The 1996 write-ups

“ER Patients” From the 1996 Physiology Class

Case # 1
(from "Take These Broken Wings")
by Brandi Pfleiderer & Jill Brederson

Scenario:

A ten year old girl was admitted with a fever of 101 and signs of jaundice. Upon examination, it was discovered that she had underwent a Kasai procedure at eight weeks of age and she was now suffering from an enlarged liver. Test results showed elevated LFTs, leukocytosis, and prolonged PT consistent with ascending cholangitis. Due to the severity of her present condition, her liver transplant status was raised from status 3 to status 2, which is a higher priority status.

Symptoms:

Jaundice - accumulation of bilirubin in the blood and subsequent diffusion of bilirubin into the tissues, causing yellowish coloration of the skin & eyes
Leukocytosis - increase in the number of circulating white blood cells (leukocytes)
Cholangitis - inflammation of the bile ducts

Diagnostic Tests:

LFTs - Liver Function Test; series of blood chemistry tests used to determine whether liver cells are healthy or damaged and to detect changes in the way the liver makes new substances, breaks down and/or excretes old ones
BU - Bilirubin; predominant bile pigment formed when the heme portions of hemoglobin are broken down during destruction of old or damaged erythrocytes; gives bile its characteristic yellow color
PT - Prothrombin Time; blood clotting test which depends on the presence of a protein made by the liver from vitamin K in the blood; abnormal test results are indicative of two disorders that result either when this protein is not made due to liver cell damage or when there is a bile flow blockage to the liver, which causes a lack of bile flow in the intestines and interferes with fat and vitamin K absorption

Treatments:

Kasai Procedure - or Hepatoportoenterostomy; procedure performed for liver failure or bile duct obstruction
IV Q6 - number of times an IV is administered per day ; this case, six times a day
Cefotaxime - sodium salt used to treat respiratory & urinary tract infections

Case # 2
(from "John Carter, M.D.")
by Liisa Viitanen & Meghan Conley

Scenario:

A cyanotic two day old male infant was admitted after being released from the hospital only 12 hours following his birth. A right axis deviation and heart failure diagnosis was confirmed by a chest X-ray and an EKG. His treatment included Dig. 0.1, Lasix, keeping his ductus arteriosus open and cardiac surgery.

Symptoms:

Cyanotic - bluish coloration of skin and mucus membranes due to excessive concentration of reduced hemoglobin in the blood
Sinus Tach at 150 - tachicardiac; a fast or accelerated heart rate
Right Axis Deviation - mean electrical axis of the heart pointing right 90 degrees
RAH - Right Atrium Hypertrophy; enlargement or overgrowth of the right atrium of the heart due to an increase in the size of its constituent cells
RVH - Right Ventricular Hypertrophy; enlargement or overgrowth of the right ventricle in the heart due to an increase in the size of its constituent cells
Hypoplastic Heart - incomplete development or underdevelopment of the heart
Ductus Arteriosus - fetal blood vessel connecting the pulmonary artery directly to the descending aorta
CHF - Congestive Heart Failure; blood accumulation in a small area of the heart

Diagnostic Tests:

CBC - Complete Blood Count; all purpose test that counts red blood cells, white blood cells, erythrocyte indices, and a differential blood count
Chem 7 - series of seven tests pertaining to blood chemistry; "seven" refers to the seven segments of the series, which test for sodium, glucose, creatinine, chloride, blood urea nitrogen, bicarbonate, and potassium
EKG - Electrocardiogram; graphic monitoring of the cardiac electric potential caused by stimulation of the heart muscle that is detected at the body's surface
Echo -Echocardiogram; ultrasonic record obtained from the application of ultrasound techniques that facilitate the study of the aorta

Treatments:

Lasix - furosemide; a diuretic drug used to treat disorders in which edema is a symptom
Hyperventilation - increase in ventilation relative to metabolic carbon dioxide production so that carbon dioxide pressure decreases to below normal

Case # 3
(from "John Carter, M.D.")
by Shelley Robertson & Lara Kendall

Scenario:

A twelve year old was rushed to the E.R. after having been hit by a bus while riding her bike. Since she was claiming that her left ankle hurt, tib/fib and ankle films were taken. These X-rays clearly showed that her ankle was fractured and surgery was needed.

