Ventilator

Patient S.W.

By jas2529

  • Pre hospitalization

    Pre hospitalization
    S.W. complained of chest pain with exertion for 4 days. pt experienced dizziness when standing up from a seated position and orthopnea.

  • Emergency Room 1630

    Emergency Room 1630
    The patient was admitted to the ER, where a 12 lead EKG was performed, and ST elevation was noted in II, III, AVF indicating an inferior MI. Patient was then transferred to the Cardiac Cath Lab for intervention.

  • EMS 1500

    EMS 1500
    Pt's wife called 911 after the patient passed out on the kitchen floor. When EMS arrived, the patient was pulseless, and CPR was initiated. The patient's initial rhythm on the monitor was ventricular tachycardia, and the patient was shocked with 200 joules when he achieved ROSC with sinus bradycardia in the 50s. S.W.'s BP was 128/62 with agonal respirations. The patient was intubated in the field and brought to LGH.

  • CCU 1900

    CCU 1900
    S.W admitting vitals were:
    BP- 108/72
    HR-100
    RR- 18
    O2 Sat- 100% on 70% Fi02
    Cardiac Index- 2.0 L/min/m2
    CVP-11
    PAP- 32/12
    Temperature- 37.0 C (oral)

  • Cardiac Cath Lab 1730

    Cardiac Cath Lab 1730
    While in the Cath Lab, pt received two stents to the RCA. S.W. experienced severe hypotension with SBP in the '60s, and the patient was started on Levophed at 5mcg/min with a goal MAP >65. A swan ganz catheter was placed in the RIJ. The cardiac index was 1.6 L/min/m2, leading cardiologists to place an IABP for cardiogenic shock. The patient was also started on Epinephrine at 3 mcg/min for a goal CI of 2.0 L/min/m2. The patient was transferred to the CCU for monitoring.

  • POD #1

    Doctors ordered a bedside echocardiogram which showed an ejection fraction of 15-20% with hypokinesis of the left lateral wall. The potassium level on AM labs was 3.5 mmol/L and was replaced with 40 MEQ IVPB.

  • POD #2

    POD #2
    The patient's ventilator settings were weaned to 50% FiO2, RR 15, TV 500, and PEEP 5. S.W.'s CI was 2.1 L/min/m2 3mcg/min of epinephrine and Levophed at 8mcg/min with BP 95/50. Cardiology spoke with the patient's wife and updated the family on POC. Troponins peaked at 212 ng/ml

  • POD #3

    POD #3
    S.W. was weaned off of epinephrine with a cardiac index of 2.3 L/min/m2, and IABP was pulled at 1730 pressure was applied for 10 minutes. A Femostop was applied to the groin site to prevent bleeding.