Question: VANCED CONCEPTS Scenario F: Mr. Calico Mr.Calico, Age 76. Was Taking A Walk When He Developed Chest Heaviness. He Went In And Told His Wife He Was Going To Lie Down On The Sea For A While. She Grew Concert Hour Later When She Called His Name And He Didn’t Answer. Mrs. Calico Called 911 And Parumedics Arrived To Find Mr. Calico In The Rhythm Seen In …

VANCED CONCEPTS Scenario F: Mr. Calico Mr.Calico, age 76. was taking a walk when he developed chest heaviness. He went in and told his wife he was going to lie down on the sea for a while. She grew concert hour later when she called his name and he didn’t answer. Mrs. Calico called 911 and parumedics arrived to find Mr. Calico in the rhythm seen in Figure 18-19. 1. What is this rhythm? 2. Whut symptoms would you expect to see in Mr. Calico? 3. Mr. Calico was unconscious and had no pulse und no breathing. What should the paramedics do to resuscitate Mr. Calico? After appropriate initial treatment, Mr. Calico’s pulse returned and he began tu awaken. The paramedics ran another rhythm strip. See Figure 18-20. 4. What is this rhythm? Paramedics rushed Mr. Calico to the nearest hospital, where : 12 lead EKG WA done. His 12-lead EKG is seen in Figure 18-21. 5. What conclusion do you draw from this EKG? 6. Thrombolytic medication was started and the EKG was repeated. See Figure 18-19 What has changed since the last EKG? 7. Mr. Calico went into ventricular fibrillation a few minutes later. The nurse prepareal to cardiovert the rhythm, but when he depressed the buttons to deliver the shock. nothing happened. Why and what corrective action is needed for this problem! After correctly defibrillating Mr. Calico, the ER staff sent him to the CCU, where he spent a week recovering. He went home and did well with no further problems. FIGURE 18-19 Mr. Calico’s initial rhythm. re FIGURE 18-20 h 르 르 VL L h < – VE t 나 p FIGURE 18-21 Mt. Calico’s Initial 12-lead EKG. VI th ㄴ 국 fr 록 SNL tu th ㄴ 록 루 h th fr FIGURE 10-22 Scenario C: Mr. Farley A few years ago. Mr. Farley had been diagnosed with chronic atrial fibrillation and was started on digitalis. He’d done well, with a heart rate running in the 70s and 80s since then. For the past few days, however, Mr. Farley had felt lousy nothing specific. Just “not right,” as he would later describe it. He didn’t think it was important enough to bother his physician, although his wife had fussed at him to do so. Believing his problem to be related to his atrial fibrillation. Mr. Farley doubled up on his digitalis dose. If one pill a day was good, two a day had to be better, he reasoned. After five days of this, he began suffering from violent nausea and vomiting episodes. His wilo dragged the reluctant Mr. Farley to the hospital. His initial rhythm strip is shown in Figure 18-2 1. What is the rhythm in Figure 18-9? 2. What effect does this rhythm have on the atrial kick! 3. Lab tests revealed that the level of digitalis in Mr. Farley’s bloodstream was an oxid levels. Name three rhythms that can be caused by digitalis toxicity. The physician contemplated sending Mr. Farley to the CCU, but since his blood pressure was good and he looked OK. he was sent to the telemetry floor instead. His nausea was treated with medication and he was taken off digitalis. Three hours after arriving on the telemetry floor, Mr. Farley passed out in the bathroom. His wife ran to get the nurse just as the nurses, having seen his rhythm on the monitor, were running toward his room. His new rhythm is shown in Figure 18-10. 4. What is the rhythm in Figure 18-107 FIGURE 18-9 Mr. Farley’s initial rhythm strip. module_item_id=943450 CHAPTER 18 – PUTTING IT ALL TOGETHER CUTICAL THINKING FIGURE 18-10 Mr. Farley’s second rhythm strip. 5. The emergency learn was called and CPR was initiated What to medications would be appropriate to give at this time? 6. After successful resuscitation. Me. Furley was transferred to the CCU, where a temporary Transvenous pacemaker was inserted. What beneficial etfect would the pucemaker have? 7. A few hour ander the pacemaker wasserted, the nurse noticed evidence of loss of capture on the monitor On the monitor strip in Fire 18-11. what would tell her there was loss of capture & What can be done to restore capture Capture was restored, and Morted well bento V.tach with a heart rate of the ORS compless that the Vach of induced by uitation from the T- Scenario B: Ms. Capitano Ms. Capitano was a 23-year-old woman who presented to the ER with complaints of Pasigue and dizziness. She had a negative medical history and did not smoke. Aside from birth control pills, she took no medication and denied illegal drug use. She did drink five or six soft drinks daily and had two to three cups of coffee every morning. Cardiac monitor revealed the rhythm seen in Figure 18-7. 1. What is the rhythm shown in Figure 18-7? 2. What is the likely cause of this rhythm in Ms. Capitano’s case? 3. The physician ordered adenosine to be given intravenously. The rhythm strip shown in Figure 18-8 was the result. What happened? After a few seconds of the slow heart rate, Ms. Capitano’s heart rate sped back up to the 250s this time—and she complained of feeling fint. Her blood pressure, which had been normat 110/60. plummeted to 6850. and she was now pale and drenched in a cold sweat. 4. What effect was the tachycardia having on her cardiac output? Ms. Capitano’s condition bad worsened-she was now in shock. The ER physician elected to perform synchronized electrical cardioversion. After a low-voltage shock. Ns. Capitano’s rhythm converted to sinus rhythm with a heart rate in the 90s und her blood pressure improved. Soon her color was back to normal and her skin was dry. She was admitted to the coronary care unit for close observation and was started on calcium channel blockers to prevent recurrences of her tachycardia. The physician advised her to curtail her caffeine intake. After a day in CCU, Ms. Capitano was transferred to the telemetry flour. She was sent home a day later. doing well. Infefffffffffffff Ms. Capitano’s initial rhythm in the ER. 18-8 Capitano’s rhythm after adenosine administration.