An 88 yo patient is brought into the emergency department with significant bradycardia. During the evening the patient has been at home and has become incontinent, lethargic and progressively short of breath. On ambulance arrival the heart rate is 36 beats per minute and blood pressure is 120/65.
Within 30 minutes of arrival to the emergency department the blood pressure is unrecordable and only with a manual BP cuff is 75/45. She is becoming drowsy. The blood pressure continues to drop despite Isoprenalol infusion, metaraminol boluses and fluid.
She then spikes a temperature and is found to be acidotic and hyperkalaemic.
Past Medical History includes:
- Giant cell arteritis
- Atrial Fibrillation
- CCF
- Hypertension
What do you do first? What did we do? The outcome surprised even me... It was good.
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