Anantomy Help PLZ!?!
Question: Kip is 65. He is brought to the ER b/c he almost fainted when he stood up. He says he has felt tired and weak 4 the last few days. He is short of breath but attributes this symptom to his chronic bronchitis. (he has smoked for 25 yrs)
When Kip gets to the ER, his bp is 100/70 and his pulse is 110 bpm while lying down. His bp is 90/70 while sitting and his pulse is 115 bpm. On palpation, he has mild epigastric tenderness and his stool guaiac test is positive for blood. A stat Hct/Hb is performed & the results are Hct=33, Hb=10 g/dl. He is given IV fluids and oxygen and his bloog is sent for typing and cross-match testing. A tube is inserted into Kip's stomach;suction reveals the stomach contains black-brown material looking like coffee grounds. A guaiac test on the material is positive for blood. It's flushed w/water and the suctionfluid clears. Acis inhibitors are given intravenously and Kip is given antacids orally. A gastroenterology consult is requested w/ diagnostic and
Answers: Kip is 65. He is brought to the ER b/c he almost fainted when he stood up. He says he has felt tired and weak 4 the last few days. He is short of breath but attributes this symptom to his chronic bronchitis. (he has smoked for 25 yrs)
When Kip gets to the ER, his bp is 100/70 and his pulse is 110 bpm while lying down. His bp is 90/70 while sitting and his pulse is 115 bpm. On palpation, he has mild epigastric tenderness and his stool guaiac test is positive for blood. A stat Hct/Hb is performed & the results are Hct=33, Hb=10 g/dl. He is given IV fluids and oxygen and his bloog is sent for typing and cross-match testing. A tube is inserted into Kip's stomach;suction reveals the stomach contains black-brown material looking like coffee grounds. A guaiac test on the material is positive for blood. It's flushed w/water and the suctionfluid clears. Acis inhibitors are given intravenously and Kip is given antacids orally. A gastroenterology consult is requested w/ diagnostic and
He probably had an upper GI bleed. His low Hgb and Hct levels, coffee ground stomach contents, low BP all of that indicate that he's bleeding from somewhere. His pulse increased because his heart had to increase it's workload in order to circulate the low blood volume adequately. His later symptoms of chest pain are indicative of a heart attack. This could have been caused because he didn't have enough Hgb to adequately perfuse the coronary arteries, pluse he has chronic bronchitis which means his O2 levels were probably low to begin with. having a low Hgb would only make matters worse.
What was done wrong? Well, number one, any medical professional who didn't recognize this as being a hemorrhage of some sort is a moron (not you, you are still in school). I would not have 'requested' a GI consult, I would have demanded one, right then and there. The fluids helped temporarily, but because the source of the bleed wasn't fixed, he continued to bleed, so the fluids did no good. The ultimate cause of death was a heart attack.
Heh heh, I kinda had fun doing this....
What is the question?????
Well the fact that he has a low hct and his heart rate is elevated and they found "coffee grounds" in his stomach tells me Kip was bleeding in his gut. It could be a large bleeding ulcer. His heart was working over time due to the reduced oxygen carrying capacity of his blood, he was anemic. The stood guaiac test is positive for blood in his stool which confirms the bleeding in his gut. Now his heart is stressed for a smoker of 25 years and he easily could have died from a heart attack.