Cardiovascular Critical Care I
Patient Case (contined)
mendations to the team for J.M.’s current management? (Assume that a basic metabolic panel [Chem 7], a
pulse oximetry, and a capillary blood glucose have already been completed.)
All tests previously mentioned have been ordered, and the following results are available. J.M.’s blood
pressure is 90/56 mm Hg (MAP 67 mm Hg), and his heart rate is 56 beats/minute. A 12-lead ECG showed
normal sinus rhythm without evidence of acute ST-T changes.
| • | Chest radiography reveals diffuse patchy opacities; however, infiltrate cannot be ruled out; lines are all in |
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appropriate positions.
| • | Serum chemistry panel results are as follows: sodium 126 mEq/L, potassium 4.8 mEq/L, chloride 102 |
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mEq/L, carbon dioxide 21 mEq/L, BUN 32 mg/dL, SCr 1.6 mg/dL, and glucose 134 mg/dL.
| • | Results of the CBC are as follows: WBC 9.8 × 103 cells/mm3, hemoglobin 11.1 g/dL, hematocrit 32.6%, |
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and platelet count 173,000/mm3.
| • | Additional laboratory values include the following: troponin 0.9 ng/mL, AST 114 IU/L, ALT 102 IU/L, |
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and BNP 1936 pg/mL.
| • | Invasive hemodynamic variables include CVP 28 mm Hg, pulmonary artery pressures 46/22 mm Hg, |
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cardiac index 1.8 L/minute/m2, and Scvo2 53%; pulmonary artery occlusion pressure is not yet available.
| • | ABG results are as follows: pH 7.36, partial pressure of oxygen (Po2) 93.7, partial pressure of carbon |
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dioxide (Pco2) 43.2, bicarbonate 23.9, oxygen (O2) saturation 89%, and lactate 6.9.
| • | ECHO results are pending. |
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The patient’s physical examination reveals that his extremities are cold to the touch, and his capillary refill
is poor. The team has ordered furosemide 80 mg intravenously once and would like to initiate a vasopressor
or inotrope for this patient. Which would be best to recommend at this time?
Manifestation of prolonged cessation of oxygenated blood supply to a portion of the myocardium that
is most commonly caused by an acute thrombus at the site of coronary atherosclerotic plaque rupture
leading to local or regional myocardial ischemia and necrosis
meet such demands may result in a scenario where “demand ischemia (type II NSTEMI)” is considered
versus a diagnosis of ACS.