bluestar
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a 65 y/o is admittted to ICU for acute MI and cardial shock. He's on dobutamine, dopamine, aspirin, furosemide and potassium. all of a sudden, the nurse noticed change in the tele monitoring. his Bp is 120/60, potassium level=4.2, he is alert , awake and oriented. exam shows bilateral crackles, peripheral pedal edema and elevated JVD, what's the most likely diagnosis and what's the next step magnagement?
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| mikyro
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a 65 y/o is admittted to ICU for acute MI and cardial shock. He's on dobutamine, dopamine, aspirin, furosemide and potassium. all of a sudden, the nurse noticed change in the tele monitoring. his Bp is 120/60, potassium level=4.2, he is alert , awake and oriented. exam shows bilateral crackles, peripheral pedal edema and elevated JVD, what's the most likely diagnosis and what's the next step magnagement?
Sth. is not right in this picture:
bilateral crackles, peripheral pedal edema and elevated JVD :?:
what's JVD? maybe JVP. Ok, if JVP elevated
seems like pulmonary edema to me; plus peripheral edema and elevated JVP - the pt. has acute heart failure (left and heart), quite expectable considering that the pt. was admitted with cardiogenic shock. The pt. had presumably an ECHO - if not, order it now!
Possible dx:
right ventricle infarction
acute valvular insufficiency (mitral > aortic)
reinfarction
An ECHO would be now appropriate :roll: . Next: Coronary angiography / Ventriculography
However, the pt. already has a very poor prognosis :cry: . Any of the above three options will further negatively influence the prognosis :cry: .
Pls. give the answer. I am really curious.
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| mikyro
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the next step in the management: probably aortic counterpulsation balloon insertion?
I'm not quite sre since you mentioned anything abt. ECHO results and how the dx of cardiogenic shock was secured...
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| rap_pig
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diag:right heart failure(AMI)
hyperpotasiumia(cardiogenic/underyling renal manifestations?)
Rx:1.ABG,ECH,c-tni,ck-mb
2.glucose+insulin,digoxin,acei,duretics,oxygen,
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| rap_pig
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and,quit KCl injection at once!
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| bluestar
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as a matter of fact, there's a ECK in this question that I can't paste here. It shows V tach when the nurse found out changes on the tele monitoring. now easier to answer the Q?
ps. JVD is jugular venous distension
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