You respond to a local skilled nursing facility for respiratory difficulty and find a gravely ill elderly female with severe shortness of breath and a very poor respiratory effort. The staff tells you that she was recently diagnosed with pneumonia and started on Levaquin. She is unresponsive and you attempt to bridge her on CPAP as you package her to go out to the ambulance. She is febrile and tachycardic in the 130s / sinus tach. Initial BP is 142/90. When you load her in the ambulance you notice that her resp effort has nearly ceased, and your partner switches to a BVM. You subsequently intubate her without difficulty and without the need for RSI medications. Two minutes later the Lifepack is alarming. She is now in a sinus bradycardia at 38 bpm, and her BP is reading 58/30. Why is she suddenly bradycardic and hypotensive? What interventions must be taken immediately and how would you manage care from this point?
Posted on: Tue, 30 Dec 2014 00:04:10 +0000
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