Diaper Manual Intructions

Question No. 2


A 28 year old man with an intravenous drug addiction is brought to the emergency department with dyspnea, agitation, sweating, cold extremities and pink sputum productive cough. There had fever and chills the last two days, but suddenly starts 1 hour before dyspnea. Vital signs are BP 105/40, BP 126 per min., 38 breaths per min., Oxygen saturation 88%, temperature 39.7 º C. The carotid pulse is full and collapsing (Corringe pulse) and presents an early diastolic murmur. Pulmonary auscultation revealed widespread bilateral moist rales. Besides the urgent intubation and intravenous administration of furosemide, which of the following immediate actions is the most important:

1. naloxone and nitrites.
2. Call cardiac surgeon.
3. urgent echocardiograms.
4. Remove blood cultures and start intravenous antibiotics.
5. naloxone and intravenous antibiotics and place an intra-aortic balloon counterpulsation.

We describe a typical clinical endocarditis that evolution as sharp, frequency and history of IDU, whether caused by S. aureus. Physical examination and bounding pulse and early diastolic murmur suggests that endocarditis is conditioning a severe aortic insufficiency. The patient is at Acute heart failure with acute pulmonary edema with tachycardia and blood pressure just that soon will lead to a shock if they do not act quickly. In this situation the most important thing is to warn the cardiac surgeon to proceed to replace the diseased valve with a prosthesis. Of course, no surgeon in the world would submit the patient to a median sternotomy with cardiopulmonary bypass without a diagnostic confirmation of endocarditis by transesophageal echocardiography (TEE). Despite the sense of the question is addressed to the immediate attitude that would save the life of the patient, and this would only valve replacement. The TEE may be in the ICU waiting to prepare the operating room or in the operating room itself and with the patient intubated. MIR commission gave as correct in the provisional squad for option 2. After the appeals were eventually overturned.


(question No. 60 drill 1, AMIR)