ED: Case Study Review August, 2015 by Deborah Lynch, RN, MSN, APN, BC.

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Presentation transcript:

ED: Case Study Review August, 2015 by Deborah Lynch, RN, MSN, APN, BC

Case Study M.S is a 71 y/o right-handed male who presented to Rush’s ED on 11/18/14 His chief complaint(s) was sudden onset of headache, double vision and right-sided tingling sensation starting at 1300 while giving a lecture Previous complaints and w/u for visual changes, dizziness, facial numbness; carotid disease (moderate bilaterally), MRI-microhemorrhages –r/t HTN)

Past Medical History Hypertension HL CAD-CABG CHF AVR OSA Colon cancer

Medications (PTA) Pitavastatin HCTZ Cozaar Toprol Aspirin 81mg/d MVI **allergies: ramipril, simvastatin

Social History Non-smoker Married No recreational drugs Retired Chicago policeman Son with bipolar disease- recent increased level of stress

Initial CT head (non-contrast)

CTA head

CTA Neck

Circulation

CSF-Subarachnoid Space

Subarachnoid Hemorrhage (SAH)

Non-traumatic SAH Common causes- Aneurysms AV Malformations Bleeding Diasthesis

Signs & Symptoms-SAH Nuchal rigidity Papilledema Sicker than ischemic stroke Bigger change in level of consciousness than ischemic stroke Severe headache May have severe nausea and vomiting

Hunt and Hess (SAH)

Time Line - ED 1300 Symptom onset 1648 ED Arrival 2119 NSICU Admission

BP Management Time BP Medication Dosing 1655 217/87 1752 Labetolol 20mg IVP 1756 188/72 1805 181/74 1849 179/82 1855 Cardene gtt 5mg/h 1922 159/75 1926 Cardene gtt 7.5mg/h 1939 10mg/h 1942 162/74 2028 132/64 2035

Progress Notes/Flow 1726 CT head 1737 MD Note; d/w NS rec: CTA, keppra, sBP < 140, cardene gtt 1741 EKG interpretation 1756 CXR CTA 1912