Critical Care Experience Report ( Micu )

Her drug screen showed positive benzodiazepines and blood alcohol was negative. Troponins were negative. Also, her initial work up showed acute kidney injury with a creatinine of 1.84, and potassium of 5.8. Her chest x-ray showed small amount of infiltrate in the right lower lobe. The CT scan of the head did not show any acute changes. The abdominal CT scan showed constipation and 6 mm opacity in her bladder. She had an electroencephalogram (EEG) which revealed diffuse generalized nonspecific encephalopathy. In addition, there was slowing of the left hemisphere consistent with left intracerebral lesion. The assessment diagnoses were acute respiratory failure (ABG of 87.287, pCO2 of 45.2, pO2 of 380 and biacarbonate of 20 on vent settings), altered mental status, attempted suicide, infectious process, medication use, hyperglycemic nonketotic, and less likely cerebrovascular accident given that her CT scan of the head was normal. She was admitted to the Intensive Care Unit under the care of Dr. Modupe Kehinde. She was intubated for airway protection and remained intubated until 5/23/2016 (7 days). She was on ventilator and was given nutritional support

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

The patient did have black soot around his nose and mouth. Thats when first responders started manual ventilation's via BVM and 02 at 15 LPM. At this time Medic 1 assumed patient care. Medic 1 assigned first responders to obtaining vitals signs that are stated in the vital section of the report. It was at this time that Medic 1 applied a OPA after first measuring on what size to use. First responders also applied fast patches to the patients right upper chest and left midaxillary line At this time Medic 1 assigned first responders to start chest compressions a 15:2 ratio. Medic 1 at this time started a IO in the patients plateau region of the right leg. The Plateau region is inferior and lateral to the knee cap. At this time Normal Saline bolus was started with a 60 drop per ML set. Medic 1 found the patient to be in a sinus rhythm At this time miscommunication with Medic 1 and first responders happen with chest comparisons started. We then secured the patient on the cot via 4 straps and transported a code red patient to the nearest hospital. While enroute to hospital radio report was given with chief compliant and treatments listed in the appropriate category of the report. Vitals was continued to be taken every 5

The author read Mrs. X’s medical notes prior to their initial consultation to afford herself the knowledge she required should she need to prescribe for her when fully qualified. It was evident from reading her medical notes that there were a few considerations to take note of before commencing any treatment, such as her medical history, drug history and allergies. Her past medical history consisted of Type 2 diabetes mellitus, which was diet controlled, hypertension, hypercholesterolaemia, neuropathy, rheumatoid arthritis and raynauds syndrome.

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

A (assessment): Ms. O’Reilly’s vital signs are temperature of 37.5 C, pulse of 112, blood pressure of 102/52, and respirations of 24. Her respirations are still deep but have a regular rhythm. She has a CBS of 8.1 and regular insulin running as per orders. The lab work shows uncompensated metabolic acidosis with no hypoxia. Ms. O’Reilly’s neurological status has improved with a GSC of 13. Her dehydration is being treated with NS containing 40mEQ KCL/L running at 200ml/hr and potassium levels maintained at 4.

This process paper will evaluate the complex relationship between disease pathophysiology and how it has progressed to the patient’s current state of health. It will include a comprehensive discussion of chronic and acute problems leading to the patient’s hospital admission, a complete description of interrelationships and pathophysiology for all medical diagnoses, a comprehensive discussion of the client’s signs and symptoms and results of all diagnostic studies to the underlying pathophysiology, and a comprehensive listing of all medications ordered at the time of admission with explanations of why each was ordered and identification of the most common side effects which may

Patient C.Z. was a 64 year old female who presented to the Emergency Department (ED) with acute chronic heart failure (CHF). Prior to her arrival, the patient had been seen by her primary care provider (PCP) for a routine visit. Due to the patient’s poor status, the PCP sent her to the emergency department (ED) of Christiana Hospital. Upon arrival to the ED, the patient’s chief complaint was difficulty breathing; this was evidenced by the patient stating she could not breathe. As part of her treatment plan for CHF, patient C.Z. explained she had been prescribed 40 milligrams (mg) of furosemide (lasix) to relieve symptoms related to hypervolemia which often accompanies CHF; her presenting condition corroborated that the prescribed lasix had

(Medical Law and Ethics, 2009 Chap. 6 Pg. 216) No, there isn’t any legally recognizable injury to the patient. None of these accorded the patient suffered cardiac arrest and died. The patient would have to seek recovery or compensation but in this case the patients family has filed a wrongful death suit.

This paper will specifically focus on a case involving an intellectually disabled adult female who was reported to be experiencing sudden onset shortness of breath. Upon arrival of EMS, the patient’s caretaker escorted the responding personnel to a back room where the patient was sitting upright in bed and appearing cyanotic throughout the face. Upon initial assessment, it was determined that the patient was both pulseless and apneic indicating the need to begin immediate resuscitation efforts. This patient was transported under the strong suspicion that she was suffering from a pulmonary embolism which resulted in cardiac arrest. Care of this patient was transferred at the hospital where resuscitation efforts were continued by emergency room staff with no success. The ultimate goal of this report is to discuss the pulmonary circuit as well as the implications of impaired circulation within the lungs. This case study also aims to identify key clinical findings of pulmonary embolisms and signs of deterioration in an effort to help improve prehospital recognition within the EMS community.

81 y.o. female, admitted for hypertension and has a history of dementia. The woman was experiencing severe hypertension when she checked her blood pressure and her daughter immediately took her to the emergency department (ED). In the ED, she was given IV hydralazine and was also had a brain CT scan to rule out stroke. The patient was stable and on her bed with the lights off on arrival to the unit. She remained on the med-surg cardiac floor for continued management of her blood

The patient was on hydromorphone for his abdominal pain due to liver disease, deferoxamine mesylate to treat secondary hemosiderosis, insulin due to diabetes mellitus, folates for sickle cell anemia, sertraline for possibly depression due to the hepatitis C, lansoprazole for stomach acid balance, promethazine for pain, and digoxin for cardiomyopathy.

On Monday, November 11, 2015, a 79-year-old female was brought to the emergency department (ED) of Fairview Southdale via ambulance for myocardial infarction (MI). A few hours prior to the ambulance arriving, the patient was experiencing chest discomfort, shortness of breath, and upper abdominal pain. At that time, she called her son who then went to her house to check on her. Her son made the decision to call 911. Minutes after the paramedics arrived, the patient went into cardiac arrest. The patient had previously expressed to her family that she wanted to be “do not resuscitate” (DNR) to her family, however, upon cardiac arrest her son told the paramedics that he wanted all measured taken to resuscitate her. Cardiopulmonary resuscitation (CPR) was initiated with a Lucas device and the patient was deemed rapid transport. In route to the ED, the patient was in ventricular tachycardia and ventricular fibrillation. An automated external defibrillators (AED) was used to shock her 3 times in route and 1 dose of epinephrine was given. She was intubated with a 7.0mm endotracheal tube (ETT) to protect her

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.