Describe the pathophysiologic mechanism of the patient

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Reference no: EM133868147

Assignment:

A 68-year-old man with a past medical history of hypertension, hemorrhagic stroke, and tobacco use and a family history of coronary artery disease was convalescing in their family home after a recent hospital admission for community-acquired pneumonia when he was noted to develop acute dyspnea. On arrival at his residence, the paramedics found the patient moaning, with a Glasgow Coma Scale score of 8 and increased work of breathing.

Upon arrival at the emergency department, his temperature was 36.8°C; heart rate, 47 beats/minute; blood pressure, 97/56 mm Hg; respiratory rate, 36 cycles/minute; and he had an oxygen saturation of 70% while he breathed oxygen via a nonrebreather mask. The patient was intubated on an emergency basis. The patient became progressively bradycardic and hypotensive. He was administered atropine in divided doses, 4 L of crystalloid solution, and was started on norepinephrine and sodium bicarbonate infusions.

Physical examination after intubation and initiation of sedation revealed a well-nourished, unresponsive man. The trachea was midline and lungs were clear to auscultation. Cardiac examination revealed regular bradycardia, no precordial heaves, and a grade III/VI holosystolic murmur along the left sternal border, which had not been noted during his previous hospitalization. There were diminished dorsalis pedis and radial pulses and his skin was cool to palpation. The abdomen was soft, nontender, and without organomegaly. There was no asymmetric lower extremity edema

Chest radiograph performed in the emergency department revealed a severely dilated right ventricle (RV) and interventricular septal flattening. Computed tomography (CT) imaging of the head without injection of contrast dye, revealed no acute abnormality. Electrocardiogram reveals bradycardia and an inferior ST segment elevation.

ABG's are as follows: pH - 6.9, PCO2 - 47 mm Hg, PO2 - 49 mm Hg, HCO3 - 10 mEq/L. Peripheral blood cells: WBC - 16.9 3 103 cells/ml, Hgb - 10.0 mg/dl. Blood studies: Na - 139 mEq/L, K - 6.2 mEq/L, Lactate - 11.0 mmol/L, Anion gap 21, Troponin-I 10.82 ng/ml.

Tasks:

Discuss briefly the pathophysiologic mechanism of the patient.

Reference no: EM133868147

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