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Code Review. August 26, 2010. July ‘10 Dr. CART Stats. July ‘10 Hypothermia Stats. Cases for review. Case Presentation.

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Code Review

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Code review

Code Review

August 26, 2010


July 10 dr cart stats

July ‘10 Dr. CART Stats


July 10 hypothermia stats

July ‘10 Hypothermia Stats


Cases for review

Cases for review


Case presentation

Case Presentation

  • The patient is a 48-year-old woman with past medical history of coronary artery disease status post CABG in 2007, admitted on 6/27 for syncope and chest pain. Left Heart cath 6/29 showed a 95% lesion of the native vessel at the anastomosis with the RIMA.

  • PMH:

    • CAD- DES to LAD in 2006, CABG in 2007- LIMA to OM and RIMA to LAD, and DES to LAD and left circumflex in 12/2009.

    • CHF, ejection fraction of 25% s/p ICD placement on 08/17/2007

    • Moderate-to-severe MR, Moderate-to-severe TR.

    • Diabetes with complications including retinopathy of the left eye(2004)

    • End-stage renal disease on hemodialysis

    • Hypertension.

    • Hyperlipidemia.

    • Obstructive sleep apnea on C-PAP of 9.

    • Morbid obesity.


Admission cxr

Admission CXR


Admission ekg

Admission EKG


Hospital course

Hospital Course

  • Patient went to the OR on 6/30 for High-risk redo CABG (recycled right internal mammary artery to distal left anterior descending, saphenous vein graft sequential to first circumflex OM1 and OM2), mitral valve repair, and tricuspid valve repair.

  • Post operatively the patient slowly improved and was eventually weaned off of pressors, but remained on Dobutamine and Amiodarone gtts. Her vitals on the days preceding the code were notable for hypotension with BP’s ranging between 60’s/30’s to 80’s/50’s


Nursing notes on 7 25

Nursing Notes on 7/25

  • 17:07- Pt had bowel movement. Pt turned to L side to clean bowel movement. When pt turned to back-she was not responding and had blank stare on her face. Episode lasting approx 1 min. Pts BP 88/62 HR 112, 100% on 4 L nc, blood sugar 146. RRT called then canceled as patient became responsive. Pt able to state name and squeeze with both hand. Pt requesting BI-PAP to be placed. Resp therapy in room and placed equipment on patient with appropriate settings. Pt drowsy but arousable. Awaiting EKG to bedside.

  • 19:35- Report given to night RN. Responded to alarm-low O2 saturations. Pt found drooling w shallow respirations. Pt placed on Bi-PAP O2 100% BP 102/47 HR 118. Pt unresponsive and gradually became responsive with residual drowsiness. Service and night RN at bedside

  • 21:13- Dr. Cart called


Code review

Compressions begin


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Poor pad contact

Ongoing compressions


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Pulse/Rhythm check


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Shock #1


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Rhythm check


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Pulse check


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Pulse check


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Pulse check


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Pulse check


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Pulse return


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Pulse return

10s


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Pulse check


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Brief pulse return


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Shock #3


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Anticipatory charging


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Shock #4


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Pulse check


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Shock #5


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Anticipatory charge


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No shock


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Anticipatory charge, long pause


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Pulse check


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No shock


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Labs

  • ABG: 6.863/50/32/20%

  • Calculated HCO3: 9


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Anticipatory charging, pulse check


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Shock #7


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Am J Cardiol 2002; 90: 853-859


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Resume chest compressions


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Pulse check

10s


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Pulse return


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Loss of pulse

Compressions?


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Shock #9


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Great compressions


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Anticipatory charge, pulse check


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No shock, pulse return


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Rhythm change


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Shock #10


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Rhythm change


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Shock #11


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Compressions resume

Compressions resume


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End of code- Pt made DNR


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Zoomed out


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