Percutaneous Coronary Intervention (ED)

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Mr. ABC came in to the emergency department (ED) with a chief complaint of left sided chest pain with giddiness and associated with diaphoresis the same morning. While in the ED, he developed a sudden episode of shortness of breath. Mr. ABC has nil past medical or surgical history and has an allergy to Enalapril.
His parameters taken are as follows:
Blood pressure: 112 /60 mmHg
• Pulse rate: 42 beats/min
• Temperature: 35.9°C
• Spo2: 97% on room air
• Respiration rate: 17 breaths/min
An echocardiogram (ECG) was ordered stat to view the electrical activities of the heart at different angle by heart muscle during a cardiac cycle and create a graphical representation of the electrical of the heart which used to assess abnormal cardiac rhythms,
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During PCI, a deflated balloon or other device on a catheter is introduced from the inguinal femoral artery or radial artery until they reach the site of blockage in the heart under X-ray imaging guidance. At the blockage, the balloon is inflated to open the artery, allowing blood to flow. A stent is often placed at the site of blockage to permanently open the artery. (Kushner et al., 2009). The part of the heart muscle does not die immediately after occlusion of coronary artery. If blood supply is restored within a few hours, much of the affected area of the heart muscle will be saved from damaging (Deckers, …show more content…
XYZ was noted to be having CO2 retention. Besides, he was very restless and kept removing his face mask overnight, causing an increase in breathing effort with a chest X ray showing decreased expiratory effort bilaterally. Thus, the decision to put him on BIPAP PSV/ST mode, fio2 of 40%, IPAP at 12cmH20, EPAP at 5cmH20 with back up rate of 12 breaths/min. Fio2 of 40% acts as a supplementary oxygen to bring up the oxygen saturation. It decreases the hypoxic drive and thus attenuating the hyperventilatory response to a change in PaCO2. Inspiratory Positive Airway Pressure (IPAP) is a boost of pressure that helps in delivering comfortable sized breaths. On the other hand, it improves ventilation and decrease breathing workload. More importantly, it is applied to help blow off carbon dioxide. End Positive Airway Pressure (EPAP), similar to CPAP, is a continuous positive airway pressure during exhalation that helps keep patient’s air passages open so that the next breath comes in easier. A back up rate is pseudo-ventilation. This pressure support ventilation will be automatically delivered as soon as the Mr. XYZ breaths beyond the set respiration rate with the intention to trigger spontaneously breaths (Positive Airway Pressure Titration Task Force of the American Academy of Sleep Medicine,

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