Diagnostic Tests:

BP - blood pressure
Distal Pulse - pulse taken from an extremity
Dorsalis Pedis Pulse - pulse taken from the back part of the foot
Posterior Tibial Pulse - pulse taken form the back side of the tibia
Pulse Oximeter - instrument that measures the force and rapidity of blood flow
"Dip a urine for blood" - check for red blood cells in a urine sample
Tib/Fib Films - radiographs of the tibia and fibula

Treatments:

IV Saline TKO - intravenous saline drip
O2 Five Liters Cannula - five liters of oxygen administered via a tube inserted into a duct or cavity

Case # 4
(from "Dr Carter, I Presume")
by Heather Millette & David Foote

Scenario:

An eighty-eight year old man was admitted with symptoms of heart trauma or failure. He had an altered LOC., a b/p of 60 palp, a sinus tach of 128, and was hypotensive. His respiration was shallow (around 30) and his skin was warm and dry. Since the EMTs could not insert an IV, he also had poor cap refill.

Symptoms:

Altered LOC- Level of Consciousness; in this case, it is altered
Sinus Tach at 128 - tachicardiac; a fast or accelerated heart rate
Hypotensive - persistently low level of or an acute drop in arterial blood pressure
Poor Cap Refill - condition in which the capillaries have collapsed and failed to refill
Pseudomonas - genus of aerobic gram-negative bacilli; one species (Pseudomonas aeruginosa) causes human diseases like endocarditis, meningitis, pneumonia, etc.

Diagnostic Tests:

B/P 60 Palp - refers to the normal procedure for taking a patient's blood pressure

Treatments:

02 Four Liters - administration of four liters of oxygen
IV - intravenous; a tube that is inserted into a vein
Trendendellenburg - cannula covered by a dilatable rubber bag used to close the trachea to prevent entrance of blood after a tracheotomy
Nasal Cannula - tube or hollow needle used with a trocar that is inserted into a blood vessel or body cavity; after insertion, the trocar is removed to allow fluid to flow through the cannula
Chest tube - a tube that is inserted into the chest in order to remove air or blood
Central Line - insertion of a catheter into the center of the heart due to a collapse of the central vein; it is usually laterally inserted
Intubation - insertion of an endotracheal tube within part of the body to maintain an airway for artificial ventilation and administration of general anesthesia
Lidocaine - a topically applied cardiac depressant drug that is used as a local anesthetic
Epi - Epinephrine; hormone, secreted by the adrenal medulla, that produces physiological effects characteristic of the sympathetic division of the autonomic nervous system
Ceftazidime - cephalosporin antibiotic treatment for enterobacteria and pseudomonas
Q8 Plus Gent -gentamicin; an antibiotic given every 8 hours with ceftazidime

Case # 5
(from "Let the Games Begin")
by Jerome Reed & Laura Gordon

Scenario:

An eighty-one year old man was admitted with an altered LOC and abdominal pain. A CBC, Chem 7, UA abdominal series and EKG were ordered. After the patient had "graded down", he flatlined and went into cardiac arrest. An oxygen mask was placed over the patient's face and CPR was administered that inadvertently broke one of his ribs.

Symptoms:

Altered LOC - Level of Consciousness; in this case, it is altered
BP 90/60 - blood pressure was 90 (systolic) over 60 (diastolic)
Guarding - when a patient is reluctant to have an area of the body examined; possibly indicative of infections, broken bones, or tumors
Rebounding - when a patient reacts out of pain physically and instantaneously to a physical examination
Grading Down - ?? slowing of pulse; deterioration of a steady beat ??
Flatline - occurs when an EKG shows no waves of cardiac activity

Diagnostic Tests:

