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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Discuss possible causes for cardiac arrest.

  • Outline medications used to treat cardiac arrest.

  • List the pharmacologic actions of medications used in cardioversion.

  • Outline the Advanced Cardiac Life Support (ACLS) guidelines.

  • Identify appropriate parameters to monitor a patient who has been returned to spontaneous circulation.

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PATIENT PRESENTATION

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Chief Complaint

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“I feel like I can’t breathe.”

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HPI

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Beatrice (“Bee”) A. Hart is a 68-year-old female who presented to the emergency department Monday morning with shortness of breath and weakness. She reports these symptoms along with a decreased oral intake beginning Thursday last week, which ultimately led to her missing her scheduled dialysis session prior to the weekend.

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PMH

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  • ESRD requiring hemodialysis Monday, Wednesday and Friday

  • Endometriosis

  • HTN

  • Dyslipidemia

  • Type 2 DM

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PSH

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Hysterectomy in 1985

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FH

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Mother had HTN and died of an AMI at age 69; no information available for father; one brother is alive with HTN and DM at age 73.

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SH

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Smoker; quit 8 years ago; previously 1.5 ppd

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Meds PTA

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  • Atorvastatin 20 mg PO daily

  • Metoprolol 50 mg PO twice daily

  • Sevelamer 800 mg PO TID with meals

  • Lisinopril 20 mg PO daily

  • Epoetin Alfa 10,000 units SC three times a week

  • Insulin glargine 40 units SC daily

  • Insulin lispro 5 units SC with meals

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All

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Sulfa

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ROS

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Difficulty breathing

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Physical Examination

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Gen
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White woman

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VS
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BP 98/60, P 112, RR 24, O2 saturation 81% on 4L NC; T 37.9°C; dry weight 90 kg; height 162.5 cm

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Skin
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Cold

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HEENT
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PERRLA; EOMI; arteriolar narrowing on funduscopic exam; no hemorrhages, exudates, or papilledema; oral mucosa clear

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Neck/Lymph Nodes
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Supple with no JVD or bruits; no lymphadenopathy or thyromegaly

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Chest
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Mild bibasilar rales with decreased breath sounds

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CV
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Tachycardic; S1, S2 normal; no S3 or S4; no murmurs or rubs

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Abd
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Obese, soft, nontender; (+) BS

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Genit/Rect
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Stool heme (–)

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MS/Ext
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3+ pitting edema, age-appropriate strength and ROM

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Neuro
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A & O × 3, GCS 15

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Labs

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