“ER Patients”
From the 1999 Physiology Class
Case # 1
(episode title not known)
by Ross Franklin & Natalie Sztaba
Scenario:
Amy, a female over the age of 18 was brought into the emergency room because
she was having trouble breathing due to her condition of Melanoma. Her father
wanted to ease her pain but not to continue treatments on her cancer. Amy
signed a DNR order, which she asked to be revoked during treatment. The
controversy arouse when treatment was given dispite
the DNR order requested by Amy's father.
Symptoms:
- Small mole of back - when
tested was revealed to be a stage four Melanoma.
- Altered mental status-
- Loculated
fluid around lungs-
- Surplus of Mets- Belly tense
and abdominal pain
Diagnostic Tests:
- Chest x-ray-
- CBC- Complete blood count
- PT
- PTT
Treatment:
- Removed 3 liters of fluid
from around the lungs
- Rapid induction- arousal of a
part or area (as of the retina) by stimulation of adjacent part or area
the sum of the processes by which the fate of embryonic cells is
determined and differentiation brought about.
- 15ml of Ecomidate-
- 100ml of Sux
- CPR- Cardio Pulmonary
Resuscitation
- Amp of Lidocane
Additional Terms:
- Melanoma- a skin tumor
composed of cells called melanocytes (dealing
with coloration of skin).
- Metastasis- the spreading of
a cancerous tumor to another part of the body through lymph, blood, or
across a cavity; also sometimes refers to a tumor that has been produced
in this way.
- Chemotherapy- the treatment
of infections or cancer with drugs that act on disease producing organisms
or cancerous tissue; may also affect normal cells.
- Immunotherapy- treatment of
or prophylaxaf against diesease
by attempting to produce active or passive immunity.
- Plural infusion- a buildup of
fluid between the membranes that line the lungs and chest cavity (the
pleura); causes compression of the lungs, which leads to breathing
difficulty
- Mets- a pentapeptide
having a terminal methionine residue that is one
of the two enkephalins occurring naturally in
the brain --called also Met-enkephalin.
- DNR (Do not Resesatate)
- Cardiovert-
: a device for the administration of an electric shock in cardioversion.
- Atropine- a racemic mixture of hyoscyamine
obtained from belladonna and related plants and used in the form of its
sulfate for its anticholinergic effects (as
relief of smooth muscle spasms or dilation of the pupil of the eye)
Case # 2
(from "The Storm")
by Jona Agnoli and Sara
Hotchkiss
Scenario:
An eight-year old boy named Ricky Abbott is dying of End Stage ALD in his bed
at home. He is on a pain medication named Dilaudid,
which is administered to him through a P.C.A machine at his home. A regulated
dosage is given to him, and every hour he is given a booster. His mother would
like to see her son no longer in pain and suffering. Dr. Rosss
routinely comes to his house to help care for him. On one visit, the doctor
gives the mother the code to the P.C.A machine so she can administer a large
dosage of Dilaudid to her son. This is against policy
rules because the machine is regulated to only release a certain amount of the
drug to the patient, and only the doctors are supposed to know the access code.
That night, the mother winds up giving Ricky a huge dosage to end his misery, and in the morning he is dead. The next scene shows
him being brought to the hospital by ambulance and he is unresponsive. The
doctors say they found him in his bed in full arrest, and now he is in asystole and unresponsive. The doctors dealing with him
knew he wasn't supposed to make it through the night, but Ricky's father begs
them to try to save the boy. They do CPR on him, give him an intibation kit, administer 2mg of Narcan
to him, and an atropine of epi. They try to
resuscitate him, but he flat lines. Afterwards, the father wants an autopsy
done because he feels that the doctor killed Ricky by allowing the mother to
administer a large dosage of Dilaudid to him to put
him out of his misery.
Symptoms:
- End-Stage ALD=ALD, otherwise
known as Adrenoleukodystrophy, is a painful
terminal illness. It is a rare genetic (inherited) disorder characterized
by the breakdown or loss of the myelin sheath surrounding nerve cells in
the brain and progressive dysfunction of the adrenal gland.
