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    Case 1.4 Discussing Cardiopulmonary: Resuscitation When It May Be Useful

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    Ed is a 67-year-old man presenting with chest pain and shortness of breath. He has a history of heart failure and is living alone after his wife passed away. On physical exam, he has signs of congestive heart failure including jugular vein distention and murmurs. Diagnostics show sinus bradycardia, right bundle branch block, and an ejection fraction of 15-20%. When asked about resuscitation, Ed states he wants to be DNR. A palliative care consult is then ordered to discuss goals of care and treatment options given Ed's condition and values.

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    Case 1.4 Discussing Cardiopulmonary: Resuscitation When It May Be Useful

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    Dumdum
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    Ed is a 67-year-old man presenting with chest pain and shortness of breath. He has a history of heart failure and is living alone after his wife passed away. On physical exam, he has signs of congestive heart failure including jugular vein distention and murmurs. Diagnostics show sinus bradycardia, right bundle branch block, and an ejection fraction of 15-20%. When asked about resuscitation, Ed states he wants to be DNR. A palliative care consult is then ordered to discuss goals of care and treatment options given Ed's condition and values.

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    Case 1

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    Ed is a 67-year-old man presenting with chest pain and shortness of breath. He has a history of heart failure and is living alone after his wife passed away. On physical exam, he has signs of congestive heart failure including jugular vein distention and murmurs. Diagnostics show sinus bradycardia, right bundle branch block, and an ejection fraction of 15-20%. When asked about resuscitation, Ed states he wants to be DNR. A palliative care consult is then ordered to discuss goals of care and treatment options given Ed's condition and values.

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    11 views2 pages

    Case 1.4 Discussing Cardiopulmonary: Resuscitation When It May Be Useful

    Uploaded by

    Dumdum
    Ed is a 67-year-old man presenting with chest pain and shortness of breath. He has a history of heart failure and is living alone after his wife passed away. On physical exam, he has signs of congestive heart failure including jugular vein distention and murmurs. Diagnostics show sinus bradycardia, right bundle branch block, and an ejection fraction of 15-20%. When asked about resuscitation, Ed states he wants to be DNR. A palliative care consult is then ordered to discuss goals of care and treatment options given Ed's condition and values.

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    of 2

    Case 1.

    4 Discussing Cardiopulmonary
    Resuscitation When it May Be Useful
    Kelli Gershon

    HISTORY

    Ed was a 67-year-old white man being evaluated at an acute care hospital after
    complaining of chest pain. He described the pain (eight out of 10) as stabbing in nature and
    it was associated with shortness of breath and “sweating.” He also mentioned that he had
    been having shortness of breath at night and when he lays flat for weeks to months. He had
    driven himself to the emergency room because his family practitioner would not “call in
    something,” because he had not been seen for three years.
    Ed recently lost his wife to a long battle with breast cancer and the past three to five
    years he had been her primary caregiver. He was living alone in the house that they shared
    and he had three children that lived out of state. He stated his only past medical history
    included gastric esophageal reflux disease and arthritis. He treated both of these conditions
    with over-the-counter medications.
    The emergency room physician asked Ed about resuscitation, specifically, “If you die do
    you want me to do anything?” Ed responded, “Are we talking about a DNR (do not
    rescusitate) order? If so I want to be DNR. All that stuff doesn’t help anyway.” With this
    information a palliative care consult was ordered.

    PHYSICAL EXAMINATION

    Temperature: 37.1°C, blood pressure: 180/100 mm Hg, heart rate:


    32 bpm, respiratory rate 15
    Central nervous system: Alert, oriented, diaphoretic
    Head, eyes, ears, nose, throat: No defects or abnormalities
    Cardiac: Bradycardic, III/VI midsystolic murmur, IV/VI systolic
    murmur, jugular vein distention 8 cm
    Lungs: No wheezing or rales, good air movement, SpO2 98% on room air GI: Positive bowel
    sounds all four quadrants, non-tender/non-distended GU: voiding
    Ext: Lower extremities no pitting edema, 2+ dorsal pulse/pedal pulses

    DIAGNOSTICS

    Serum creatine: 1.0 mg/dl, hematocrit: 36%


    Electrocardiogram (EKG): Sinus bradycardia with rate of 35 beats/
    minute, right bundle branch block with left anterior hemi-block, no
    acute ischemic changes
    Echocardiogram: Ejection fraction 15%–20%, inferior wall hypokinesis,
    3+ aortic insufficiency, 2+ mitral regurgitation, moderate left atrium
    enlargement, moderate dilation of thoracic aorta (over 5.5 cm)
    CLINICAL QUESTION

    1. How should cardiopulmonary resuscitation (CPR) be discussed when it may be


    beneficial?
    2. What the intervention for the patient?
    3. Discus about ethic legal aspect

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