EKG - Electrocardiogram; graphic monitoring of the cardiac electric potential caused by stimulation of the heart muscle that is detected at the body's surface
Chem 7 - series of seven tests pertaining to blood chemistry; "seven" refers to the seven segments of the series which test for sodium, glucose, creatinine, chloride, blood urea nitrogen, bicarbonate, & potassium
UA Abdominal Series - ?? Unknown ?? Treatments:
Epinephrine - hormone, secreted by the adrenal medulla, that produces physiological effects characteristic of the sympathetic division of the autonomic nervous system
Atropine - a commonly used cardiac stimulant
Dopamine - a commonly used cardiac stimulant

Case # 6
(from "Don't Ask, Don't tell")
by Lyntaii Thao & Ruben Kim

Scenario:

A middle-aged man who had fallen off a 30 ft. beam was admitted with head trauma and near amputation of his left leg. While on the operating table, this patient was diagnosed with decreased breathing sounds on the right side, facial trauma, an open fracture, a femoral artery laceration, and tension pheumo. During his surgery, the patient's pulse ox dropped to 78 suggesting a possible blockage of the throat and the possibility of nasopharynx bleeding. To determine the cause of these symptoms, a laryngoscope was used to "pack the nose".

Symptoms:

Laceration - torn, irregular shaped wound
Facial Trauma - severe physical injury to the face
Fracture - break in a bone
Tension pheumo - respiratory problem
Nasopharynx - passage connecting the nasal cavity behind the nose to the top of the throat behind the soft palate; also the upper section of the pharynx

Diagnostic Tests:

Pulse Ox 78 - measurement of the force and rapidity of blood flow by a pulse oximeter
Laryngoscope - viewing tube that is inserted into the mouth to examine the larynx

Treatments:

O-Negative Blood (8 units) - 8 pints of O-negative blood; which is the universal donor
Catheter - insertion of a flexible tube into the mouth that is used either for draining fluid from or injecting fluid into the body
16 Foley - type of catheter equipped with a balloon that holds the catheter in place used for draining fluid from the body
"Pack The Nose" - procedure used to clear the pharynx by inserting a catheter with a balloon into the mouth & down the throat; the balloon is inflated and then retracted
Amputation -removal of part or all of a limb

Case # 7
(episode title not known)
by Nima Pahlavan & Steven Lupo

Scenario:

A Jane Doe, who had been drinking and using cocaine, was admitted with seizures, which were later diagnosed as epilepsy. Following examination, the following tests were ordered: a CBC, toxic screen, EEG and blood alcohol and glucose levels. Treatment consisted of intubation and the administration of sedative drugs. With a temperature of 106.2 and a pH of 7.1, she was both hyperthermic and acidotic. In order to relieve these two symptoms, the doctors covered her with cooling blankets and administered stronger anti-convulsant drugs. Unfortunately, none of these treatments worked and this patient died.

Symptoms:

Tonic-Clonic Seizure - sudden episode of uncontrolled electrical activity in the brain that results in twitching, hallucinations, and /or intense fear; the tonic phase is a state of rigidity while the clonic phase is a series of jerking movements
Meningitis - inflammation of the meninges resulting from microorganisms
Coma - state of complete unconsciousness in which the patient does not respond to arousal stimuli
Hyperthermia - state where the body reaches temperatures dangerously above the normal body temperature of 98.6
Acidotic - state in which pH in the body is lower than the normal pH of 7.5

Diagnostic Tests:

CBC - Complete Blood Count; all purpose test that counts red blood cells, white blood cells, erythrocyte indices, and a differential blood count
Toxic Screen - test to find various toxins, such as drugs & alcohol, in the blood
Blood Alcohol/Glucose Tests - measure blood concentrations of alcohol & glucose
Blood Gas Kit - used for blood gas analysis; determines the concentrations of 02, CO2, hydrogen ions, and hemoglobin levels in blood
EEG - Electroencephalogram; graph of the electrical activity of the brain

Treatments:

Ativan - aka Lorazepan; weak sedative used primarily for anxiety
Dilantin - anti-convulsant drug
Benzos - Benzodiazepine;tranquilizer used to control epileptic seizures and anxiety
Phenobarbitol - drug that works as an anti-convulsant when used with dilantin

