1. Look at the EKG strip. What is her atrial excitation rate per minute? What is
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1. Look at the EKG strip. What is her atrial excitation rate per minute? What is her ventricular excitation rate per minute? Show your math. Relative to rest, is this high, low, or normal? 2. The physicians stabilized her using the standard Trauma procedure. Since her blood pH and oxygenation were low, they were concerned about metabolic issues. Why is she acidemic? What was the sequence of events that led to this condition? 3. Physicians were also worried about her low blood oxygenation. In a healthy patient, how do low blood oxygen levels affect the local controls that regulate vasodilation/constriction? In Bobby Sue’s case, how does this affect her TPR? Bobby Sue was ready for her second date. She was a little nervous because the first date went really well, and she was hoping that this might work out. After all, she was a junior at State University, and her mother kept reminding her that it was time to get that Mrs. degree. She was meeting Sam at the local cafe for dinner and then a movie. As Bobby Sue got into her car, she thought about how perfect her outfit was, and that she didn't want to wrinkle her dress with a seatbelt. It would only be about a mile away-no harm, right? Well The sound of crunching was overwhelming as the pick-up truck swerved into her lane-head-on collision. Then there was the smell of burning, and she felt like her legs were bent backwards as her knees were both broken. But the pain on her chest was crushing, She couldn't breathe. Sam saw the whole thing, and was able to keep calm enough to call 9-1-1. Bobby Sue's blood made the road slippery when Sam ran over. He wiped out, but got up in time to talk to her and keep her calm while they waited for the ambulance. Luckily the ambulance came quickly, and Bobby Sue was brought to the ER where she was assessed for trauma. (More on this later.) Physicians were worried about a myocardial contusion or other myocardial damage, and ran an EKG. Below is an image of a 6 second strip. They checked her blood pH (7.11 ; low), blood oxygenation (86%, low), and body temperature (95.8 °F). The broken knees were wrapped, but surgery was put off until her metabolic condition was stabilized. After all, bones can be fixed later-cells are more difficult to replace. This is termed Damage Control" in trauma: stabilize the patient, schedule major surgeries to repair massive injuries once the patient is stable. In exsanguinating hemorrhage, patients die from coagulopathy, hypothermia, and metabolic acidosis. The metabolic failure is often the terminal condition, and therefore must be dealt with immediately. (More on all of this later in the semester.)Explanation / Answer
1. Here the EKG is regular. Calculation is simple 300 / 2 large squares plus 2 small squares (0.2 each) is equal to 125bhp (measure from p wave to next p wave). ventricular rate is measured as R-R interval: (i.e):again the same: 300/ 2 large boxes plus 2 small squares (0.2 each) equals : 125/bhp. both these rates are high relative to rest.
2.Due to trauma there is increased blood loss. Patient will go into hypovoluemic / hemorrhagic shock and hypothermia which is not related to season. As a result of this, a series of cascade of events take place that induce the coagulation system to inhibit coagulation factors that can stop bleeding. The coagulation system is pH and temperature dependent. Any change in these two factors will trigger the cascading events. Hypothermia prevents the the body to cease bleeding as it impairs the coagulation cascade. Added to this situation is the inability to perfuse organs tissue properly due to blood loss, and decreased cardiac and respiratory output. This leads to utilization of anaerobic pathway of metabolism, the byproduct of which is lactic acid. lactic acid then accumulates and lowers pH leading to a metabolic acidosis condition.
3. Low blood oxygen levels in a normal healthy person causes blood vessel vasodilation that will help perfuse tissues better. In Bobby sue 's case, temperature is decreased (hypothermia), pulse is increased and respiratory rate will also be increased.
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