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LEARNING OBJECTIVES

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.

PATIENT PRESENTATION

Chief Complaint

“I feel like I can’t breathe.”

HPI

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.

PMH

  • ESRD requiring hemodialysis Monday, Wednesday and Friday

  • Endometriosis

  • HTN

  • Dyslipidemia

  • Type 2 DM

PSH

Hysterectomy in 1985

FH

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.

SH

Smoker; quit 8 years ago; previously 1.5 ppd

Meds PTA

  • 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

All

Sulfa

ROS

Difficulty breathing

Physical Examination

Gen

White woman

VS

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

Skin

Cold

HEENT

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

Neck/Lymph Nodes

Supple with no JVD or bruits; no lymphadenopathy or thyromegaly

Chest

Mild bibasilar rales with decreased breath sounds

CV

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

Abd

Obese, soft, nontender; (+) BS

Genit/Rect

Stool heme (–)

MS/Ext

3+ pitting edema, age-appropriate strength and ROM

...

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