- Unresponsive=When the
paramedics found Ricky in his bed he was not responding to their attempts
to wake him, talk to him, or resuscitate him.
- Asystole=
The state of having an absence of electrical
activity on the EKG and no pulse.
- Flat Line=The EKG is a flat
line instead of pulse peaks because the patient is dead-another way of
saying a patient is dead.
Treatment:
- Booster=An
additional dose of a vaccine taken after the first dose to maintain or
renew the first one.
- P.C.A Machine=The machine used to administer the Dilaudid
to the patient because it can be programmed to give a certain dosage and
can only be changed by a doctor's code.
- Dilaudid=An opiate drug that produces euphoria, which is a
physical state of feeling good.
- CPR=This
stands for Cardio Pulmonary Resuscitation and is used to try to make a
person's heart beat again by having someone administer thrusts to their
chest cavity. It is the form of resuscitation the doctors used on Ricky.
- Intibation
Kit=A kit used for the passage of air into an organ or body structure;
commonly used to refer to the passage of a tube down the windpipe for
artificial respiration. This was given to Ricky because the overdose of Dilaudid had caused him to stop breathing.
- 2mg Narcan=This is used in the management and reversal of
overdoses caused by narcotics and synthetic narcotic agents because it is
a synthetic opioid antagonist.
- Atropine of Epi=Epi stands for
epinephrine, which is a substance produced by the medulla (inside) of the
adrenal gland. An atropine is a dosage of epinephrine, which causes a quickening
of heartbeats, strengthens the force of the heart's contractions, and
opens up airways to the lungs.
- Autopsy=An
examination of the body after death, possibly to determine cause of death
or for research.
Case # 3
(episode title not known)
author unknown
Scenario:
A construction accident occured a few blocks from the
hospital. A construction worker ran over to the hospital to get some help. Dr.
Carter and Dr. Malucchi grabbed minimal supplies from
an unattended ambulance parked outside the ER. Upon arrival on the scene they
found a man, Joe Sanders, pinned under large metal frames. They were unable to
pull him free from the frames so Dr. Carter performed a blind intubation with the guidance of Dr. Malucchi.
Once at the hospital they found that he had abrasions to his abdomen,
and a fractured left femur and his blood pressure was 90/60 and pulse was 110.
His radial pulse was weak and thready, his chest was
not moving, and he was hypotensive.
Symptoms:
- Femur Fracture-Break of the
bone between the hip and the knee: the thighbone.
- Hypotension-Abnmally low blood pressure which results in reduced
blood flow to the brain causing dizziness and fainting.
- Radial Pulse
- Altered Meal (Mental?) Status
- Blood Pressure-Fluid pressure
imparted to blood by heart contractions. (Systolic pressure is the peak
pressure that contracting venticles exert
against the areterỳs wall during a cardiac ycle. Diastolic pressure is the lowest pressure when
blood is draining into the vessels after.)
Diagnostic Tests:
Treatments:
- O-neg-type
O blood, Rh negative. The patient recieved four units.
- Intubation-intubation
of an endtracheal tube within part of the body
to maintain an airway for artificial ventilation.
- Traction-the use of tension
to hold the body part in place or to correct or prevent an alignment
problem.
- Sager Splint
- Peritoneal Lavage-washing out of the membrane that lines the
abdominal cavity and covers the organs in the abdomen
Case # 4
(from "Car Accident")
by Vickie Viera and Jocelyn Griggs
Scenario:
A motor vehicle accident occured when a thirteen year
old girl attempted to drive a car. Her father was having an epileptic seizure
and she was trying to get him to the emergency room. She was too short to reach
the brake pedal and was not able to stop the car in time to avoid hitting the
el stanchion. When the doctors got to the victems in
the car, the girl was concious and the father was
still having a seizure. The girl, and her father were
removed from the car and placed on gurneys. Upon arriving in the emergency
room, his pulse was 100 and blood pressure was 125/75.
Symptoms:
- Unconcious:
A partial of complete loss of conciousness with
the interuption of awareness of ones self and
ones surroundings due to a temporary reduction in blood flow resulting in
an oxygen shortage to the brain.
