Hey, what's up everyone, Doctor Zeshan here.
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All right, so let's answer this other prioritization question
that we posted here. It's four patients.
Obviously, prioritization, you're going to have four
patients. So it's pretty much standard.
So what patients are you going to see first?
Initial priority, urgent, most concerning, immediate report to
HCP. Of course, we're looking for ask
graph. We're looking for one of the
things that we're freaking out about as well too.
In this situation, you have 4 patients on your telemetry unit.
Which one are you going to prioritize first?
So remember those seven keywords first, initial priority, urgent,
most concerning, immediate report to HCP.
Those are going to be the keywords that we're looking at.
That's that are going to indicate that we're looking for
ask graph and what we're freaking out about.
South synonymous. We obviously we start with D&D
is a 55 year old female with stable angina complaining of
chest pain. Rated 6 out of 10 after walking
to the bathroom, now resting in bed versus And again, notice I
didn't make a decision versus CA 75 year old male with a history
of atrial fibrillation who has suddenly developed slurred
speech, right sided weakness and an irregular heart rate of 130
BPM. So between the two, we've got
the 55 with stable angina, meaning we know that we can
elicit this pain. We can elicit that chest pain.
Remember, angina and chest pain are synonymous.
They're the same exact term. But in this situation it's
stable, meaning it's predictable.
So if I tell them to walk to the bathroom or I tell them to walk
up a flight of stairs, if I tell them to jog for a few minutes,
we know for a fact that we can cause that chest pain, that
ischemia trying to get past that atherosclerotic plaque is going
to cause chest pain because we're not getting that blood
flow or that oxygen completely like we would like to.
So now this patient is resting and the pain is 6 out of 10.
So now we compare that to the 75 year old with a fib who has
slurred speech, right sided weakness, so unilateral weakness
and we've got that irregular heartbeat which is indicative of
that atrial fibrillation. So what is happening between the
two? Well, we've got that stable
predictable angina or chest pain or we've got somebody that
potentially is having a stroke. Now of the two types of strokes,
well is this ischemic or hemorrhagic?
Well, we're going to go on the side of ischemic, which we
talked about in neuro a lot. So know the difference between
ischemic stroke and hemorrhagic stroke and more so with ischemic
stroke, thrombotic versus embolic because in this
situation, we've actually had an embolic ischemic stroke.
So again, refer back to neuro. So we're going to keep C / D and
now we're going to compare C to B.
So B is a 42 year old female with end stage renal disease who
missed her dialysis yesterday and now is reporting nausea,
fatigue with the potassium level of 6.5 milliequivalents per
liter. Now we've got a patient who's
got one of ask. Well we've got 2 of Asgraf here.
We've got somebody that's developed a stroke.
So we said remember we've added the S from sepsis and also to
stroke. We've got 2 s s now and I'll do
an updated version of Asgraf here shortly as well too.
So we've got stroke in the one before that and now we've got
potassium at 6.5. So if we've got potassium at
6.5, it becomes 1 of Asgraf as well too.
But this patient has end stage renal disease.
So if they've got end stage renal disease, that means that
having high potassium levels is kind of almost expected.
When I would be freaking out about this is when we have a
situation where they're having dysrhythmias.
Because remember, potassium, if you go back to the EKG lecture,
is in fact going to predominantly control the
ventricles. And what we're worried about is
that ventricular fibrillation in this situation, they've got
nausea and fatigue, but they've got a potassium level of 6.5
with no dysrhythmias and they've got end stage renal disease.
So are we really freaking out about it compared to somebody
who is actively having an ischemic stroke?
Absolutely not. That is expected.
They miss dialysis. Get them back on dialysis and
watch the potassium get corrected.
So now we're down to 5050. Again, we're sitting pretty
here. So we've got 5050 and we've got
C that we've held onto with the stroke and now we're down to A A
is a 68 year old male with chronic heart failure, chronic
heart failure who has bilateral 3 plus pitting edema and is on
continuous IV infusion of ferresimide reporting a mild
headache. So again, we've got heart
failure, OK. We've got 3 plus pitting edema,
OK, and we've got a mild headache, but they're on
ferresimide. So what more can we do?
Remember, who do we have less time with and what more can we
do? Those same two questions that I
ask you when you're dealing with prioritization questions,
because in this situation, we've got somebody that potentially
has shortness of breath that may have some sort of exacerbation
of heart failure, but what more can we do?
Well, we get that fluid off with IV ferresimide.
So in this situation, the one that I'm freaking out about with
Ask Graph is that S, that S is in fact stroke, which we're
going to modify that as graph. We've added sepsis and stroke.
So again, we want to make sure that we are taking care of C
first. So the answer choice is CI.
Hope you all get it right. If not, I hope you understood
the explanation and see y'all on Wednesdays, remember free weekly
zoom on Wednesdays. Those of you that are
considering the on demand, remember the on demand is always
going on. It's self-paced and it's got all
this information that I've been talking about and then some.
So hope you enjoyed. Take care.