The 1998 write-ups

“ER Patients” From the 1998 Physiology Class

Case # 1

(from "A Good Fight")
by Voeung Chau and Heather Pavlech

Scenario:

A young girl, Corinna, and her father come into the ER harboring injuries which they suffered in a car accident. Corinna has a splenic injury, with a pulse ox of 80, a BP of 120/30, and a pulse of 80. She desperately needs a blood transfusion, for although a transfusion is initially attempted her body rejects this blood. Unfortunately, her father is the only one with her exact blood type and he has run away from the hospital. Therefore, by the time the father is found, Corinna has already suffered kidney and renal failure, and is in a coma.
General Terminology:

Crit 24 - short for hematocrit, or volume of red blood cells in a complete blood count
rigors - a coagulation of muscle proteins which is induced by heat
febrile reaction to transfusion - febrile refers to a fever, or a rise in body temperature, which was induced as a result of the blood transfusion
60 Palp - blood pressure taken under emergency conditions through feeling a patient's pulse, when listening for systolic and diastolic pressures with a stethoscope was not possible
foley bag - foley refers to a thin tube which is inserted into the urethra in order to drain the bladder, the tube is connected to a bag
hemolyzing - as a result of the destruction of red blood cells, hemoglobin is liberated from these cells
bolus of saline - a bolus is a large dose of a drug given at the start of treatment in order to raise blood level concentrations to a therapeutic, or normal, level
Epi - epinephrine, or adrenalin, used to make heart beat faster and raise blood pressure
free hemoglobin - a hemoglobin unattached to any red blood cells
hemolytic reaction to transfusion - red blood cells are being destroyed as body does not accept transfused blood, thus liberating hemoglobin from red blood cells
hematologic disease - relates to the physiology and therapeutics involving the blood and blood forming tissues
hemodynamically stable - relates to the presence of normal blood flow, or circulation
hemolysis - alteration, dissolution, or destruction of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended
vel and lan antibodies - a lan antibody may be the Donath Zandsteiner cold antibody, which will bind to a P blood group antigen on red blood cells at a low temperature and when the temperature is raised hemolysis will then occur
hypoxic - a severe deficiency of oxygen in the blood and tissues which causes the patient to have trouble breathing
Linea ALBA incised - a fibrous band running vertically the entire length of the center of the anterior abdominal wall
peritoneum - a transparent membrane enclosing the abdominal cavity
retractor - instrument for drawing aside the edge of a wound for holding back structures adjacent to the place of operation
bovie - instrument used for electrosurgical dissection and hemostasis
gastrolocolic ligament - related to the stomach and the colon
tamponade on the hemotoma - compressions of the heart on the hemotoma; a hemotoma is a localized mass of extravasated blood confined within an organ, tissues, or any space
vascular clamp - clamp used on blood vessels
v-tach - ventricular tachycardia, or rapid heart rate and increased blood flow
cardiac ischemia - heart is starving for oxygen

Tests:

C.T. - computed technology; images anatomical information from a cross-section plane of the body; is useful when a mass distorts the contour of an organ, such as a lesion of the spleen
CBC haptoglobin - Complete Blood Count; an all-purpose blood test - a red blood cell count, white blood cell count, erythrocyte indices, hematocrit, and differential blood count
direct, indirect Coombs - a Coombs test is a test that detects antibodies to the body's red blood cells; a direct test identifies those antibodies that are bound to the red blood cells; an indirect test identifies those antibodies which are circulating unattached in the serum
P.T. - prothrombine time; a clotting factor test for blood
P.T.T. - partial prothrombine time; a clotting factor test for blood

Treatments:

titrate another two of morphine - morphine produces a combination of depression and excitation in the central nervous system and some peripheral tissues; it is used as an analgesic as it relieves pain by altering perception of nociceptive stimuli
saline - a solution, made of salt and water, that is used as a temporary substitute for lost blood
dopamine drip - dopamine is a catecholamine neurotransmitter similar to adrenalin, which increases the cardiac output and renal blood flow
25g IG - may refer to immunoglobulin
heparin flush - heparin is a blood anticoagulant which prevents platelet agglutination and thrombus/clot formation; a flush removes this from the body
plasmapheresis unit - removal of whole blood from body through separating bloods' cellular element and refusing them suspended in saline, thus depleting the body's own plasma without depleting the actual number of cells
phenobarbital - a barbiturate that has sedative and anticonvulsant effects
intubate - insertion of an endotracheal tube in order to aid breathing
D-50 - an abbreviation for dextrose (glucose) given in a 50% normal saline solution
third MIG of ativan first - a minor tranquilizer drug that is used to minimize anxiety, tension, agitation, or fatigue

References:

http://www.geocities.com/TelevisionCity/5196/index.html
Macpherson, Gordon. Black's Medical Dictionary. 37th ed. A and C Black: London, 1992.
Spraycar, Marjory. Stedman's Medical Dictionary. 27th ed. Williams and Wilkins: Baltimore, 1995.
Stedman's Concise Medical Dictionary for the Health Professions. 3rd ed. Williams and Wilkins: Dayton, 1997.

