SAQ 1010 – Cardiology – older adult with severe bradycardia and AKI

An 86-year-old woman is brought to ED by relatives because she has become confused over several days. She is usually cognitively normal and lives independently.

Background history includes hypertension, GORD, mild COPD, mild cardiomegaly and congestive cardiac failure. Her medications are atorvastatin, propranolol, ezetimibe, fluticasone/vilanterol, pantoprazole and verapamil SR.

She looks mildly dehydrated and confused. Observations: HR 26/min, BP 105/55 mmHg, temperature 37 C, GCS 15 and SpO2 97% on air. The ECG and initial venous blood gas are shown.

Parameter	Result	Reference range
pH	7.28	7.35-7.45
pO2	51 mmHg	–
pCO2	19 mmHg	41-51
Bicarbonate	16 mmol/L	22-26
Base excess	-8.0	-2 to +2
Sodium	136 mmol/L	135-145
Potassium	6.7 mmol/L	3.5-5.5
Creatinine	200 micromol/L	62-106
Glucose	5.2 mmol/L	2-8
Lactate	3.7 mmol/L	0.5-2

Describe the ECG.

(Marked out of 3.0)

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Briefly explain the likely pathophysiological process causing this presentation.

(Marked out of 4.0)

/ 4

Outline four important clinical issues and the concurrent treatments that should be undertaken.

(Marked out of 8.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Issue</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Treatment(s)</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

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Total Score: 0 / 15

Percentage: 0%