75 yr Fijian old male presenting to hospital following syncopal episode while walking upstairs in his home. Initial ED arrival with GCS 15 but appears tachypneic and dyspneic. Initial VS are normotensive but tachycardic and tachypnic. Patient will eventually progress to hypotension and likely arrest regardless of learner actions but will arrest more promptly if aggressive diuresis or aggressive preload reduction. If patient arrests he will develop V.Fib arrest due to coronary hypoperfusion with progression from V.Fib to PEA to ROSC. Following ROSC learner will need to consult Cardiology and/or Cardiovascular/Thoracic Surgery and request CCU admission and consideration for balloon valvulotomy vs LVAD bridge to therapy to definitive surgical valvular management.
Goals and Objectives
Educational Goal: Achieve familiarity with the clinical considerations necessary for evaluation and management in a crashing critical AS patient.
- Discussion of sonographic and physical exam findings in critical AS
- Discussion of appropriate medical management for stabilization of critical AS
- Discussion of clinical considerations prior to intubation in critical AS
- Discussion of available options surgical options for definitive management of severe AS
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