Case # 8
(from "A Shift in the Night")
by Kim Casey & Liz Donovan

Scenario:

After being in a car crash, an unconscious middle aged woman was admitted with a blood pressure of 90/160 and a pulse of 140. She had good bilateral breath sounds, a fractured left femur, a rigid abdomen, and a suspected probable flail chest. Later it was discovered that her heart was punctured by one of her ribs and as a result she went into fibrillation. Treatment consisted of shocking the heart with internal paddles to get the heart to beat rhythmically again. Once stabilized, she was sent to the operating room.

Symptoms:

Tamponade - compression of the venous return to the heart due to increased fluid volume in the pericardium
Sacs Tense with Blood - secondary anticoagulation system is tight due to the amount of blood present
Sinus Brady - refers to the SA node; slow heart rate originating from the SA node
Cardiac Laceration - wound made by the tearing of the tissue of the heart
Flail Chest - refers to the abnormal movement of the chest
Air Embolus - air within a vessel which is carried in the bloodstream from another site until it lodges and becomes an obstruction to circulation
Bilateral Breath Sounds - regular respiration is heard from both lungs
Neck Vein Distention - refers to the swelling of the veins in the neck
Coding - ?? when a patient flatlines ??

Diagnostic Tests:

Type & Cross - cross-matching procedure used to determine compatibility between a blood donor and blood recipient

Treatments:

Lavage - washing out a body cavity or hollow organ
Thoracotomy - surgical incision on the chest wall
16 Foley - type of catheter equipped with a balloon that holds the catheter in place used for draining fluid from the body
Rapid Infuser - machine used for infusion of intravenous fluid to the body
Metz - Metolazone; diuretic drug used to treat hypertension or to reduce edema

Case # 9
(from "Fear of Flying")
by Ava Dufort & Larry Mulcahy

Scenario:

After being in a traffic accident, a middle aged man was admitted suffering head trauma with the possibility of intercranial bleeding. Following treatment at the accident scene, he had been airlifted to the hospital. Upon arrival, the patient's blood pressure was 70 palp, his pulse ox was at 85, his heart sounds were distant, and he was suffering from some loss of memory. A pericardiocentesis was ordered and he was diagnosed with possible tamponade.

Symptoms:

Head Trauma - severe physical injury to the head
Hemo-pneumo - occurrence of blood and air in the pericardium
Intercranial Hemorrhaging - escape of blood in the cranium due to the loss of integrity of vascular channels; frequently, forming a hematoma
Tamponade - compression of venous return to the heart due to increased volume of fluid in the pericardium

Diagnostic Tests:

BP 70 Palp - refers to the normal procedure for taking blood pressure
Pulse Ox 85 - measurement of the force and rapidity of blood flow by a pulse oximeter
Pericardiocentesis - tapping a passage into a cavity with a hollow instrument for the purpose of removing fluid; in this case, paracentesis of the pericardium
EKG - Electrocardiogram; graphic monitoring of the cardiac electric potential caused by stimulation of the heart muscle that is detected at the body's surface
MRI - Magnetic Resonance Imaging; used to make detailed images of the brain to detect abnormalities or damage
CAT Scan - Computerized Axial Tomography; used to check for brain damage

Treatments:

2 Units of Blood - 2 pints of blood
Central Line - insertion of a catheter into the center of the heart due to a collapse of the central vein; it is usually laterally inserted

Case # 10
(from "No Brain, No Gain")
by Kevin Backman & Judy Speel

Scenario:

A middle aged man was admitted after his right foot had been severed at the ankle by a car. At the accident scene, he had lost one liter of blood and was in shock. The doctor ordered 6 units of O negative blood, a CBC, a type A cross, and four milligrams of morphine. When his blood pressure decreased to 60, a side cuff was applied to stop the bleeding from his ankle. He was sent to vascular surgery for reimplantation of his severed foot, but due to a mix-up in the E.R. the foot was not able to be reattached.

