Cardiac Emergency Essay Example

Case Study 1: Cardiac Emergency

: History

A 48-year-old man called Barack Obama presented with chest pain that had been increasing in nature. He reported that on that day the pain came on suddenly and was crushing in nature, radiating to jaw; he rated the pain’s severity at 8 out of 10 on the point scale. He states that his health was generally good. The pain was not worsen on inspiration and he denied any history of recent trauma or illness. He reported that he had recently retired from a very stressful job, and had been experiencing increased periods of chest pain since his successor took over. He was not under any medication at that moment.

His vital signs were as follows: pulse,148 and irregular, thready; Respirations, 28 breaths/min; Temperature, 37.5^oC; Blood Pressure, 172/90 mm Hg; saturation, 95%; and Respiratory Sounds, Nil adventitious sounds. His pupils were equal and reactive and the blood glucose were 5.8mmol. Review of findings on electrocardiography (ECG) revealed ST elevation and review of Oedema revealed mild pitting oedema at both ankles.

Provisional Diagnosis:

The differential diagnosis obtained from the examination results are as follows

.Lewis et al., 2014)( is an indication that he is suffering from angina. ST elevation is also symptom of Angina. The illness is caused by a sudden reduction of the flow of blood to some parts of the heart muscle , radiating to jawThe fact that Obama had experience crushing chest pain

Myocardial infarction

Crushing chest pain, radiating to jaw indicate that Obama may be suffering from Myocardial infarction, though the pain is not worsen on inspiration (Davey, 2010; Lewis et al., 2014).

: Assessment

A — Airway

The patient was able to talk so the airway was likely to be clear. Oxygen mask is applied and oxygen is turned up to 15 litres. Wheeze or gurgling indicate partial airway obstruction.

B – Breathing

The observation were as follows:

Sats 90% on air

Respirations, 28/min

Respiratory Sounds, Nil adventitious sounds

C –Circulation

Full examination was conducted which include blood pressure, pulse, capillary refill, and assessment if there was any heart auscultation. The following observations were made:

148 and irregular, threadyPulse,

Respiratory Sounds, Nil adventitious sounds

172/90 mm HgBlood pressure,

centrally cyanosedCapillary refill <2 secs,

Blood Glucose, 5.8mmol

: Pathophysiology

It is a condition where the patient feels uncomfortable sensation or pain in the chest. This occurs when part of the heart fails to get enough oxygen due to some disease in the coronary arteries or blocked arteries. The situation lead to deficiency of oxygen in the muscles.

The heart has to work at fast rate and harder (Lewis et al., 2014).

Myocardial infarction

This condition occurs when the heart stopped when coronary artery is blocked when fatty acids in the artery walls rapture. Lack of oxygen and blood supply cause death of heart muscles. The common symptoms include nausea, chest pain, short breathing, sweating and palpitations. The patient suffering from this condition requires immediate medical attention (Davey, 2010).

Chest pain is a very common symptom, about 30% of the population experience chest pain in their lives, and up to 1% of the visits to a medical practitioner due to chest pain. About 5% of the patients who visit emergency complaints of chest pain (Liu et al., 2013). Chest pain in older people is likely to be related to a serious underlying problem; however, older people are likely to be present with typical or vague symptoms and lead to delay in seeking medical care (Murdoch et al., 2015).

: Investigations

ECG test is carried out to establish whether the patient is suffering from angina or Myocardial infarction. Angina exhibit ST-segment depression, while Myocardial infarction will show ST segment elevation or depression and T-wave inversion (Davey, 2010).

:Treatment

• Nitro-glycerine is administered to widen and relax the blood vessels, which enable more blood to flow and reduce the workload of the heart. Other medicines such as anticoagulants can help to relax blood vessels, lower cholesterol levels and blood pressure and prevent blood clotting.

• . Lewis et al., 2014; Davey, 2010)The medical procedure that can be used to treat the disease is angioplasty. It opens narrowed or blocked coronary arteries. A thin tube is threaded through the blood vessel to the coronary artery. The plague that is causing the blockage is blown thus restoring the blood flow and relieve pain (

Myocardial infarction

• such as nitrendipine works to dilate blood vessels. ACE inhibitors minimizes blood pressure and reduce the weakening of heart muscles. Anticoagulants minimize blood clotting in the arteries.  DihydropyridinesThe treatment include administration of

• . Lewis et al., 2014)Medical procedure include coronary artery bypass surgery by grafting. The vein or artery is used to bypass the section that is blocked in the coronary artery. The patient is position properly to promote rest (

: Transport

After stabilising and physiological abnormalities, the patient is transported to the nearest medical facility for special treatment. Local ambulance is be best, as the patient will continue receiving oxygen treatment.

References

. Chichester, West Sussex, UK: Wiley-Blackwell.Medicine at a glanceDavey, P. (2010).

Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & In Harding, M. (2014). Medical-surgical nursing: Assessment and management of clinical problems.

Liu D., Alippi C., Zhao D., and Hussain A., Brain Inspired Cognitive Systems (Conference), (2013). Advances in brain inspired cognitive systems: sixth International Conference, BICS 2013, Beijing, China, June 9-11, 2013: proceedings. Berlin: Springer. http://public.eblib.com/choice/publicfullrecord.aspx?p=3096824.

Murdoch, I., Turpin, S., Johnston, B., Maclullich, A., & Losman, E. (2015). Geriatric emergencies. http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=936289.