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After completing this case study, the reader should be able to:
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.
“I feel like I can’t breathe.”
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.
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.
Smoker; quit 8 years ago; previously 1.5 ppd
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
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
PERRLA; EOMI; arteriolar narrowing on funduscopic exam; no hemorrhages, exudates, or papilledema; oral mucosa clear
Supple with no JVD or bruits; no lymphadenopathy or thyromegaly
Mild bibasilar rales with decreased breath sounds
Tachycardic; S1, S2 normal; no S3 or S4; no murmurs or rubs
Obese, soft, nontender; (+) BS
3+ pitting edema, age-appropriate strength and ROM