Diagnostic Tests:

CBC - Complete Blood Count; all purpose test that counts red blood cells, white blood cells, erythrocyte indices, and a differential blood count
Type A Cross - category or class based on shared characteristics; a specimen or example of a category is taken as a standard for determining membership in that category

Treatments:

Pressure Dressing - dressing applied to an open wound to inhibit bleeding
Side Cuff - wide band equipped with an inflatable balloon that controls the flow of fluid passing through by constricting or sealing the conveying vessel
Rapid Infuser - machine used for the intravenous administration of fluid to the body
Transfusion - to administer a transfusion of blood or other fluid to a recipient
O Negative Blood - type O negative blood; which is the universal donor
Morphine - potent narcotic analgesic which causes drowsiness, nausea, vomiting, respiratory depression, decreased gastrointestinal motility, and mood changes including euphoria

Case # 11
(from "Union Station")
by Joe Pellegrino & Chris Kelly

Scenario:

A vehicle with three joy-riding teenagers had collided with a kindergarten car-pool van and seven people had been injured. The boy that had been driving the teenagers' vehicle had a BP of 190/130, a pulse ox of 90, and poor cap refill. A left tib/fib film, a C-spine, a type & cross, and a lavage were ordered for this boy. A girl from the teenagers' vehicle had sustained left knee damage and an X-ray was ordered. The last teenager was suffering from minor head scraps and bruises. The car-pool van driver had sustained minor knee lacerations and a ruptured spleen, which required surgery. While the second car-pooler was complaining of chest pains and shortness of breath. Upon examination, diminished breath sounds were heard on the left side, indicating possible lung damage. The third car-pooler sustained a deep head wound and was taken to the suture room for stitches. The final car-pooler had a sluggish left pupil, suggesting nerve or brain damage and a possible subdural hematoma.

Symptoms:

Laceration - torn, irregular shaped wound
BP 190/130 - blood pressure at 190 (systolic) over 130 (diastolic)
Poor Cap Refill - condition in which the capillaries have collapsed and failed to refill
Subdural Hematoma - accumulation of blood in a subdural space resulting from a break in a blood vessel wall; usually due to a closed head injury

Diagnostic Tests:

Portable C-spine - Cerebral X-ray; in this case, taken with a portable machine
Left Tib/Fib - X-ray of the tibia and fibula - the two bones in the lower leg
Pulse Ox 90 - measurement of the force and rapidity of blood flow by a pulse oximeter
Type & Cross - cross-matching procedure used to determine compatibility between a blood donor and blood recipient

Treatments:

Lavage - washing out a body cavity or hollow organ
Intubation - insertion of an endotracheal tube within part of the body to maintain an airway for artificial ventilation and administration of general anesthesia
Hyperventilation -increase in ventilation relative to metabolic carbon dioxide production so that carbon dioxide pressure decreases to below normal
Mannitol - intravenously administered sugar alcohol that is used as a vasodilator

Case # 12
(from "It's not easy being Greene")
by Carin Walker

Scenario:

A 32 year old male brought in unconscious as a result of a grand mal seizure. His EKG showed mutifocal PVC's representing an abnormal heart rhythm. An echocardiogram was performed after a CAT scan. The patient then entered ventricular fibrillation and defibrillation was performed.

Symptoms:

tachycardia - abnormal, high heart rate
grand mal seizure - major seizure, characterized by convulsions; sudden brain cell activity known as an aura is a cause of this condition; usually a result of epilepsy
V - Tac - Ventricular tachycardia; a condition due to rapid impulse formation in a ventricle.
V - fib - Ventricular fibrillation; uncoordinated heart muscle contraction with no effective pumping action

Diagnostic Tests:

CAT scan - a device which takes pictures of cross section of the brain
Tox screen - toxicology screen, which measures certain toxins present in the blood

Treatment:

External defibrillation - Electrical method used to terminate severe irregular heart contraction and reinstitute a normal spontaneous heart rhythm.
Lidocaine - A drug used to depress the electrical activity of the atria and ventricles.
Epinephrine - A drug that increases heart rate, and cardiac muscle contraction force
Brytelium- A drug which increases sympathetic activity

Case # 13
(from the "Baby Shower")
by Amy Marquis - Barriault

Scenario:

A thirty year old male jumped on to train tracks in attempt of suicide. Patients heart entered ventricular fibrillation. The patient's heart rate was brought under control by external defibrillation. The patient suffered from a head trauma, a fracture to lower extremity, a fractured left femur and a nearly amputated right arm.

