Critical Conversations

Autor: Ernest Benjamin, Roopa Kohli-Seth, Ryoko Tanabe, Dani Hackner, Philip K. Ng, Erin S. Dupree, Claude Killu
Rok vydání: 2010
Předmět:
Zdroj: ICU Director. 1:300-303
ISSN: 1944-4524
1944-4516
DOI: 10.1177/1944451610396163
Popis: Vignette A 36-year-old homeless man was brought in to the emergency room with altered mental status and was unable to give a history. Based on prior emergency visits, he has a history of IV drug abuse and alcohol abuse. His vital signs on arrival are the following: HR of 110 (regular), BP of 102/58, temperature of 98.0, and respiratory rate of 8/min. His Glasgow Coma Scale score is 7. Physical examination results are that he is grossly obtunded, responds only to deep painful stimuli, is nonverbal, and moves all extremities. Pupils are small, 2 to 3 mm, and reactive. His heart reveals regular tachycardia. Lungs are clear to auscultation. Abdomen is within normal limits. His extremities are warm to touch. Skin reveals ecchymosis. His initial head CT finding is negative for bleeding, infarct, or mass. He has severe metabolic acidosis, and the urine toxin screen result is positive for cocaine and opiates. His creatinine kinase enzyme is greater than 20,000 IU/L. Peripheral venous access attempts are unsuccessful. The right internal jugular vein is accessed via a needle with ultrasound guidance, but a guidewire failed to pass on multiple attempts. The emergency physician inserts a right femoral line triple lumen catheter without ultrasound. The patient is intubated via an endotracheal tube for airway protection and admitted to the medical ICU.
Databáze: OpenAIRE
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