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I am doing my cardiology class now and was thinking of this scenerio on my way to work.
43 y/o male with hx of CAD, HTN, and MI x2 (inferior & lateral wall). Pt. presents with CP, dyspnea, diaphoresis, pallor, and a real crappy appearance. Lungs reveal crackles throughout and heart failure is obvious. B/P is 102/70, HR is 98 in pt. is in severe respiratory distress.
During assessment pt. CODES and is shocked x1 with a ROSC. Post-resuscitation pt. remains unconscious and needing ventilatory support, B/P is now 80/50 with HR of 70 and showing a sinus rhythm with occasional PVC's.
Question:
Prior to arrest the treatment for this pt. would have consisted of O2, NTG, MS, ASA, and Furosemide for CHF and MI diagnosis. But since pt. is now hypotensive post-arrest you can't give the NTG and I would be hesitant to give the MS and Furosemide due to fear of decreasing B/P even further causing an even more decrease in perfusion. And you could'nt give a bolus of fluid since you know the pt. was in failure prior to arresting.
So my action would be to start a Dopamine infusion and run at 7-10mcg/kg/min to improve B/P and perfusion and then if the pt. responds well to the Dopamine with a decent pressure to go ahead and give the NTG, MS, and Furosemide to treat the heart failure and reduce overall workload of the heart to stabilize the pt.
Would this be the correct pharmacological treatment for this pt. scenerio? I don't have class til Monday and was really wondering so any feedback would be awesome. Thanks.
43 y/o male with hx of CAD, HTN, and MI x2 (inferior & lateral wall). Pt. presents with CP, dyspnea, diaphoresis, pallor, and a real crappy appearance. Lungs reveal crackles throughout and heart failure is obvious. B/P is 102/70, HR is 98 in pt. is in severe respiratory distress.
During assessment pt. CODES and is shocked x1 with a ROSC. Post-resuscitation pt. remains unconscious and needing ventilatory support, B/P is now 80/50 with HR of 70 and showing a sinus rhythm with occasional PVC's.
Question:
Prior to arrest the treatment for this pt. would have consisted of O2, NTG, MS, ASA, and Furosemide for CHF and MI diagnosis. But since pt. is now hypotensive post-arrest you can't give the NTG and I would be hesitant to give the MS and Furosemide due to fear of decreasing B/P even further causing an even more decrease in perfusion. And you could'nt give a bolus of fluid since you know the pt. was in failure prior to arresting.
So my action would be to start a Dopamine infusion and run at 7-10mcg/kg/min to improve B/P and perfusion and then if the pt. responds well to the Dopamine with a decent pressure to go ahead and give the NTG, MS, and Furosemide to treat the heart failure and reduce overall workload of the heart to stabilize the pt.
Would this be the correct pharmacological treatment for this pt. scenerio? I don't have class til Monday and was really wondering so any feedback would be awesome. Thanks.