Reference no: EM133561676

Case Study: In the ED, Mr. Johnson's chest pain was unrelieved after three sublingual nitroglycerin tablets. Morphine sulfate 5mg IVP was administered, resulting in a small decrease in pain. A chewable aspirin was also given. After evaluation of the initial laboratory results, presenting symptoms, and the EKG, the diagnosis was an extensive anterior MI. Mr. Johnson was taken immediately to the cardiac catheterization laboratory for emergency angioplasty. The angiogram showed 90% blockage of the left anterior descending (LAD) artery. An emergency percutaneous transluminal coronary angioplasty (PTCA) was performed, but the artery continued to re-occlude, so a stent was placed. While the PTCA was being performed, Mr. Johnson became hypotensive, tachycardic, pale, cool, and diaphoretic. He complained of having shortness of breath, was restless, rales were auscultated throughout all lung fields, and he was found to have jugular vein distention (JVD). A CXR showed pulmonary edema. A dobutamine drip was started at 6 mcg/kg/min. Abciximab (Reopro) bolus of 0.25mg/kg was given followed by an infusion at 0.125 mg/kg for 12 hours.. He was also given 40 mg furosemide IVP and a nitroglycerin drip was started. A pulmonary artery (Swan-Ganz) catheter was placed. An intra-aortic balloon pump (IABP) was inserted in the right groin.

Question 1.) What are the rationales for the pharmacological agents (6) that Mr. Johnson received?

Question 2.) Explain the rationales for both the Swan-Ganz catheter and IABP assist in Mr. Johnson's plan of care.