Myasthenia Gravis Case Analysis

ICU to the floor. She has essentially stabilized. Again, she is having some type of

admitted from the ED today for a GI bleed. She¶s had one unit of packed RBCs

A 66-year-old man presented to the emergency room complaining of increased swelling of the back of his throat and difficulty breathing. Despite treatment with epinephrine, antihistamines, and corticosteroids, the patient's condition progressed from that of severe laryngeal edema to total laryngospasm and complete airway obstruction. Emergency measures to intubate the patient were complicated by severe swelling of his neck and oropharynx, forcing the physician to perform a grossly traumatic tracheotomy. The difficulty encountered during intubation deprived the patient of oxygen for a significant amount of time, precipitating cardiopulmonary arrest. The anoxic episode resulted in hypoxic, ischemic

Banting and Best went from bedside to bedside, injecting the unconscious patients with their new discovery, and before reaching the last few in the ward, the first were already waking up. The patients would gradually get better, gaining their appetites back, and gathering the strength to get up out of their beds.

A 62-year-old white male presented to the hospital for a scheduled ventriculoperitoneal shunt removal. The patient had developed cysts in the brain seventeen years ago in 1998 leading to increased intracranial pressures from accumulation of cerebrospinal fluid. After discovering the brain cysts, the patient underwent a ventriculoperitoneal shunt placement. Two years after the shunt was placed, the patient underwent another procedure for shunt revisions due to complications with infection. Now, the patient is presenting for removal of the shunt. In the pre-op holding area, the patient’s vital signs were taken. The patient’s blood pressure was 153/75, heart rate 80, respirations 18, oxygen saturation 93% on room air, and temperature was 36.5 degrees Celsius. Prior to the patient’s surgery, lab work was performed consisting of a CBC and CMP. The patient’s white blood cell count was 11.7, platelets 379, hemoglobin was 10.8 and hematocrit was 33. The patient’s potassium level was 3.7, calcium 9.1, sodium 145, BUN 35, and creatinine 2.21.

I was also surprised to see a comatose patient gain consciousness after 35 days. As a part of a team caring for this comatose patient in the ICU, I was involved in monitoring his vital signs, airway, nutrition and urine output. I worked closely with other members of the health care team to maintain his physical health. Swithching him form oropharyngeal ventilation to cricothyrotomy for airway management was another challenging task caring for this patient. I built a good rapport with his family members as I communicated

The unresolved infection has landed the patient on septic shock. Sepsis is the body’s response to inflammation of a particular or unknown infection. The presence of hypotension despite adequate fluid infusion and inadequate tissue perfusion is the result of septic shock. The treatment of shock is centered on the restoration of blood pressure to normal, the presence of adequate tissue perfusion, making sure organs return to functioning well, and avoiding further complications (Lewis, Dirksen, Heitkemper, Bucher, & Harding,

Marie is pale, weak, and anxious, but no longer disoriented. Her fundus is firm and is 1 cm above the umbilicus. She is receiving O2 per nasal cannula at 4 liters/minute and has an O2 saturation of 88%. Her vital signs are: BP 74/44, pulse 116 and respirations 26. Her bleeding has slowed considerably. The nurse asks the UAP to bathe Marie and change the bed linens.

Ridgewood High School is not exactly the perfect school. The school is full of delinquents, guns, and drugs. Lunch period was the prime time for trouble. The sound of the glass shattering from the window awoke the whole school. The people started to gather around the three boys creating the commotion. One of boys Douglas, a big, mean bully was heaving rocks at two boys Glen and Taylor. Glen is a smart fella who wants absolutely zero trouble. His only desire is getting into MIT. Taylor is the starting wide receiver for the football team and tries to protect Glen. During Lunch, Douglas pushes Glen to the ground and Taylor steps in front of Douglas in attempt to stop him. In the end, there were a couple bloody noses and several broken windows. On the other end of the school, Davis is waiting to sell Kevin marijuana. Davis really needs the money and Kevin has nothing going for him. He cuts class, abuses drugs and flat out does not care. After their exchange, behind them stands the school narcotics officer.

What began as seemingly innocent muscle weakness and cramping has lead to this patient’s fatal diagnosis. He is one of 2.5 per 100,000 people worldwide who have been

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

worsened. The nurses tried to comfort me, but nothing they did helped. I was a

The case I will discuss comes from the Journal of General Internal Medicine and is as follows: the patient is an 80-year-old woman who suffers from nonresectable lung cancer and has been diagnosed with lobar pneumonia. Other conditions present are: hypertension, diabetes, chronic renal insufficiency and severe degenerative joint disease. While improvement was seen with initial treatment, the patient suffered worsening hypoxemia, level of consciousness obtunded, and developed acute renal failure. Thus, the only means to prevent death was intubation with

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She has an ostomy. She was fresh from surgery yesterday, so they gave her pain meds to manage the pain. When I first walked into the room, I learned that she was making snore-liking sounds when she was breathing. From what I have learned, it is called rhonchi. She had many secretions going on. What I was concerned of was how much oxygen she was getting in. I looked at her last vital signs and found that she was had a 92 percent o2 sat level. I was also concerned about her aspirating. Therefore, we had to make sure her HOB 30-45 degrees. I made sure the side rails were up x3 because of fall precaution. She was comfortable most of the time but I taught her but the risk for pressure sores. She understood the need turn frequently to prevent pressure sores. Later I looked in her labs and found that her hemoglobin at 7.1. She was a candidate for blood transfusion. The nurse was teaching me how blood transfusions are done. Before they give her blood, they have to get her last vital signs. We were consistently checking her vitals as we were giving her a blood transfusion. After giving her blood, we had to monitor her and her vital signs for any transfusion reaction. The symptoms of transfusion reaction is shortness of breath and depressed vital signs. Later we found that her oxygen level was at a 93 percent. Afterwards, I looked into her chart and found that he had an XRAY done, which revealed