Kiwiology Posted September 9, 2009 Share Posted September 9, 2009 You're called to a 43 year old male who has fallen down at a mall out in the burbs 30 minutes from hospital. Upon arrival you find he has been helped into a chair in the food-court, is struggling for breath and in obvious resp distress. Initial workup: GCS 15 4/5/6 Speaking 2-3 word sentences BP 105/90 RR 36, shallow and laboured PR 102 SPO2 89% RA Breath sounds reveal coarse bilateral crackles Patient denies any cardic hx; pmhx renal failure, has not been dialysed in 5 days 12 lead ECG: Initial treatment: - O2 NRB 10lpm - IV access - 0.8mg GTN SL His oxygen saturation does not imrpove and the Advanced Paramedic attempts rapid sequence intubation using midazolam and suxamethonium. Although successful at gaining an airway and bringing the oxygen saturation up to 97%; the patient sufferes a cardiac arrest and does not survive. So ... venture a guess at what killed this guy? Link to comment Share on other sites More sharing options...
CBEMT Posted September 9, 2009 Share Posted September 9, 2009 (edited) Already hyperkalemic and in renal failure from lack of dialysis, the sux pushed him over the edge by significantly increasing potassium levels. I dunno about RSI though. Sounds like a case for CPAP, IMHO (*listens for Vent's pounding footsteps on her way to tell him how stupid he is....*). Edited September 9, 2009 by CBEMT Link to comment Share on other sites More sharing options...
Kiwiology Posted September 9, 2009 Author Share Posted September 9, 2009 .... if only we had CPAP lol; well, watch this space Link to comment Share on other sites More sharing options...
itku2er Posted September 9, 2009 Share Posted September 9, 2009 (edited) Why didnt he have dialysis for 5 days? Edited September 9, 2009 by itku2er Link to comment Share on other sites More sharing options...
Kiwiology Posted September 9, 2009 Author Share Posted September 9, 2009 That I do not know Link to comment Share on other sites More sharing options...
itku2er Posted September 9, 2009 Share Posted September 9, 2009 My guess and I could be wrong here what killed him was a build up of fluid and toxins that his body couldnt get rid of on their own. Unless a jealous wife/gf/or other poisioned him for the money. I know its the nurse in me. Link to comment Share on other sites More sharing options...
Chief1C Posted September 9, 2009 Share Posted September 9, 2009 Does this food court have a mini sonic? Because I'd get a Cherry Limeade, while my partner is treating the patient. Link to comment Share on other sites More sharing options...
medic82942003 Posted September 10, 2009 Share Posted September 10, 2009 High potassium? Labs outa wack, Flash pulmonary edema? Link to comment Share on other sites More sharing options...
dreamynurse Posted September 11, 2009 Share Posted September 11, 2009 Having been a dialysis nurse for a couple moons, I would say that did contribute to his demise. It's really hard to tell with out labs to back up any thoughts one migh have. But I would be willing to bet it was cardiac related some way. Link to comment Share on other sites More sharing options...
chbare Posted September 17, 2009 Share Posted September 17, 2009 (edited) The XII lead is characteristic for a possible sine wave pattern. This is highly suggestive of severe hyperkalemia. Add this to a history of renal failure and we need to assume severe hyperkalemia. The team demonstrated poor understanding of the pathophysiology of renal failure and overall knowledge of their medications when they decided to use suxamethonium. (Succinylcholine for those of us who speak proper English. ) Edit for emoticon. Edited September 17, 2009 by chbare Link to comment Share on other sites More sharing options...
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