Upon entering the ER at 7:52 a rapid assessment was performed to ensure whether or not the

pt. should be put in isolation. The pt. scored 2 out of 9 ergo the pt. was not isolated.
The pt. was given 3 BTB salbutamol with Atrovent.
An ECG and a CXR were performed as well.

At 8:22 the pt. developed a cardiac arrest that required 3 cycles of CPR during which the pt. was
given 1 dose of epinephrine and 300 mg of Amiodarone.
An ECG was performed after that as well.

Before the admission, the pt. was assessed on the braden risk assessment to assess whether or
not the pt. is at risk of developing a pressure-ulcer. The pt. scored 21 indicating a lower risk.

At 9:30 the pt. was admitted. Labs were ordered, an ECG, and an Echo was performed.
The Echocardiography report:
The left ventricle is normal in size. There is normal left ventricular wall thickness. Left
ventricular systolic function is mild to moderately reduced. Ejection Fraction = 45 %.The
transmitral spectral Doppler flow pattern is normal for age.
There are regional wall motion abnormalities as specified. There is a large sized apical, septal,
anteroseptal, and anterior wall motion abnormality with akinesis of the segments.
The right ventricle is normal in size and function.
The mitral valve is normal in structure and function.
The tricuspid valve is normal in structure and function. No tricuspid regurgitation.
There is no pleural effusion.

By 10:34 the pt. had undergone 1 diagnostic procedure Diagnostic Coronary Angiography and
two interventive procedures PPCI and Coronary Clot Aspiration.
During which the pt. was given: Verapamil 300Mcg, Nitroglycerin 300Mcg, and Heparin
3000units all of which intra arterially. An additional 200 Mcg of nitroglycerin was given intra
coronary. Abciximab 200 Mcg was given intravenously alongside with 50 Mcg of Fentanyl and
10000 units of Heparin.

At 14:32, the pt. was given full anti ischemic medications and BA asthma exacerbation
treatment. A Tox. screen was performed as well.

Labs by 8:00
Troponin I 44823.7
Hgb 152
WBC 26.70
Platelet 337
eGFF. 118
Uric Acid 525
Bili T 7.5
Alk Phos 75
Total Protein 68
Phosphorus 0.95
Adj Ca 2.26
Potassium 4.5
Albumin 38
Magnesium 0.82
Sodium 140
Chloride 108
Glu F 7.2
Creatinine 73
CO2 20
BUN 4.6
ALT 135
AST 190

HDL : 0.87
TSH : 0,42
LDL: 3.1.4
Cholesterol Total: 4.29
Triglyceride: 1,94
Hgb A1C: 6.1

Tox. screen:
Cannabinoids Scr Negative
Cocaine Scr Negative
Amphetamines Ser positive
Barbuturates Ser Negative
Opiates Scr Negative
Benzodiazepines Ser Negative

Follow up Labs by the 11th of Jun:

eGFR 137
Uric Acid 396
Bili T 3.7
Alk Phos 78
Total Protein 66
Phosphorus 1.08
Adj Ca 2.32
Potassium 4
Albumin 37
Magnesium 0.79
Troponin I 10804
Sodium 139
Chloride 103
Glu F 6.6
Creatinine64
CO2 24
ALT 57
AST 37
Hgb 150
WBC 18.30
Platelet 298
INR 0.93

By the 11th of Jun the pt. was discharged provided he complies to the medications and follow
ups.

Timeline:

At 7:49, a CXR was performed.

At 7:51 the first ECG was performed.
At 7:52, the pt. was given 3 BTB salbutamol with Atrovent.
After that a nebulizer was applied along with Salbutamol and Ipratropium.
At 8:22, developed a cardiac arrest and was given 1 dose of epinephrine and 300 mg of
Amiodarone.