Dalton Ingram Module 3 Assignment 4 Prompt 1 1. My initial concerns with this patient would be basic ABC’s as well as this patients heart stopping soon due to possible overdose on a CCB. 2. Glucagon has a positive chronotropic and inotropic effect on the heart, but depending on the reason why some people think that glucagon has a positive effect in CCB overdoses is mainly due to two possible trains of thought. One reason being that in the past glucagon medication was made up of a different compound and effected insulin secretion with an equivalent to 100 units. (Nickson, Glucagon as an antidote 2020)The other train of thought is that glucagon affects cAMP secretion which in turn helps secrete more insulin as well as has a catecholamine effect. (Nickson, Glucagon as an antidote 2020) 3. Calcium chloride is thought to be effective due to possibly being able to overcome the amount calcium receptors that are bound to CCB medication. This can also cause organ toxicity due to the amount of Calcium chloride needed to offset CCB medication. (Chakraborty, National Center for Biotechnology Information 2023) 4. Atropine is most likely not going to be affective due to being an anticholinergic and would have minimal affect on a problem that caused by a CCB binding to a completely different receptor. (Chakraborty, National Center for Biotechnology Information 2023) 5. I would refer to local protocol if possible, but I believe either route would be effective in managing this patient. (Murphy, 2017) Prompt 2 Primary tachycardia: Any endogenous, bodily system or force applied to cardiovascular system that results in a heart rate greater 100bpm. Secondary tachycardia: Any exogenous, external chemical or force applied to cardiovascular system that results in a heart rate greater than 100bpm. 1. Primary tachycardia: Runing a mile and having a heart rate greater than 100 bpm. 2. Primary tachycardia treatment: Rest, move to a cool calming place. 3. Secondary tachycardia: Drug use: stimulants like amphetamines or any external force or factor influencing tachycardia. 4. Secondary tachycardia treatment: Cholinergic medications or time allowed for drug to metabolize below therapeutic range. Prompt 3 1. Unstable, at 50 years old maintaining a heart rate of 180 will likely result in infarction. 1.1. I would start by asking if this patient has taken his medications if any, immediately from there I would start with vagal maneuver, if ineffective I would move onto to electric cardioversion with possible analgesic medication. If still ineffective I would move on to administer adenosine. 1.2. Possibly put on a medication drip based off blood test results showing if patient had any deficiencies or abundances of certain electrolytes, hormones or medications. Also possible augmentation to medication regimen. 1.3. Depends on how patient’s condition was induced i.e. not concurrent with medication, first time occurrence or bad diet. Dalton Ingram Module 3 Assignment 4 2. Stable, too many variables to definitively say if her heart rate is normally in this range. Also dehydration, bad diet, medication discipline, and other pathologies could be playing a part as well. 2.1. I would start by asking if this patient has taken their medications today, then assess bp, spo2, temp, blood sugar, lung sounds and cap refill. If any vitals listed above were abnormal, I would possibly treat for the following, dehydration, mild sepsis, or hyperglycemia. Most of the above include starting with administering fluids iv. If no other signs or symptoms arise, I would closely monitor the patient. 2.2. Patient would most likely have blood test drawn as well as treated for dehydration. Also continuous cardiac monitoring would be used to determine if patients current state was cardiac related. Many different ways a hospital could treat this patient would all depend on doctors route and methodology. 2.3. I believe this is likely to happen again. Depending on patients’ ability to care for themselves. If medication adjustment is needed and patients’ ability to care for themselves is not the issue, then I believe the likelihood of this happening again is slim. Also depending on if patient has obtained a new illness, the likelihood might rise. 3.1. Stable, a&o times 4, sinus rhythm. 3.2. I would ask this patient if they take any medications like amphetamines, as well as what they were doing before this and basic OPQRST/SAMPLE. Further vital signs would be obtained and oxygen via nasal cannula would be administered at 4 lpm. If no improvement I would move onto talking with the patient about possible drug use or anxiety. 3.3. Possible fluid administration for possible dehydration with cardiac monitoring. 3.4. Unknown, if condition is correctly diagnosed by a doctor than likelihood is slim. 4.1. Unstable, bp too low considering HR and RR. Bp too low to perfuse well. 4.2. I would ask if this patient had made a medication error possibly and if he is concurrent on his meds. If medication error was made (too much) I would treat with vasopressors, alpha 1 adrenergic medication or iv fluids. If no med error was made (correct dose taken) id ask of last oral intake of fluids, and then administer oxygen nc@4lpm as well as iv fluids. If ineffective use of vasopressor medication would be administered. 4.3. Unknown, doctors’ diagnosis would be helpful determining factor. 5.1. Unstable, patient fits circumstances for possible clots, myocardial infarction and stroke. 5.2. I would start by treating the heart rate with vagal maneuvers, if unsuccessful I would administer Cardizem. If unsuccessful I would move to synchronized cardioversion and adenosine. 5.3. Medication refill and cardiac monitoring. 5.4. Most likely, due to patients’ ability to take care of themselves and financial status. Dalton Ingram Module 3 Assignment 4 Chakraborty, R. K. (2023). National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK537147/. Retrieved May 5, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK537147/ Murphy, N. (2017, April 11). Calcium channel blocker toxicity · California Poison Control System (CPCS). California Poison Control System (CPCS). Retrieved May 5, 2023, from https://calpoison.org/news/calcium-channel-blocker-toxicity Nickson, C. (2020, November 3). Glucagon as an antidote. Life in the Fast Lane • LITFL. Retrieved May 5, 2023, from https://litfl.com/glucagon-as-an-antidote/ Song, G., Pacini, G., Ahrén, B., & D'Argenio, D. Z. (2017, February). Glucagon increases insulin levels by stimulating insulin secretion without effect on insulin clearance in mice. Peptides. Retrieved May 5, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272823/#:~:text=A%20well%2Dknown %20effect%20of,raises%20insulin%20concentrations%20(4).
