1. In the first scenario, we are presented with a 77-year-old male patient named Adam Smith who has been admitted to the intensive care unit (ICU) from a nursing home. Adam is suffering from septic shock due to urosepsis, which is an infection of the urinary tract that has spread into the bloodstream. Upon examination, it is observed that Adam has a Foley catheter in place, which has resulted in cloudy greenish-yellow urine with sediments. The nurse removes the Foley catheter and replaces it with a condom catheter attached to a drainage bag, as Adam has a history of urinary and bowel incontinence.
In terms of Adam’s vital signs, he is found to be confused and hypotensive with a blood pressure reading of 82/44 mm Hg. Additionally, his respiratory rate is elevated at 28 breaths per minute, and his pulse oximeter reading shows an oxygen saturation level of 88% on room air. As a result, the physician prescribes 2 to 4 liters of oxygen per nasal cannula to be titrated in order to maintain Adam’s arterial oxygen saturation (SaO2) above 90%. Initially, Adam responds well to 2 liters of oxygen per nasal cannula, achieving a SaO2 of 92%.
Furthermore, it is important to note that Adam is experiencing diarrhea and has an elevated blood glucose level of 160 mg/dL. His white blood count (WBC) is also elevated at 15,000, indicating the presence of infection or inflammation. Given these findings, Adam is being treated with broad-spectrum antibiotics and norepinephrine (Levophed), a vasopressor medication used to increase blood pressure. The initial dose of norepinephrine is 2 mcg/min, which will be adjusted according to Adam’s systolic blood pressure, with the goal of maintaining it above 100 mm Hg. Additionally, a subclavian triple lumen catheter has been inserted and verified by chest x-ray to ensure correct placement. Moreover, an arterial line has been placed in Adam’s right radial artery to closely monitor his blood pressure during the administration of vasopressor therapy.
2. In the second scenario, we encounter a patient named Carlos Adams who has sustained blunt trauma to his abdomen as a result of a motor vehicle accident. When Carlos arrives at the emergency department, the following vital signs are recorded: a temperature of 100.9°F, a heart rate of 120 beats per minute (bpm), a respiratory rate of 20 breaths per minute, and a blood pressure of 90/54 mm Hg. Upon examination, Carlos’s abdomen is noted to be firm, with bruising around the umbilicus. Although he is alert and oriented, Carlos reports feeling dizzy whenever he changes positions. Given the suspicion of hypovolemic shock due to his condition, Carlos is admitted for management.
The physician has ordered several interventions for Carlos, including the placement of two large-bore intravenous (IV) lines and the infusion of 0.9% normal saline (NS) at a rate of 125 mL per hour for each line. This is intended to restore and maintain Carlos’s intravascular fluid volume. In addition, a complete blood count and serum electrolyte levels are to be obtained to assess Carlos’s blood and electrolyte status. Oxygen is prescribed at a rate of 2 liters per minute via nasal cannula to ensure adequate oxygenation. Furthermore, Carlos is to undergo a type and crossmatch procedure to determine his blood type and find compatible units for potential blood transfusion. Lastly, a flat plate of the abdomen is to be performed immediately to assess possible internal injuries.
Overall, both scenarios depict patients in critical condition requiring prompt and thorough management to stabilize their physiological status and address the underlying causes of their symptoms. Proper assessment and intervention are key in these situations, as they can significantly impact patient outcomes.