Case # 2

(from “A Hole in the Heart”)
by Julia Lou and Cory Johannessen

Scenario:

Nurse Hathaway finds a woman and two children shot in a locked car outside of Emergency Bay. One of the children is a young boy who has been shot in the thoracic cavity by his psychologically depressed father. He is brought to the ER and treated by Dr. Green and Dr. Ross.

General Terminology:

Pulse- a pulsating artery that gives evidence that the heart is beating, usually about 70x's per minute
Focused H and P- a history and physical examination. H and P is the term used to describe an examination that results in a patient history and makes an assessment of his/her condition. The patient is physically examined and then talked to regarding his/her complaint. The doctor makes a diagnosis based on these studies. Focused refers to examining only areas specific to the patient's complaint.
Blood Pressure- a measure of how well blood circulates through the arteries, listen to the format of the systolic pressure over the diastolic pressure. Normal blood pressure is about 120/80.
Palp- Blood pressure taken under emergency conditions when listening for the systolic and diastolic pressures w/a stethoscope is impossible. Taken by feeling (palpation) the pulse.
Bagging- manual respiration for a patient having breathing trouble that uses a handheld squeeze bag attached to a face mask.
Thoracatomy Tray- holds surgical blades and other such instruments for thoracic surgery.

Status upon Arrival:

Weak Carotid Pulse- weak pulse in carotid artery
Pulse- 120 beats/min
Blood Pressure- 70/50 (systolic/diastolic)
Flat Neck Veins- low blood flow in veins from heart to head
Decent Respiratory Effort- breathing
No Tracheal Shift- lack of physical shift of the windpipe due to trauma or trachea midline

Symptoms:

Acidotic- when the body is undergoing acidosis, a condition where there are production of two abnormal acids in the body. Beta hydroxybutric Acid and Acetoacetic Acid, or a diminution in the bloods alkali reserve.
Asystole- a complete absence of electrical activity in the myocardium
V-fib- ventricular fibrillation, dangerous and rapid arrhythmia (variation of normal heartbeat) of ventricle
Fib- rapid contraction or tremor of muscles

Tests:

CBC- abbreviation for complete blood count, which is an all-purpose blood test; combining diagnostic evaluations of red blood cell count, white cell count, erythrocyte indices, hematocrit, and a differential blood count
cc- abbreviation for cubic centimeters
Chem 20/Chem 7- a battery of blood chemistry tests; seven parts of Chem 7: sodium, potassium, chloride, bicarbonate, blood urea nitrogen (BUN), creatinine, and glucose
Saline Solution- a blood volume substitute made of salt and water, a temporary substitute for lost blood
Type and Cross match- blood typing to identify patient's blood type

Procedures:

Central Line- the central location in the circulation of the vein used, usually in the internal jugular and subclavian veins in the neck, or the femoral veins in the groin. This has the benefit of being able to send more fluid into the body.
Thoracotomy- surgery on the thoracic (chest cavity)
Start a Line- start an IV line to be used for treatment
Internal Paddles- paddles placed directly on heart walls that give and electrical charge to restimulate heartbeat. Used when the heart shows no electrical activity (flat line).
Occlude- closing of duct, hollow organ, or blood vessel

Treatments:

Ancef- a cephalosporin antibiotic
Platelets- components of blood designed to form clots and plug leaks from bleeding arteries and veins
epi- adrenaline, used to make heart beat faster and raise blood pressure
Lidocaine- a local anesthetic, also used to reduce cardiac muscle automaticity, given intravenously
Bolus- a large dose of a drug that is given (intravenously) at the beginning of treatment
Secure Subclavian- to stop bleeding of artery and vein in upper arm between collar bone and first rib
Saline- a sodium chloride solution that produces excavation of bowels and acts as a blood substitute
Two Lines Saline Wide Open- two IV's administered at full drip of saline
Rapid Infuser- a piece of medical equipment used to quickly infuse blood into the patient's body

References:

Web site: http://www.geocities.com/TelevisionCity/5196/index.html
Macpherson, MB, BS. Blacks Medical Dictionary, 37th Edition. A & C Black: London, 1992.

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