NU4710/NU47100 Cardiac Assignment (12 points)
Situation: .Mr. .Smith .is .brought .to .the .emergency .room .with .sudden .onset .of .substernal .chest .pain
.which .started .while .mowing .lawn. .He .rates .his .chest .pain .a .7 .of .10. .He .was .given .one .ASA .and
.three .SL .NTG. .A .TKO .IV .was .started. .He .is .diaphoretic, .cool, .clammy, .and .pale. .BP .154/88 .mmHg,
.pulse .95 .bpm, .RR .24 .and .nonlabored. .Sinus .rhythm .with .frequent .premature .ventricular .contractions
.(PVCs). .Labs: .Electrolytes .are .sodium .143 .mEq/L; .potassium .3.4 .mEq/L; .chloride .109 .mEq/L;
.carbon .dioxide .34 .mEq/L; .glucose .354 .mg/dL. .Cardiac .enzymes .creatine .kinase, .456 .units/L .and
.troponin, .151 .mcg/L.
Background: .63-year-old .Caucasian .male, .220 .lb, .6 .feet .2 .inches, .married .41 .years. .PMH:
.hypertensive .and .diabetes .type .II, .smokes .1½ .packs .of .cigarettes .per .day. .Allergic .to .penicillin.
In .the .emergency .room, .Mr. .Smith .develops .ventricular .fibrillation. .BLS .and .ACLS .initiated.
.Defibrillated .with .200 .joules .with .return .to .normal .sinus .with .frequent .PVCs .after .one .shock. .BP
.now .is .92/56 .mm .Hg, .pulse .thready, .and .skin .diaphoretic. .Pupils .are .4 .mm, .equal .and .reactive. .RR
.16 .bpm, .shallow, .SpO2 .92%. . He .is .not .fully .awake .but .is .moving .all .his .extremities .and .breathing
.independently.
Post .cardiac .resuscitation, .a .150-mg .bolus .of .amiodarone .is .given .over .10 .minutes, .and .an
.Amiodarone .infusion .is .started .at .1 .mg .per .minute. .ABGs .drawn .are .pH, .7.32; .PaCO2 .49 .mm .Hg;
.PaO2 .77 .mm .Hg; .and .bicarbonate .24 .mEq/L. .Hemoglobin .is .16.9 .g/dL, .and .his .hematocrit .is
.47.2%.
A .12 .lead .ECG .is .completed, .and .Mr. .Smith .is .diagnosed .with .a .myocardial .infarction
1. Considering .the .ECG .(see .image), .Mr. .Smith .is .experiencing .what .type .of .MI .(i.e. .location
.in .myocardium)? .You .know .this .by .identifying .this .ECG .change Anterior
.wall . (location) .in .these .leads
. V1, .V2, .V3, .V4 . .
2. What .coronary .artery .most .likely .is .diseased .based .on .this .type .of .MI?
a. LAD
Tissue .plasminogen .activator .(t-PA) .is .administered.
3. What .a .complication .related .to .the .infusion .of .tPA .and .a .sign .that .this .complication .may
.be .occurring? .How .do .you .monitor .for .its .occurrence?
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Situation: .Mr. .Smith .is .brought .to .the .emergency .room .with .sudden .onset .of .substernal .chest .pain
.which .started .while .mowing .lawn. .He .rates .his .chest .pain .a .7 .of .10. .He .was .given .one .ASA .and
.three .SL .NTG. .A .TKO .IV .was .started. .He .is .diaphoretic, .cool, .clammy, .and .pale. .BP .154/88 .mmHg,
.pulse .95 .bpm, .RR .24 .and .nonlabored. .Sinus .rhythm .with .frequent .premature .ventricular .contractions
.(PVCs). .Labs: .Electrolytes .are .sodium .143 .mEq/L; .potassium .3.4 .mEq/L; .chloride .109 .mEq/L;
.carbon .dioxide .34 .mEq/L; .glucose .354 .mg/dL. .Cardiac .enzymes .creatine .kinase, .456 .units/L .and
.troponin, .151 .mcg/L.
Background: .63-year-old .Caucasian .male, .220 .lb, .6 .feet .2 .inches, .married .41 .years. .PMH:
.hypertensive .and .diabetes .type .II, .smokes .1½ .packs .of .cigarettes .per .day. .Allergic .to .penicillin.
In .the .emergency .room, .Mr. .Smith .develops .ventricular .fibrillation. .BLS .and .ACLS .initiated.
.Defibrillated .with .200 .joules .with .return .to .normal .sinus .with .frequent .PVCs .after .one .shock. .BP
.now .is .92/56 .mm .Hg, .pulse .thready, .and .skin .diaphoretic. .Pupils .are .4 .mm, .equal .and .reactive. .RR
.16 .bpm, .shallow, .SpO2 .92%. . He .is .not .fully .awake .but .is .moving .all .his .extremities .and .breathing
.independently.
Post .cardiac .resuscitation, .a .150-mg .bolus .of .amiodarone .is .given .over .10 .minutes, .and .an
.Amiodarone .infusion .is .started .at .1 .mg .per .minute. .ABGs .drawn .are .pH, .7.32; .PaCO2 .49 .mm .Hg;
.PaO2 .77 .mm .Hg; .and .bicarbonate .24 .mEq/L. .Hemoglobin .is .16.9 .g/dL, .and .his .hematocrit .is
.47.2%.
A .12 .lead .ECG .is .completed, .and .Mr. .Smith .is .diagnosed .with .a .myocardial .infarction
1. Considering .the .ECG .(see .image), .Mr. .Smith .is .experiencing .what .type .of .MI .(i.e. .location
.in .myocardium)? .You .know .this .by .identifying .this .ECG .change Anterior
.wall . (location) .in .these .leads
. V1, .V2, .V3, .V4 . .
2. What .coronary .artery .most .likely .is .diseased .based .on .this .type .of .MI?
a. LAD
Tissue .plasminogen .activator .(t-PA) .is .administered.
3. What .a .complication .related .to .the .infusion .of .tPA .and .a .sign .that .this .complication .may
.be .occurring? .How .do .you .monitor .for .its .occurrence?
This .study .source .was .downloaded .by .100000899586247 .from .CourseHero.com .on .07-11-2025 .10:16:53
.GMT .-05:00
https://www.coursehero.com/file/92478811/NU4710NU4711-Cardiac-Assignmentdocx/
