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Josephine Slowvicki, a 55 yo housekeeper, is brought into the
ED by her coworker because she is pale and feels like she is going to faint.
The patient reports not feeling well for several hours. She has a history
of diabetes, and she reports taking her insulin 2 hours ago, but has not
yet eaten. Patient denies chest pain but does feel short of breath. She is
nauseous, but no vomiting.
PE reveals pale diaphoretic, rr22 hr 40 BP 90/60 Sat 97% T97 HEENT no JVD,
Lungs CTA, Abd obese soft. ext 1+ pitting. |
| 1. | Discuss your initial management. | ||
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| 2. |  |
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| Review the difference between first second, and third degree heart block. | |||
| The patient is placed on the transcutaneous pacer and set at 60. 100% paces with BP 100/50. The patient felt better, but was uncomfortable secondary to the pacer. While discussing the case with your attending and trying to arrange for CCU team to evaluate the patient, the patient becomes unresponsive, apneic and although 100% paced, pulseless. | |||
| 3. | What do you do next? | ||
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| Pacer captures initially, but within 5-10 minutes patient again becomes pulseless. CPR is begun again, but your patient remains pulseless and dies. | |||
| 4. | Retrospectively, would you have done anything differently? | ||
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| 5. | What are the contraindications to thrombolysis? | ||
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