Yоu аre оn med surg. Yоur pаtient is а 58 year old man who is one day post knee replacement. He has been non-compliant with knee exercises and movement stating "too much pain". Height: 5'10" (178 cm) Weight: 210 lbs (95 kg) Medical History: Hypertension, Type 2 Diabetes Mellitus, Hyperlipidemia, Smoking (1 pack/day for 30 years), Family history of cardiovascular disease. Allegies: Cephalexin Medications: Metformin 500 mg BID, Lisinopril 20 mg daily, Atorvastatin 40 mg daily, Aspirin 82 mg daily, Lovenox 40mg daily The patient pushes the call bell and when you enter he states "my chest hurts". He appears anxious, pale, and diaphoretic. Blood Pressure; 160/95 Heart Rate: 110 beats per minute, regular Respiratory Rate: 22 breaths per minute Oxygen Saturation: 94% on room air Temperature: 98.6°F (37°C) The RAT arrives and begins to treat the patient. The 12 lead ECG shows a pattern of a left ventricular MI. A cardiac alert is called. The first nitro decreases the patient's chest pain from a 7/10 to a 6/10. His vitals supported repeat doses of nitro. He has had 3 doses of nitro, and 4mg of morphine. His chest pain is now 4/10. Blood Pressure; 144/88 Heart Rate: 106 beats per minute, regular Respiratory Rate: 20 breaths per minute Oxygen Saturation: 99% on oxygen Temperature: 98.6°F (37°C) Which of the following are priority interventions in preparing to transfer the patient to the cath lab? Choose ALL that apply.
Yоu аre wоrking in the ED. Yоur pаtient is а 79 year old female coming from a nursing home. She is complaining of cough, fever, altered mental status. EMS reports the nursing home has had a covid breakout. EMS reports the patient is currently on CPAP, RR 34, SaO2 84%, HR 126 ST, 12 lead negative for ST elevation, BP 100/66, glucose 246. On arrival the patient is nonverbal, with head bobbing, initial vital signs match the EMS reported. She nods her head in response to questions. The physician orders a stat ABG to determine status. The result is; Ph- 7.32, CO2- 32, HCO3- 15. On exam, your patient is pale, slightly diaphoretic, temperature is 38.5C. The patient is alert but does not speak. Nods when asked if she is short of breath. She remains on CPAP for the moment. IV access is obtained, labs drawn, chest Xray taken, repeat vitals are unchanged. Lung sounds are diminished. Patient history; admission to nursing home 6 days ago for rehab on hip replacement following a fall. History of osteoporosis, HTN, NIDDM, and COPD. Medications; alendronate (Fosamax), Lisinopril, Coreg, Glucophage, Albuterol Allergies; sulfa, penicillin BMP; BUN: 24 mg/dL (6- 20 mg/dl) CO2: 22 mmol/L (23- 29 mmol/L) Creatinine: 1.8 mg/dL (0.8- 1.2 mg/dL) Glucose: 268 mg/dl (64- 100 mg/dL) Serum chloride: 110 mmol/L (96 to 106 mmol/L) Serum potassium: 7.2 mEq/L (3.7 to 5.2 mEq/L) Serum sodium: 152 mEq/L (136 to 144 mEq/L) Serum calcium: 8.0 mg/dL (8.5 to 10.2 mg/dL Lactate- 3.7 mmol/L (0.5-2.2 mmol/L) Troponin- 0.2 (