3. Cardioversion Patient Learner Actions Modifiers Vitals as per concerned but - Consent for cardioversion - Shock at <200J no change previous state agrees to - Consider (250cc) fluid - Shock at 200J converts to sinus cardioversion. bolus prior to sedation rhythm HR 82, BP 100/80 - Push-dose phenylephrine at bedside Triggers - ½ dose sedation (fentanyl ± - Sinus rhythm achieved midazolam) 4. Worsening CHF - Synchronized shock 4. Worsening CHF Increased Learner Actions Modifiers Rhythm: a fib or NSR WOB. - BiPAP (if not already) - given BP 70/40 (as per previous - Lasix (10mg-40mg IV) state) Diaphoretic. - Cardiac surgery consult Triggers HR: 90 - Cardiology consult END CASE PRN BP: 100/80 Audible - Anticipate need for intubation O2SAT: 90% on crackles. 100% RR: 30 **Labs given at beginning of state Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results Na: 140 K: 4 Cl: 105 HCO3: 25 BUN: 5 Cr: 80 Glu: 5.5 Ca: 2.50 Mg: 0.80 PO4: 1.20 Albumin: 35 VBG pH: 7.30 PCO2: 35 PO2: 95 HCO3: 25 Lactate: 2.0 Troponin I: 40 TSH: 2.5 WBC: 5.0 Hg: 120 Hct: 0.4 Plt: 300 Images (ECGs, CXRs, etc.) CXR: CHF ECG: LVH + A.fib CXR source: ECG source: http://www.wikidoc.org/index.php/ Atrial_fibrillation_EKG_examples cxr/pathology2Bchest.html ECG: NSR with LVH Lung U/S: B lines bilaterally (CHF) ECG source:
3. Cardioversion Vitals as per previous state Patient concerned but agrees to cardioversion. Learner Actions - Consent for cardioversion - Consider (250cc) fluid bolus prior to sedation - Push-dose phenylephrine at bedside - ½ dose sedation (fentanyl ± midazolam) - Synchronized shock Modifiers - Shock at <200J no change - Shock at 200J converts to sinus rhythm HR 82, BP 100/80 Triggers - Sinus rhythm achieved 4. Worsening CHF 4. Worsening CHF Rhythm: a fib or NSR (as per previous state) HR: 90 BP: 100/80 O2SAT: 90% on 100% RR: 30 **Labs given at beginning of state Increased WOB. Diaphoretic. Audible crackles. Learner Actions - BiPAP (if not already) - Lasix (10mg-40mg IV) - Cardiac surgery consult - Cardiology consult - Anticipate need for intubation Modifiers - given BP 70/40 Triggers END CASE PRN Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results Na: 140 K: 4 Cl: 105 HCO3: 25 BUN: 5 Cr: 80 Glu: 5.5 Ca: 2.50 Mg: 0.80 PO4: 1.20 Albumin: 35 VBG pH: 7.30 PCO2: 35 PO2: 95 HCO3: 25 Lactate: 2.0 Troponin I: 40 TSH: 2.5 WBC: 5.0 Hg: 120 Hct: 0.4 Plt: 300 Images (ECGs, CXRs, etc.) CXR: CHF CXR source: cxr/pathology2Bchest.html ECG: LVH + A.fib ECG source: http://www.wikidoc.org/index.php/ Atrial_fibrillation_EKG_examples Lung U/S: B lines bilaterally (CHF) ECG: NSR with LVH ECG source:
aortic-stenosis-with-a-fib-and-chf.docx