Table of Contents
Washington University Experience | TRAUMA & FORENSIC | Contusions | 25A0 Case 25 History
Case 25 History ---- The patient was an 87yo female with a history of atrial fibrillation, congestive heart failure, hypertension, seizure disorder, “cerebrovascular accident” (no additional data available on this process), and Parkinson-like symptomatology. She was found diaphoretic and unresponsive in her nursing home with altered mental status, pulse under 30 and systolic blood pressure in the 60s. The patient was admitted to the Cardiac Care Unit for further work-up and subsequently diagnosed with atrial tachycardia with AV block, and a pacemaker was placed. During the procedure the right ventricle was perforated and the patient experienced hypotension and tachycardia. An emergent pericardiocentesis was performed, extracting approximately 400 cc of blood. The following morning, the patient experienced two episodes of hypotension, and her pacemaker was repositioned in the cardiac catheterization lab. She developed deep venous thrombosis in both extremities and an inferior vena cava filter was placed and she underwent a bilateral femoral popliteal bypass. After returning from the operation at 22:00, she seized and had pulselessness and apnea lasting 10-15 minutes. She remained hemodynamically unstable despite volume repletion and administration of pressors and was pronounced dead.
