Patient Encounter Part 2 Physical Exam Diagnostic Tests and Initial Treatment

PMH: Hypertension, congestive heart failure

Meds: Benazepril 10 mg daily, atenolol 50 mg daily, furosemide 40 mg daily as needed for edema

SH: Occasional alcohol use (per family)

FH: Noncontributory

VS: 80/40 mm Hg, P 130 bpm, RR 22, T 35.0°C (95.0°F), urine output: none since catheterization 10 minutes ago

Neuro: Recent loss of consciousness

Pulmonary: Normal breath sounds, undergoing tracheal intubation for mechanical ventilation

CV: ECG shows sinus tachycardia, otherwise normal Abd: WNL

Extremities: Noncontributory

Pertinent labs: pH 7.20, PaCO2 50 mm Hg (6.65 kPa), PaO2 70 mm Hg (9.31 kPa), Na 153 mEq/L (153 mmol/L), HCO3 18 mEq/L (18 mmol/L), lactate 70 mg/dL (0.78 mmol/L), SCr 1.7 mg/dL (150 pmol/L), Hct 51%

Identify treatment goals for JT in the next hour.

Identify treatment goals for JT in the next 24 hours.

What initialpharmacologic/fluid therapy is required?

Comment on the need for blood products or sodium bicarbonate in JT.

Table 13-4 Vasopressor Drugs

Drug

Uiu«l IV Dole

Adrenergic Effect*

PntBiktialto Cbum Arrhythmias

0,

¡S, EJopjrTuriergic

Dorumine

10-20 mcg/kg/min"

+ ++

Ü.5-8TI mcrjA^itfi

++

L>

++

Epinephrine

1 -200 mc^mn

++

+ + *

0

Phenylephrine

U.S-Ï mc-g/k-g/min

+++

0

0

a

"Ltwci do;-jtj<!ioiiki[iinnrrt.L nuy'Wl produce; cJi-iintl o, .icJ't'noKjk: (vasapieiSor} effects

"Ltwci do;-jtj<!ioiiki[iinnrrt.L nuy'Wl produce; cJi-iintl o, .icJ't'noKjk: (vasapieiSor} effects

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