dudefop
Forum Newbie
Topics: 5
Posts: 22
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Hello,
This q is not for the exam. I just want to hear what you think.
61 YO M c/o severe dyspnea
This 61 YO man was diagnosed as COPD and Tuberculosis destroyed lungs. Tuberculosis was cured yet his lung remained destroyed.
He was admitted to this hospital and given antibiotics, brochodilaters and steroids.
Low rate O2 of 2L/min via nasal prong was given as well.
He had a tracheostomy cannula in his throat.
He suddenly crashed with BP of 80/60 a HR 130 and O2 saturation of 65% . EKG was WNL except for the sinus tachy. ABG analysis couldn't be performed.
I raised his legs and lowerd his head (shock position)
then I dripped the fluid fast (Normal Saline)
then I put him on Dopamine 2a mixed with N/S 500cc 20 gtt
For his dyspnea I continued Aminophylline 1a mixed with N/S 100 cc 5gtt. Then I ordered cortisol 1A IV side bolus.
But his saturation wouldn't go up and BP still low.
He signed DNR documents including no ventilator care when he was admitted.
He died a few hours later.
What do you think? Did I miss something? What would you do?
In a nutshell, the patient crashed with an acute aggratvation of COPD and underlying TBc destroyed lung and He signed DNR.
If you were in my shoes, what else would you have done in this patient?
Edited by dudefop on 11/10/07 - 09:30 PM
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Passed step1, Step2 CS. Now preparing for CK. Grad of Inha Univ. College of Medicine, South Korea.
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| me007
Forum Guru
Topics: 72
Posts: 803
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any blood work? X-ray on admission? temperature?
If it was ARDS not too much could be done to help.
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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I think its acute massive PE....patient with a DNR status...probaly nothing much....may be embolectomy or thrombolysis was an option in a patient who wants resuscitation after urgent CTPA
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When going gets tough, the tough gets going
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| dudefop
Forum Newbie
Topics: 5
Posts: 22
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me007 / Blood works could not be done because the patient refused. Chest AP on admission showed Tb destroyed and emphysematous lungs. Routine blood tests back then were unremarkable.
darkhorse / There was no pleuritic chest pain or hemoptysis. Although he was in a bed-ridden state, he got physical therapy everyday and no signs of DVT were detected. PE could be one of the differentials but the possiblity was low considering his sypmtoms.
Thank you for the replies!
Edited by dudefop on 11/10/07 - 09:40 PM
___________________
Passed step1, Step2 CS. Now preparing for CK. Grad of Inha Univ. College of Medicine, South Korea.
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