Question: Below is the report/scenario of 4

Question: Below is the report/scenario of 4 patients given at the beginning of your shift. How would you prioritize these patients acuity care (#1-4) (who would you see first, second, third, fourth) and what is the rationale for the prioritization order? Savannah Davenport Age: 56 Female Adm Dx: Acute Anterior Wall ST Segment Elevation Myocardial Infarction. PMHx: HTN, CKD, GERD, CVA with R- sided weakness, Asthma EKG: Noted ST- Segment Elevation in the anterior leads V3 and V4 Patient scheduled for left heart catheterization and possible percutaneous transluminal coronary angioplasty with stenting STAT – awaiting the on-call team. NPO for Procedure Nitroglycerin Sublingual (Nitrostat) 0.4mg SL for Chest Pain (Last dose given at 0530). Aspirin 325mg PR Stat, Pantoprazole 40mg IV Push Q 6am, Morphine 4mg IVP. O2: 4L Nasal Cannula (Maintain O2 Sat greater than 95%) Heparin Infusion 25,000 units/250ml D5W per cardiac protocol – Currently infusing at 1100 units/hr. Hold on call to the cath lab. Metoprolol 12.5mg PO q 12hr. aPTT – 85.1 seconds , Hbg 12.4/ Hct 42.0 Lungs are congested, mild expiratory wheezes. IV Saline lock x 2 – (heparin infusion). Pre-Procedure checklist on chart, Consent completed and signed. Husband very anxious, pt’s father recently passed away from “massive heart attack” Patient is not U.S. Citizen – Medicaid application pending. Derrek Palino 68 yo Male Adm Dx: Ventricular Tachycardia Storm, dizziness, fever, shortness of breath, persistent fever. COVID19 +. PMHx: CAD, Severe left ventricular systolic dysfunction, Implantable Cardioverter Defibrillator (ICD) placed 2 years ago. STEMI, 20 year smoker, alcohol abuse. EKG: multiple sustained Ventricular Tachycardia (VT) episodes within 24 hrs. Chest X-ray – Pulmonary Edema. Left hazy infiltrates. Diet: NPO Meds: Metoprolol 100mg PO BID, Ramipril 5mg daily, Amiodarone infusion @ 1mg/min. Synthroid 50mcg/daily. HR: 150/min, BP : 96/70 mmHg. SP02: 88% – On Bipap 18/6 Rate 16, 100% O2. Labs: K 2.9mEq/L, Magnesium 1.5 mg/dL. Patient Scheduled for Catheter Ablation, consent in chart. Ian Abdullah 89 y.o Male Adm Dx: R/O MI, CAD, Hyperlipidemia, Aortic Stenosis PMHx: Smoker, Cholecystectomy, HTN Surgery: Transcatheter Aortic Valve Replacement (TAVR) – Post Op Day 1 Bilateral Femoral Sheaths removed 0630 by CTS Physican Assistant. Pain Medication (Oxycodone) x 2 overnight (Back/Groin Access Site Pain) O2 sat 97% on 3L NC Hgb 11.0 / Hct 36 Clear Liquid Diet – Bowel sounds – present, hyperactive, abd soft Left Jugular Trans-venous Pacer with Cordis in place. Pacer on Standby. Plavix 75mg PO Daily. Monitor: New onset Atrial Fib HR 152 at 0655 am. Stat EKG ordered. New Order: Cardizem 25mg IV Push Bolus followed by Cardizem infusion 100mg/100 mL D5W to infuse at 10mg/hr (titrate to maintain HR less than 90 bpm). Bilateral Groin Access sites intact. Retired Nurse in England, in the US on a visa visiting his children. No insurance. Jazmine Williams 46 yr Female Adm Dx: Massive Pulmonary Embolism with ongoing Ultrasound Enhanced Thrombolysis. PMHx: High Cholesterol, HTN, Diabetes, Addicted to Opioids. HIV+, CHF, Depressive Bipolar Disorder, Past DVT in lower extremity. EKG/Monitor: Sinus Tachycardia HR 142/min. CTAngio Scan: large thrombi in right and left main pulmonary arteries with incomplete occlusion. O2 Sat 99% on 100% oxygen via non-rebreather mask. Diet: Low Sodium- Cardiac Diet as tolerated. Right Groin Femoral Access Sheath in place with TPA, Heparin and Normal Saline infusing via an EKOS device catheter. – Bleeding noted around the insertion site. Intake and Output – Foley catheter in place with tea colored urine. School Teacher, Medical Insurance Estranged from family, Identified as Trasngender – recently completed hormone therapy.

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