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Case Stud: Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis. He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm. He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia. He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.
Mr. Jones regains consciousness after his rhythm converts. He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24. O2 is immediately started at 3 liters/minute. Three 18 g IV's are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given. The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4.
After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt. This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min. His blood pressure drops to 84/40. He is pale and diaphoretic. He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.
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