Symptoms:

Bilateral Hemoral Thorax - damaged thoracic cavity with internal bleeding in the plural (lung) cavity
Rigid Belly - Indicative of internal bleeding in the abdominal cavity
Pupils equal and Sluggish - the left and right pupils responded to a light equally but slowly.

Diagnostic Tests:

Chest Tube - used to relieve pressure that bleeding might exert on the lungs making breathing easier for the patient.
DPL - diagnostic peritoneal lavage, used to determine any internal bleeding in the abdominal cavity
CT -Scan - A three dimensional imaging method to determine brain damage.

Treatment/Surgery:

Dopamine - A drug used to increase blood pressure without increasing heart rate

Case # 14
(from "The Match Game")
by Nicole Ciarlelli

Scenario:

A 19 year old male was brought into the ER after being the cause of a severe car crash. His blood pressure was 140/100, had a pulse of 90 bpm and a respiration rate of 24 breaths per minute. He had a blood alcohol level of 3.22 and drugs were found in his car. Chest x - rays came back showing that he had a widened mediastium.

Symptoms:

Widened mediastium - space between the two plural cavities (lungs) are increased due to excessive bleeding from the aorta

Diagnosic Tests:

DPL - diagnostic peritoneal lavage; it is used to determine whether or not there is internal bleeding in the abdominal cavity

Treatments/Surgery:

· Central Line - IV is put directly into the subclavian vein through the chest wall

· Narcan - a narcotic antagonist which was administered to aid in counteracting the drugs in the patients system.

· Rib Spreader - a instrument used to open up the chest cavity to allow easy access to the heart.

Case # 15
(from "Sleepless in Chicago")
by Michelle M. Bedor

Scenario:

A .38 caliber bullet clipped a 16 year old teenager in the carotid artery while robbing a store , he was bleeding profusely. His blood pressure was 60/40. A cop caught a bullet in the heart, he had blood in his lungs, and a hole in his ventricle.

Symptoms:

carotid artery - A major artery that runs from the heart to the head, supplying the brain with blood and oxygen.
treddy pulse - pulse is very unsteady
collaterals - side branching of blood vessels which will help supply sufficient blood to the tissue when the main artery is blocked

Diagnostic Tests:

thoracotomy tray - tray with instruments for incision into the chest wall.
incubation tray - tray with instruments used to treat any agents that may cause infection

Treatment/Surgery:

vascular clamp - tool used to clamp the carotid artery
30 proline - a very thin suture which disintegrate aotomatically
atraumatic needle - needle of very small diameter, which causes minimal damage to the tissue being sutured

Case # 16

(from "The Right Thing")
by Sally Tetreault

Scenario:

A twenty seven year old male brought into ER for alcohol intoxication. He was ALOC ataxic, had a blood pressure 90/40 and a breathing rate of 14 per minute. He had drank 1 gallon of vodka and took some Xanax, an antidepressant drug.

Symptoms:

ALOC- Altered Loss of Consciousness
ataxic-lack of muscle coordination
Wernicke's Encephalopathy(Wernicke-Korsakoff syndrome)-Disorder of the central nervous system caused by excessive alcohol intake and nutritional depletion. Characterized by sudden weakness and paralysis of eye muscles, double vision, and inability to stand or walk which is followed by a derangement of mental function.
Scattered rales bilaterally-an abnormal sound which originates in pulmonary airway and is heard in the chest cavity; indicative of disease of the bronchi or lungs; bilaterally refers to the sound being heard in both lungs.

