Case: 45 year old patient with R BKA and L knee disarticulat…

Case: 45 year old patient with R BKA and L knee disarticulation from and on the job accident where he was trapped behind the truck bumper and the wall of a wash out stall. No other internal injuries noted. Patient transferred to in patient rehab once medically stable. PT POC includes patient education, stump care, TE, TA, balance, functional mobility, stump care, and pre-prosthetic training.Of the following, what would be the most appropriate TE intervention plan?

A 78-year old female with severe aortic stenosis presents to…

A 78-year old female with severe aortic stenosis presents to the ICU following a transcatheter aortic valve replacement (TAVR). Preprocedural transthoracic echocardiography demonstrated severe aortic stenosis with left ventricular hypertrophy and an asymmetric septal bulge. Left ventricular wall thickness in the parasternal short axis view is 1.6 cm with a small cavity. Postoperatively, the patient develops sudden onset hypotension requiring vasopressor support; however, blood pressure continues to decrease despite escalating doses of norepinephrine. The vital signs are heart rate 94 bpm, blood pressure 85/54 mm Hg, respiratory rate 18/min. Transthoracic echocardiography demonstrates an underfilled left ventricle with midventricular obstruction.  What is the most appropriate next step in management?

A patient is transferred to the ICU with a blood pressure of…

A patient is transferred to the ICU with a blood pressure of 90/60 mmHg, oxygen saturation of 85%, oliguria, and diffuse crackles. Pulmonary artery catheter readings reveal a cardiac output of 1.9 L/min. and a wedge pressure of 24 mmHg.  Which IV medication is appropriate to prescribe?

A patient being seen for adhesive capsulitis of the right sh…

A patient being seen for adhesive capsulitis of the right shoulder has completed her exercises and is placed on ice to assist with inflammation and pain. After approximately 5 minutes on ice the complains of pain in her hand. The PTA notes a significant color change in the hand described as red/purple with blanching in the fingers. What is the best course of action?

A 26-year-old woman with no prior medical history presents t…

A 26-year-old woman with no prior medical history presents to the emergency department (ED) with progressively worsening dyspnea for 1 week. Her symptoms are preceded by 3 days of fever, rigors, and nasal congestion. She is afebrile with HR of 116 beats/min and BP of 92/70 mmHg. Physical examination reveals bilateral rales, elevated jugular venous pressure, 2/6 systolic murmur at the left lower sternal border, cool extremities, and 2+ bilateral lower extremity edema. Echocardiogram reveals LVEF of 20%, nondilated LV (LV end-diastolic diameter of 3.4 cm), global hypokinesis, mild mitral regurgitation, and a normal right ventricular function. Labs are significant for creatinine of 1.6 mg/dL, aspartate aminotransferase (AST) of 385 U/L, alanine aminotransferase (ALT) of 413 U/L, troponin I of 4.8 ng/mL, and serum lactic acid of 2.8 mmol/L. Intravenous diuretics and dobutamine are initiated. Within 24 hours of admission, the patient develops hypotension and worsening heart failure refractory to inotropes and vasopressors. Urine output is 125 cc in the last 6 hours.  Which of the following is the best next step in her management to stabilize her?

A 60-year-old male with a history of nonischemic dilated car…

A 60-year-old male with a history of nonischemic dilated cardiomyopathy is admitted to the intensive care unit after presenting to the emergency department with several days of progressive dyspnea and lower-extremity swelling. He is found to be hypotensive and tachycardic and on examination is noted to be confused with edematous, cool extremities. A 12-lead ECG shows rapid atrial fibrillation with nonspecific ST-segment changes. His last transthoracic echocardiogram performed 1 year ago showed a severely dilated LV cavity with a left ventricular ejection fraction of 28%, severe mitral regurgitation, moderate aortic insufficiency, and severe tricuspid regurgitation.  In this patient, which of the following represents a contraindication to the use of an intra-aortic balloon pump (IABP)?