any guess

Dinith88 · Jun 25, 2005

Patient arrives found unresponsive with narrow complex svt, given adenocard X3 via squad, upon arival to ER given adenocard again X2 then "juiced" with 100 joules and converted to st which went to sr, ct of head was negative, patient was on daily coumadin unable to get history to determine why, also hypertensive upon arrival and extremities slightly mottled - was known to have copd - and cool. Now for the question.............PTT was >120 and inr >10.8 right sided hemiparesis upon arrival to icu, BP 140s over 60s apical (is now sinus rhythm) high 80s to low 90s respers 22-30. remains unresponsive is on amiodarone qtt and d5 1/2ns.................cirrohis thats easy, what is going on??????

from the limited info available, a good guess would be:

1) the rapid SVT was a-fib (which would explain no response to adenocard)

2) Hx of A-fib would explain daily coumadin and high INR (elevated ptt still a question mark)

3) Hx of COPD would also point to a Hx of A-fib (a-fib common in copd)

4) as you know, A-fib's are notorious for generating and throwing clots

5) ischemic/embolic CVA from a-fib (although coags are high, CT showed no bleed), also, 1st CT may not show a fresh ischemic CVA. Best expaination for his hemiparesis

6)you say crrohsis...if thats in the PT's history, surely can explain his elevated PTT

So..in a nutshell...a good guess would be ischemic/embolic CVA r/t pt's A-fib.

PTT needs investigation. (unless/again if liver failure is in pt's Hx, may be an easy expalination for elevated PTT)