Essay Example - Post-Mortem Case

JF is a 62 Caucasian male. He was admitted brought to the emergency department on October 8, 2019. For shortness of breath. He suffered from acute pain, causing a ground-level fall and various complications associated with his physical wellness. The treatment pathway in the emergency included ordering several investigational lab tests such as CMPO, CBC, CK, ABG, UA, UDS, D-dimer, and the US and starting oxygen treatment, Diuretics, IV fluids, and cardiac and renal monitoring. Within hours of admission to the emergency department, JF was admitted to more critical care in the CICU.

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Intervention

The initial diagnosis and treatment were consistent with pulmonary congestion and overlapping deep vein thrombosis in the ICU. The physician planned to stabilize JF's condition and transition his care back home to his family. In the CICU, JF spent 15 days in critical and acute care as the doctors treated his heart failure while stabilizing his circulation. He was placed on a ventilator to aid his breathing, and periodic assessments for arterial blood gases and various lab tests for body chemistry were conducted. His cardiac activities were monitored using an EKG, and his urine output was collected and analyzed. JF was given both cardiac and pulmonary congestion using various furosemide therapy and was given crystalloid vasopressors and fluids for cardiac stability, chronotropic, and contractibility. Furosemide reduces pressure caused by excess fluids in the lungs and heart (Purvey & Allen 2)

At the same time, he was put under heparin to assist him with the stability of the clot. Herapin assists with blood-thinning and treating blood clots (Felli et al. 8). Moreover, renal function was accessed periodically, and anticoagulation monitored using a PTT, PT, and periodic INR checks. These tests are used to monitor heparin (Boroumand and Goodarzynejad 10). Three days after starting treatment, JF stopped producing urine, and the furosemide therapy was stopped. Since his serum creatinine had increased from 1.5 at admission, his pressor therapy and IV fluids were carefully titrated. Elevated creatinine indicates impaired kidney function serum creatinine had increased (Davis &Shield 2019). He developed an upper tract infection on day five, which was treated with antimicrobial agents. On the seventh day, his fever reduced, and he started getting weaned off the ventilator, and on day 8, he was transferred to the general care unit. At the same time, his home medications continued, including enoxaparin, while still getting heparin, which was stopped by the pharmacy. On day ten, home medication was administered, and enoxaparin was given to the patient without being halted together with the heparin. Thus, anticoagulant therapy was not guided by risk, benefits, and pharmacological traits (Nutescu et al. 4). On day 12, the patient's mental state was altered and had blood in his urine. He was given vitamin K, and protamine to help reverse the condition. Packed RBC was administered without improvement, which led to the death of the patient.

The patient admitted with breath shortness may be associated with pneumonia, asthma, bronchitis, congestive heart failure, allergic reaction, rib fracture, and pulmonary embolism.

Comparison

In treating the patient heart failure, the patients should have been given water pills, diuretics to ensure that they urinate more frequently and guarantee that the fluids are not collecting in JF boy. Diuretics such as furosemide reduce the absorption of sodium and chloride within the kidney, enhancing the rate of forming urine (Aronson 1). thus, when the patient stopped urinating, he should have been continued with furosemide therapy.

Furthermore, since the enoxaparin and heparin have high drug-drug interaction and were stopped by the pharmacist, it should have stopped the other times the two medicines were treated together (Nutescu et al. 2). People who are treated with diuretics and IV fluids during early patient care are associated with worse outcomes (Bikdeli et al. 7). Further, when the patient showed signs of kidney failure there was no intervention.

Outcome

The intervention aims to stabilize his condition and transition his care back home.

• Ease his breathing
• Relax and expand the airways
• Demonstrate loss of excess fluid
• Demonstrate improved activity tolerance

Recommendations

The hospital should ensure that drugs with high DDI should not be administered together. Thus, the anticoagulant therapy choice should be guided by benefits, risks, and pharmacological characteristics (Nutescu et al. 2).

In the diagnosis, of a person with breath shortness, a CT scan should always be applicable to prevent diagnosing the correct underlying condition.

The medication record should warn the pharmacist about drugs that have high DDI.

Works Cited

Purvey, Megan, and George Allen. "Managing acute pulmonary edema." Australian Prescriber 40.2 (2017): 59. https://dx.doi.org/10.1016%2Fj.jchf.2014.09.007

Bikdeli, Behnood, et al. "Intravenous fluids in acute decompensated heart failure." JACC: HeartFailure 3.2(2015):127133. https://dx.doi.org/10.18773%2Faustprescr.2017.013

Felli, Alessia, et al. "Different heparin contents in prothrombin complex concentrates may impair blood clotting in outpatients with ventricular assist devices receiving phenprocoumon." Journal of Cardiothoracic and Vascular Anesthesia 30.1 (2016): 96-101. https://doi.org/10.1053/j.jvca.2015.08.012

Aronson, J. K. "A worldwide yearly survey of new data in adverse drug reactions. Vol. 33." (2011): 669-690. https://www.sciencedirect.com/topics/neuroscience/furosemide

Boroumand, Mohammadali, and Hamidreza Goodarzynejad. "Monitoring of anticoagulant therapy in heart disease: considerations for the current assays." The Journal of TehranHeartCenter 5.2(2010):57. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466827/

Nutescu, Edith A., et al. "Erratum to: pharmacology of anticoagulants used in the treatment of venous thromboembolism." Journal of Thrombosis and Thrombolysis 42.2 (2016): 296-311. https://link.springer.com/article/10.1007/s11239-016-1363-2

Davis, Charles Patrick, and W. C. Shield Jr. "Creatinine (low, high, blood test results explained)."(2019). https://www.medicinenet.com/creatinine_blood_test/article.htm