Critical Care Cases

Pt presents to ED with chest pain x 4 hrs. Pain is worse with deep breaths and she feels SOB when active. R hip replacement 3 weeks ago but had a speedy recovery up until today. What was the diagnosis?

PE

what are the diagnostic tests for PE?

-CBC, CMP

-CXR

-ABGs

-O2 sat

-d-dimer

-ESR/CRP

-ECG

-troponin

-lactate/procalcitonin

-CT angio

what are diagnostic results for PE?

-resp alk

-sinus tachycardia

-elevated d-dimer

-small filling defect of pulm artery on CTA

what is the treatment for PE?

-elevated WBCs

-resp/hemodynamic support

-anticoagulation or thrombolytics

what is the minimum amount of time a pt with a PE should be on outpatient anticoagulation?

3 months

what is the drug of choice for anticoagulation in hemodynamically unstable pts?

unfractionated heparin

Pt has PMH of a fib, aortic stenosis, AAA, CKD stage 3, hypothyroidism, and hyperlipidemia presents with chills, weakness, and dry heaves. Previous smoker quit 20 years ago. O2 94%. What was the diagnosis?

sepsis (secondary to pneumonia, cellulitis, UTI, endocarditis)

what diagnostic tests should be ordered for sepsis (secondary to pneumonia, cellulitis, UTI, or endocarditis)?

-CBC, CMP

-lactate/procalcitonin

-ESR/CRP

-CXR

-UA

-blood cultures

-cardiac workup

-d-dimer

-abdominal CT

what are diagnostic results for sepsis secondary to UTI secondary to kidney stone?

-S aureus on culture

-gram + cocci in clusters on UA

-elevated WBCs

-elevated lactate

-stone in renal pelvis on abdominal CT

-a fib w/ frequent PVCs

what is the treatment for sepsis secondary to UTI secondary to kidney stone?

-IV fluids

-piperacillin/tazobactam + vanco if MRSA

-monitor urine output

-urology consult

what is the treatment for nephrolithiasis?

-pain control

-fluids

-alpha blockers: tamsulosin

-lithotripsy

-ureteroscopy w/ extraction

-percutaneous nephrostomy

Pt has PMH of COPD, HTN, and depression. She presents to ED with fever, lethargy, and SOB x 3 days. She is coughing more frequently and struggling to breathe. Hasn't wanted to eat or drink. What was the diagnosis?

septic shock secondary to pneumonia

what are the diagnostic tests for septic shock secondary to pneumonia?

-CBC, CMP

-CXR

-d-dimer

-lactate/procalcitonin

-blood culture

-sputum culture

-PT/INR

-ABGs

-cardiac workup

what are the diagnostic results for septic shock?

-elevated WBCs w/ left shift

-elevated BUN/Cr

-metabolic acidosis

-elevated lactate

what is the treatment for septic shock secondary to pneumonia?

-give O2

-IV fluids

-3rd gen ceph (ceftriaxone) + macrolide (azithromycin)

-SABA & LABA

19 y/o presents to ED w/ altered consciousness, diffuse abd pain and vomiting. Symptoms at onset included profound fatigue, nausea, mild abd discomfort, and some urinary frequency. Pretty unresponsive. No PMH. What was the diagnosis?

diabetic ketoacidosis

what are the diagnostic tests for diabetic ketoacidosis?

-CBC, CMP

-lactate/procalcitonin

-UA w/ tox screen

-CT abdomen

-blood culture

-ABG

-BUN/Cr

what are the diagnostic results for diabetic ketoacidosis?

-elevated WBCs

-elevated glucose

-metabolic acidosis

-ketones

what is the treatment for diabetic ketoacidosis?

-IV fluids

-IV insulin

-monitor electrolyte imbalances (insulin decreases K+)

-ICU admission