Download Simulation Spring 2012_Cardiovascular

Mr. Z is a 54 y/o old male that arrives via ambulance to your emergency room. EMS provides report this
gentleman was awakened with substernal pain at 5:00 AM. The pain is described as crushing with a
sudden onset and required him to sit up and catch his breath. His movement and moaning awakened
his wife who became quickly concerned called 911. While in route Mr. Z became severely diaphoretic
with increasing shortness of breath. He is unable to identify if the pain radiates and states has never felt
anything like this before. He gives a history of having blood pressure problems but is not specific of any
treatment and that he has not seen his physician in a number of years. When asked of his medical
history he denies. When as a family history he states his father died of a massive stroke and his mother
had diabetes and has a brother who had a sudden cardiac event. Your patient lives within two blocks to
the emergency room so that the EMS was unable to acquire ID access. He was placed on a monitor and
given oxygen and transported to our facility. An EKG is ordered on his arrival and he is placed in one of
the cardiac rooms. The Physician meets you in his room as you start to initial assessment. Consider
focused history and a focused physical assessment. Your interventions begin from the time he arrives in
the emergency room. The following is Mr. Z’s EKG:
(Consider this 12 lead EKG. Remember that Leads I,II,III, AVR, AVL, AVF are the limb leads and V₁ to V₆
are his precordial leads…….refer to pp. 79-81 in your ECG Success book for assistance. Identify your
EKG!
Your initial vital signs and parameters will be noted on the screen in your simulation lab. In your
modules on canvas are all the algorhythms (pulseless, tachycardia, and bradycardia) that you will use as
a guide in the treatment of Mr. Z. Please review these so you are familiar which to use as a quick guide
and what the implications are.
Medications you will need to be familiar with, the dosage their route and their use will include:
Atropine
Epinephrine 1: 10,000
Dopamine premix 400 mg /250ml
Lidocaine
Normal saline IV fluids
Adenosine
You will work as a team as in your previous simulations and will be critiqued as a team. Be prepared to
“think out loud,” this will enhance your learning.