm. She was transferred up to the floor with three IVs (intravenous) running at 999.
On the floor, her blood pressure dropped again to 50. She went bradycardic and coded. She received at least two shocks. She received again multiple doses of epinephrine and received multiple sodium bicarbonate amps, at least eight.
Discussions were held with the husband multiple times since admission with Dr. Sutton and myself. I brought him to the room while the patient was getting CPR (cardiopulmonary resuscitation) the second time. After 20 minutes, the patient was having no cardiac activity whatsoever, and after 20 minutes decided to stop CPR after discussing this with her husband.
DISCHARGE DIAGNOSIS: Cardiac arrest, tricyclic antidepressant, resulting in severe neural and cardiac toxicity and eventually resulting in death.
Time spent with patient was 120 minutes.

T1-1B:
SERVICE CODE(S): ___________________________________________________
ICD-10-CM DX CODE(S): ______________________________________________
ICD-9-CM DX CODE(S): _______________________________________________

Dale Fremore was back home after spending the day at a picnic where he ate some "spoiled" potato salad. He developed severe abdominal pain and cramps, vomiting, and diarrhea. After about 10-12 episodes of watery diarrhea, Mr. Fremore became so pale and weak he could hardly walk. His wife took him to the hospital where he was diagnosed with severe dehydration (decreased plasma volume). Mr. Fremore was suffering from shock. Explain what happens to cardiac output, urine output, pulse pressure and blood pressure of Mr. Fremore. Would the respiratory system be affected and if so, how? Would the immune system be activated, why or why not? Answers must be to the cellular level

According to the patient's previous medical history, it is possible that he has cirrhosis of the liver? Why? Can cirrhosis of the liver be a cause of upper digestive bleeding? What is the prognosis? Explain.

Personal Information

Name: Mr. Christopher Franklin

Age: 60 years old

Gender: Male

Description

Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke, he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.

Mr. Franklin has been suffering from epigastric pain, the sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.

The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer’s disease and died of colon cancer, and his father died of cirrhosis of the liver.

On physical examination we found:

Remarkable Signs on Physical by Regions

Abdomen: Pain on palpation on epigastric region

SOMA: Right hemiplegia and hyperreflexia

Remarkable Signs on Physical by Systems

Integumentary system: Pallor, diaphoresis, coldness

Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.

Digestive system: Tenderness of epigastric region. A rectal exam showed melena.

Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia.

Lab Tests

Complete blood count (CBC)

Metabolic panel

Lipid panel

Abdominal CT scan

Esophagogastroduodenoscopy

Main Diagnosis

Upper digestive bleeding due to drug-induced gastritis

Hypovolemic shock

Acute anemia

Other Diagnoses

Stabilized thrombotic cerebrovascular accident

Epilepsy

Essential hypertension

Ulcerative colitis

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