“ER Patients” From the 2000 Physiology Class

Case # 1

(from "Loose Ends")
by, Shelby O'Donnell, Amanda Hovey, and Sarah Duclair

Patient:

 

A 45-year-old man was hit, but not run over by the L train while crossing the tracks. Paramedics intubated the patient and administered a liter of
saline in the field. His blood pressure is 80/40.

Symptoms:

·         Low voltage on the EKG

Tests & Drugs Administered:

Diagnosis:

 

A large effusion, or escape of fluid, is detected around the heart, indicating cardiac tamponade- a life-threatening situation in which there
is such a large amount of fluid (usually blood) inside the pericardial sac around the heart that it interferes with the performance of the heart. The
end result, if untreated, is low blood pressure, shock and death. The excess fluid in the pericardial sac acts to compress and constrict the
heart. Cardiac tamponade can be due to excessive pericardial fluid, a wound to the heart, or rupture of the heart.

Treatment:

 

The patient is sent to the operating room to have the fluid removed and the escape route repaired.

Case # 2

(from "Sand and Water")
by Megan Smith and Becca Pisano

Patient:

 

62-year-old female with a history of stroke has had a lacunar infarction; an area of tissue is dead due to a local lack of oxygen.

Symptoms:


Tests and Drugs Administered:

 



Diagnosis:

 

The patient has had a massive stroke and has suffered a significant amount of brain damage. A stroke damages part of the brain because of a lack of
blood supply due to a blockage in an artery or the rupturing of a blood vessel. It will often lead to a complete or partial loss of function in
the area of the body controlled by the damaged portion of the brain. She also has aspiration pneumonia, requires intubation to keep her alive, and
has an extremely low chance of meaningful recovery. It is decided that she is incompetent to make her own decisions, so unless a family member
can be reached, she will be put on a ventilator if her stats drop below 80.

Treatment:

 

The patient is put on a ventilator, as that is the wish of her brother.


Case # 3

(from "Last Call")
by Heath Floyd and Emily Auld

Patient:

 

A 25-35 year old woman, Nadine Wilkes, who has been taking vodka and tequila shots. She is having an epileptic seizure, is acidotic with a pH
of 7.1 and running a temperature of 106.2, which makes her hypothermic. The doctors don't know she is epileptic because her bracelet fell off,
they also do not know that she has been snorting cocaine.

Symptoms:

Treatments/ Drugs Administered:


Diagnosis:

 

The tox screen came back positive for cocaine in the system. Doctors never diagnosed anything, but thought it could be possible meningitis or a
tonic clonic seizure. Only Dr. Ross eventually finds out that she was epileptic.

Treatment:

 

This case ended in death, but epileptic seizures can sometimes be stopped by first giving the medication denzodiazepine, like valium or
ativan, and also by giving dilantin (an anti-epileptic drug) at the same time. The alcohol and cocaine in her system severely worsened the
seizure.


Case # 4

(from "Such Sweet Sorrow")

by Jeanne Miles and Elizabeth Soule

Patient:

 

Mrs. Wyatt, a middle aged woman is complaining of lower back pain. She is allergic to Sulfa-medications, which give her hives. The doctor treats
her condition with Bactrim (a medication with sulfa).

Symptoms:


Tests & Drugs Administered:

 


Diagnosis:

 

Pylonephritis: an inflammation of the kidney and pelvis.

 

Treatment:

 

A urine culture to identify the causative organism and appropriate antibiotics. Cranberry juice will also help eliminate some of the symptoms.


Case # 5
(from "Don't Ask, Don't Tell")
by Nikki Gerety and Jen Sutyak

Patient:

 

Mr. Jack Johnson, 89 years old, found unconscious in his nursing home. Blood pressure 50/30. Possible DNR. Has had a history of C.O.P.D., renal
failure, congestive heart failure, prostate cancer, and diabetes.

Symptoms:


Tests & Drugs Administered:

 


Diagnosis:

 

Multisystem failure: heart, lungs, and kidneys all failed to respond. Possible stroke, which is a sudden death of some brain cells due to the
lack of oxygen when blood flow to the brain is impaired by blockage or rupture of an artery to the brain.

Treatment:

 

It was discovered that Mr. Johnson had a DNR order, and after he was fully conscious, no treatment was given. He died shortly thereafter in the elevator.


Case # 6
(from "Of Past Regret and Future Fear")
by Cathy Mancuso, Dave Janas, and Mary Coulombe

Patient:

 

Our patient is Mr. Canterna, a 31 year-old male security guard who has severe hydrofluoric acid second and third degree burns to his trunk, right
arm and both legs. While working at a chemical company, he noticed a leaking chemical vat, and while trying to tighten the valve, it burst on
him.

Symptoms:


Tests & Drugs Administered:

 


Diagnosis:

 

Unfortunately, the outlook for Mr. Canterna is grim. Hydrofluoric acid burns of this magnitude are always fatal. The Fluoride ions in the
acid penetrate the skin and draw the Calcium ions out of the cells. The CaF2 molecules then crystallize and cause further irreparable tissue
damage. Hypocalcemia, the lack of calcium in the cells occurs as a result of the Fluoride ions invading his tissues. The calcium is needed to bind
to the tropomyosin complex and this allows the actin-myosin binding-, which is the basis for muscle contraction. The prolonged QT means that
his heart is taking longer to repolarize. The result is a slow and irregular heart rate. Heart failure is the ultimate result because the
heart is unable to effectively pump blood. After diagnosis it is established that he has about 12 hours to live.

Treatment:

 

In this situation, all that they could do was make him comfortable. He was given Morphine to ease the pain and the poultice
helped to neutralize the action of the Fluoride ions on his skin surface.


Case # 7
(from "Shades of Gray")
by Jessie Hubbard and Betsey Murray

Patient:

 

Zoe Kearney, a 16 year-old whose pregnancy is in the second trimester (3-6 months). She was at a clinic getting a prenatal checkup when the clinic
was bombed by protesters and a wall fell on top of her.

Symptoms:


Tests & Drugs Administered:

 


Diagnosis:

 

Zoe falls into a coma-like state from which there is no chance of survival. This is due to a pulmonary embolus, or a clot in her lungs.
This clot may have started in her leg and moved into her lungs. The clot prevented the oxygen from getting into the air sacs, which in turn
deprived her brain from oxygen. The baby appears to be fine so there are two options for Zoe: one is to perform an emergency C-section and deliver
a very premature baby who would require months of intensive care, and the second is to keep Zoe alive on the ventilator and let the baby grow to
full term.

Treatment:

 

Zoe's parents finally decide to keep Zoe alive for the sake of the baby.

Case # 8
(from “The Visit")
by Kristin Abbott and Noreen Kordziel

Patient:

 

A female seventh-grader fell at school. She is brought into the ER on a backboard to prevent spinal cord damage.

Symptoms:


Tests & Drugs Administered:


Diagnosis:

 

Patient showed no physiological problems from her "fall". X-rays came back negative and tests showed that she was pregnant.
The police and doctors determined that her boyfriend was beating her rather than her father.

Treatment:

 

Although not shown on the television show, counseling and appropriate prenatal care would be recommended for this patient.

 

 

 

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c.
Diagnosis: Patient showed no physiological problems from her "fall". X-rays came back negative and tests showed that she was pregnant.
The police and doctors determined that her boyfriend was beating her rather than her father.

Treatment: Although not shown on the television show, counseling and appropriate prenatal care would be recommended for this patient.