- Seizures: Sudden
uncontrolled waves of electrical activity to the brain, causing
involuntary movement(convulsions) or loss of conciousness.
- Convulsions: Abnormal,
uncoordinated tetanic contractions of varying
groups of muscles.
- Abrasions: The wearing away
of the uppermost layer of skin as a result of friction.
- Spinal Injury: Damage to
the spinal area which may cause a loss of sensation, muscle weakness, or
paralysis.
Diagnostic Tests:
- Head CT: A CAT scan of the
head. A technique called Computed Tomography Scanning, it is used for
producing cross-sectional images in which X-rays are passed through the
head at different angles and analyzed by a computer.
- C-Spine: an x-ray of
cervical spine's seventeen vertebrae, the topmost supports of the scull.
- Ultrasound: an imaging
procedure used to examine internal organs in which high frequency sound
waves are passed into the body, reflected back, and used to build an
image.
Diagnosis:
- Epilepsy: A disorder of the
nervous system in which abnormal electrical activity in the brain causes
seizures.
Treatment:
- Ativan:
The generic name is lorazepam. It is an antianxiety medication. It acts by enhancing the
effects of gamma-aminobutyric acid (GABA) in the
brain. Six were given to the patient.
- Dilantin:
The generic name for this medication in phenytoin.
It is an anti-convulsant. It is used as an
anti-seizure medication, and especially to prevent grand mal seizures and
psychomotor seizures. One gram was given to the patient.
Case # 5
(from "Responsible Parties")
by Jennifer Tobin and Carly-Gene Wickson
Scenario:
MED VAC brings in Andrea Brodoff, a 34 year old woman
who was in a boating accident. She complains of nausea and has a penetrating
abdominal injury from a fishing pole. The pole had to be cut in order to
transport her. The woman yells out that she has AIDS. Upon arrival to the
hospital her blood pressure is 95/60 after 800 cc's of saline were
administered.
First Scene:
- MED VAC - (medical
evacuation) A team that is organized with the knowledge to properly
evacuate people from situations of medical emergency.
- Nausea - An unpleasant
feeling in the stomach that is often characterized by the urge to vomit.
- Penetrating Abdominal Injury
- An injur through all layers of the skin. Injuries
of this nature should be explored to make sure that no organs have been
damaged.
- AIDS - A disease that is
contracted due to an infection of the human immunodeficiency virus (HIV).
- Blood pressure - The
pressure of the blood within the arteries. The systolic pressure is the
highest and it is measured after the heart contracts. The diastolic
pressure is the lowest and it is measure before the heart contracts.
- Saline - A solution of salt
in water that is used as a temporary substitute for blood loss.
Second Scene:
- Central Line Kit - This kit
is used to send fluids into the body through a centrally located major vein.The kit can include Povidone-iodine
and alcohol swabs, 16-gauge central venous catheter kit, 1% lidocaine without epinephrine
- Ultrasound - A test that
uses sound waves to create an image of the position and appearance of
internal organs.
- Morrison's Pouch - It is
the pouch which lies between the liver and right kidney. Blood can
accumulate in the recto-vesicle pouch in the setting of trauma
- O-neg
- Type O negative blood is considered the universal donor. It is used to
treat the blood loss of a trauma patient for which the blood type is
unknown.
- Cefotetan
- Treats bacterial infections and belongs to a class of drugs called
cephalosporin antibiotics. The usual dosage is 1-2 grams IV or IM every 12
hours.
- Pre-op Labs - Blood and
fluid lab tests that have to be done before an operation. These tests can
include: pregnancy tests, urinalysis, liver enzymes, CBC, and glucose. CM
that commonly has no symptoms and is infectious through bodily fluids.
While many adults carry antibodies to this virus it can cause a variety of
symptoms and infections in the immunocompromised.
CMV can also be dangerous to a pregnant woman if infected in her first
trimester. It can cause birth defects that include mental retardation,
hearing loss, and developmental delay.
- OR-- Operating Room
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