Diagnostic Tests:

Blood alcohol level- test to determine alcohol level in the blood.
tox screen- test to determine any other intoxicants in the blood
CBC- test to determine blood cell count and to check for blood coagulation
glucose stick- test to determine glucose levels in the blood
CHEM-20- test to determine 20 different biological chemical levels including blood cholesterol level

Treatment:

Naloxone-known as Narcan; drug used to counteract the effects of a narcotic which may depress respiration
Thiamine- metabolizes carbohydrates; prevent glucose from precipitating.

Case # 17

(from "The Luck of the Draw")
by Jacqueline LaMontagne

Scenario:

A 6 year old black male with previous brain damage was brought into ER for Respiratory Distress Syndrome. He developed bradycardia due to pneumonia.

Symptoms:

Respiratory Distress Syndrome- Injury sustained to the lung, accompanied by shallow, rapid breathing. Patients may enter cardiopulmonary arrest.
Bradycardia-Ventricular contraction rate of the heart slower than normal.
Septic Shock-Characterized by acute failure of the circulatory system, usually with hypotension.
V-Tach-Ventricular tachycardia; A condition characterized by rapid heart beat due to rapid impulse formation in a ventricle.
Asystole-Complete absence of any electrical activity in the heart, accompanied by absent blood pressure or pulse.
BP's 35 palp- blood pressure is 35 palpitations per 20 seconds
Peaked T waves/unstable rhythm- Irregular EKG; symptoms of hyperkalemia
Hyperkalemia- high potassium level in the blood

Diagnostic Tests:

blood culture- A test that checks for different bacteria in the blood.
12 lead- Standard 12 lead electrocardiogram. This gives a more accurate electrical reading than the standard 3 lead ECG.
lytes- a test to determine levels of electrolytes in the blood.

Treatment:

Atropine-A drug used to stimulate heart contraction, side effects include rapid pulse and breathing. Children are especially sensitive.
Lidocaine- A drug used to treat V-tach; depresses the electrical activity of the heart.
Isoprel Drip;Isoproterenol-increases heart rate, used to treat bradycardia
Insulin- Facilitates transport of sugar to cells; also has effect on blood potassium level.
Calcium Gluconate- Treatment for hyperkalemia, high potassium level
Epinephrine-A drug that causes increase in heart rate, also increases caridiac output.
Erythromycin- An antibiotic that prevents bacterial protein synthesis.
Cefotaxime- An antibiotic which acts against a gram negative bacteria, Pseudomonas aeruginosa.
piggyback-extension to an IV so that a patient does not have to be stuck with a needle more that once. One can have many IV bags going into the same vein.

Case # 18

(from "The Match Game")
by Allyson Connor

Scenario:

An 8 year old male T-boned in the back seat of a car was brought into ER unconcious; bp was 60 palp; palpation indicated a rigid abdomen possibly due to a ruptured sleen; his airway was difficult to intubate; saphenous cutdown was performed; he entered bradycardia; 0.5 cc atropine and O negative blood ordered.

Symptoms:

bp 60 palp- blood pressure is 60 palpitations per 20 seconds
Bradycardia- a slow heart rate, usually defined as less than 60 beats per minute in adults

Treatment/Surgery:

saphenous cutdown- saphenous refers to the saphenous vein in the leg; cutdown refers to the dissection of the vein for insertion of a cannula or needle for the administration of intravenous fluids or medications.
cut down tray, #15 blade- required to perform the saphenous cutdown; it contains the instruments necessary for the procedure; #15 blade refers to the scalpel
cricoid pressure- cricoid denotes the ring shaped cartilage structure located directly above the trachea; pressure refers to physical pressure exerted upon this region to help keep the airway open
o-silk tie- oiled silk; a surgical suture made of silk and coated with oil to prevent friction
14-guage angiocath- angio refers to the heart and especially blood vessels; cath is an abbreviation for catheter which is a long, thin, hollow surgical instrument usually flexible with one or more lumina that is inserted into a body cavity for purpose of drainage or administration of diagnostic or theraputic agents
atropine- used to stimulate heart contraction by blocking the parasympathetic activity

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