Question

Situation: Mr. Smith is experiencing is brought to the emergency room with sudden onset of substernal chest pain which started while mowing lawn. He rates his chest pain a 7 of 10. He was given one ASA and three SL NTG. A TKO IV was started. He is diaphoretic, cool, clammy, and pale. BP 154/88 mm Hg. pulse 95 bpm, RR 24 and nonlabored. Sinus rhythm with frequent premature ventricular contractions (PVCs). Labs: Electrolytes are sodium, 143 mEq L: potassium, 3.4 mEq/L: chloride, 109 mEq/L, carbon dioxide, 34 mEq L; glucose 354 mg/dL. Cardiac enzymes creatine kinase, 456 units/L and troponin, 151 mcg/L. Background: 63-year-old Caucasian male, 220 lb, 6'2", married 41 years. PMH hypertensive and diabetes type II, smokes 1% packs of cigarettes per day. Allergic to penicillin In the emergency room, Mr. Smith develops ventricular fibrillation. BLS and ACLS initiated. Defibrillated with 200 with return to normal sinus with frequent PVCs after one shock. BP now is 92/56 mm Hg, pulse thready, and skin diaphoretic. Pupils are 4 mm, equal and reactive. RR 16 bpm, shallow, SpO2 92%. He is not fully awake but is moving all his extremities and breathing independently.

1. Interpret his cardiac enzymes and describe what they tell you.

2. what thoughts do you have on other labs and what do you think needs to be done?

Answer 1

1.The normal creatinine kinase ranges between 22 to 198 units per liter here it is elevated .This happens when the smooth muscles are affected .In case of heart attack or any injury to the heart muscle too can release this enzyme as a marker for diagnostic purposes. This remains elevated for about 12 to 24 hours.

The normal Trop T ranges between 0.01mcg/L to 0.1mch/L.Here the patient value is very high indicating a heart damage or heart attack. It is a specific enzyme when heart tissues are injured confirming myocardial infarction or heart attack.

2.The other lab values which concern are

• Potassium (3.5 _5.5) decreased ,so it has to be supplemented. A low level can affect the cardiac activity. Potassium diluted in isotonic solution can increase the level.Also this can increase the fluid volume and increase the blood pressure
• Increased level of glucose has to be corrected with insulin to prevent ketoacidosis
• The carbon dioxide level is increased ,which can lead to hyoercapnea and make patient deprive of oxygen ,so oxygen administration has to be initiated