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Hey, what's up everyone, Doctor 
Zeshan here. 

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enjoy the lecture. 
Take care. 

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All right, so let's answer this 
other prioritization question 

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that we posted here. 
It's four patients. 

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Obviously, prioritization, 
you're going to have four 

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patients. 
So it's pretty much standard. 

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So what patients are you going 
to see first? 

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Initial priority, urgent, most 
concerning, immediate report to 

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HCP. 
Of course, we're looking for ask

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graph. 
We're looking for one of the 

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things that we're freaking out 
about as well too. 

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In this situation, you have 4 
patients on your telemetry unit.

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Which one are you going to 
prioritize first? 

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So remember those seven keywords
first, initial priority, urgent,

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most concerning, immediate 
report to HCP. 

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Those are going to be the 
keywords that we're looking at. 

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That's that are going to 
indicate that we're looking for 

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ask graph and what we're 
freaking out about. 

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South synonymous. 
We obviously we start with D&D 

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is a 55 year old female with 
stable angina complaining of 

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chest pain. 
Rated 6 out of 10 after walking 

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to the bathroom, now resting in 
bed versus And again, notice I 

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didn't make a decision versus CA
75 year old male with a history 

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of atrial fibrillation who has 
suddenly developed slurred 

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speech, right sided weakness and
an irregular heart rate of 130 

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BPM. 
So between the two, we've got 

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the 55 with stable angina, 
meaning we know that we can 

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elicit this pain. 
We can elicit that chest pain. 

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Remember, angina and chest pain 
are synonymous. 

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They're the same exact term. 
But in this situation it's 

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stable, meaning it's 
predictable. 

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So if I tell them to walk to the
bathroom or I tell them to walk 

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up a flight of stairs, if I tell
them to jog for a few minutes, 

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we know for a fact that we can 
cause that chest pain, that 

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ischemia trying to get past that
atherosclerotic plaque is going 

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to cause chest pain because 
we're not getting that blood 

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flow or that oxygen completely 
like we would like to. 

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So now this patient is resting 
and the pain is 6 out of 10. 

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So now we compare that to the 75
year old with a fib who has 

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slurred speech, right sided 
weakness, so unilateral weakness

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and we've got that irregular 
heartbeat which is indicative of

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that atrial fibrillation. 
So what is happening between the

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two? 
Well, we've got that stable 

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predictable angina or chest pain
or we've got somebody that 

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potentially is having a stroke. 
Now of the two types of strokes,

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well is this ischemic or 
hemorrhagic? 

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Well, we're going to go on the 
side of ischemic, which we 

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talked about in neuro a lot. 
So know the difference between 

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ischemic stroke and hemorrhagic 
stroke and more so with ischemic

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stroke, thrombotic versus 
embolic because in this 

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situation, we've actually had an
embolic ischemic stroke. 

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So again, refer back to neuro. 
So we're going to keep C / D and

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now we're going to compare C to 
B. 

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So B is a 42 year old female 
with end stage renal disease who

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missed her dialysis yesterday 
and now is reporting nausea, 

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fatigue with the potassium level
of 6.5 milliequivalents per 

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liter. 
Now we've got a patient who's 

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got one of ask. 
Well we've got 2 of Asgraf here.

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We've got somebody that's 
developed a stroke. 

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So we said remember we've added 
the S from sepsis and also to 

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stroke. 
We've got 2 s s now and I'll do 

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an updated version of Asgraf 
here shortly as well too. 

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So we've got stroke in the one 
before that and now we've got 

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potassium at 6.5. 
So if we've got potassium at 

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6.5, it becomes 1 of Asgraf as 
well too. 

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But this patient has end stage 
renal disease. 

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So if they've got end stage 
renal disease, that means that 

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having high potassium levels is 
kind of almost expected. 

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When I would be freaking out 
about this is when we have a 

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situation where they're having 
dysrhythmias. 

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Because remember, potassium, if 
you go back to the EKG lecture, 

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is in fact going to 
predominantly control the 

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ventricles. 
And what we're worried about is 

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that ventricular fibrillation in
this situation, they've got 

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nausea and fatigue, but they've 
got a potassium level of 6.5 

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with no dysrhythmias and they've
got end stage renal disease. 

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So are we really freaking out 
about it compared to somebody 

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who is actively having an 
ischemic stroke? 

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Absolutely not. 
That is expected. 

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They miss dialysis. 
Get them back on dialysis and 

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watch the potassium get 
corrected. 

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So now we're down to 5050. 
Again, we're sitting pretty 

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here. 
So we've got 5050 and we've got 

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C that we've held onto with the 
stroke and now we're down to A A

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is a 68 year old male with 
chronic heart failure, chronic 

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heart failure who has bilateral 
3 plus pitting edema and is on 

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continuous IV infusion of 
ferresimide reporting a mild 

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headache. 
So again, we've got heart 

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failure, OK. 
We've got 3 plus pitting edema, 

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OK, and we've got a mild 
headache, but they're on 

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ferresimide. 
So what more can we do? 

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Remember, who do we have less 
time with and what more can we 

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do? 
Those same two questions that I 

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ask you when you're dealing with
prioritization questions, 

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because in this situation, we've
got somebody that potentially 

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has shortness of breath that may
have some sort of exacerbation 

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of heart failure, but what more 
can we do? 

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Well, we get that fluid off with
IV ferresimide. 

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So in this situation, the one 
that I'm freaking out about with

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Ask Graph is that S, that S is 
in fact stroke, which we're 

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going to modify that as graph. 
We've added sepsis and stroke. 

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So again, we want to make sure 
that we are taking care of C 

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first. 
So the answer choice is CI. 

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Hope you all get it right. 
If not, I hope you understood 

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the explanation and see y'all on
Wednesdays, remember free weekly

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zoom on Wednesdays. 
Those of you that are 

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considering the on demand, 
remember the on demand is always

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going on. 
It's self-paced and it's got all

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this information that I've been 
talking about and then some. 

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So hope you enjoyed. 
Take care.