Chapter 27: Cardiac Arrest: Staying Alive Level II

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LEARNING OBJECTIVES

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

• Discuss possible causes for cardiac arrest.

• Analyze 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 had circulation restored after cardiac arrest.

PATIENT PRESENTATION

Chief Complaint

“I feel like I can’t breathe.”

HPI

Beatrice (“Bee”) A. Hart is a 68-year-old woman 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

Former 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 subcutaneously three times a week

Insulin glargine 40 units subcutaneously daily

Insulin lispro 5 units subcutaneously 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