- Joined
- Oct 18, 2005
- Messages
- 113
- Reaction score
- 22
(I am in private practice)
Getting ready to go home last week and the pager goes off. TEE / CV. No problem, easy money, will still be able to get my son to basketball practice as promised (until I look in the EMR)...
51 year old male, STEMI 2 days ago. Occluded branch of the RCA, ballooned open, no stent (not sure why). loaded with 300 plavix and therapeutic lovenox (was given lytics at OSH but not sure which drug). Cath reveals EF < 10%. Currently in rapid afib between 130 - 150 / min.
Patient is in NAD other than feeling very weak - awake and talking, VS essentially normal, good airway. No know PMH, but he hasn't seen a physician in "35 years" by his own admission. Occasional smoking, nothing crazy. Significant ETOH intake (cardiology notes suggest alcoholic CMP as a possible etiology). Not obese but clearly doesn't take care of himself.
Labs show an increased troponin (3.96), normal H/H, normal renal function, minimally increased lactate, normal coags.
How would you do this case?
Note: I posted this for 2 reasons:
1) Interesting case
2) An illustration to the residents that private practice does not = healthy patients! A wise resident seeks out sick patients to "practice" with and focuses on developing responsible management of really sick people because THEY ARE EVERYWHERE! Even in private practice...
Getting ready to go home last week and the pager goes off. TEE / CV. No problem, easy money, will still be able to get my son to basketball practice as promised (until I look in the EMR)...
51 year old male, STEMI 2 days ago. Occluded branch of the RCA, ballooned open, no stent (not sure why). loaded with 300 plavix and therapeutic lovenox (was given lytics at OSH but not sure which drug). Cath reveals EF < 10%. Currently in rapid afib between 130 - 150 / min.
Patient is in NAD other than feeling very weak - awake and talking, VS essentially normal, good airway. No know PMH, but he hasn't seen a physician in "35 years" by his own admission. Occasional smoking, nothing crazy. Significant ETOH intake (cardiology notes suggest alcoholic CMP as a possible etiology). Not obese but clearly doesn't take care of himself.
Labs show an increased troponin (3.96), normal H/H, normal renal function, minimally increased lactate, normal coags.
How would you do this case?
Note: I posted this for 2 reasons:
1) Interesting case
2) An illustration to the residents that private practice does not = healthy patients! A wise resident seeks out sick patients to "practice" with and focuses on developing responsible management of really sick people because THEY ARE EVERYWHERE! Even in private practice...