This 54-year-old female with end-stage renal disease on hemodialysis had an apparent VFib arrest at hemodialysis and was admitted to the CCU after being intubated in the Vibay General Hospital ED. She was intubated, received amiodarone and dopamine, as her BP was low. An x-ray revealed diffuse bilateral opacities, possible pulmonary edema versus aspiration pneumonia, and an EKG showed normal sinus rhythm 100 beats per minute with no acute ST changes. Her first set of cardiac enzyme revealed a creatinine kinase of 116 and the MB fraction of 0.7 and troponin T of less than assay and lactate of 1.8. A fistulogram and angioplasty of her right AV fistula was performed on 9/14/06 with prednisone premedication but it was unsuccessful and therefore a left IJ tunneled dialysis catheter was inserted on 10/18/06 with the tip ending in the right atrium. HOME MEDICATIONS at the time of admission included amitriptyline 25 mg p.o. bedtime, enteric-coated aspirin 325 mg p.o. daily, enalapril 20 mg p.o. b.i.d., Lasix 200 mg p.o. b.i.d., Losartan 50 mg p.o. daily, Toprol-XL 200 mg p.o. b.i.d., Advair Diskus 250/50 one puff inhaler b.i.d., insulin NPH 50 units q.a.m. subcu and 25 units q.p.m. subcu, insulin lispro 18 units subcu at dinner time, Protonix 40 mg p.o. daily, sevelamer 1200 mg p.o. t.i.d., tramadol 25 mg p.o. q.6 h. p.r.n. pain. A bronchoscopy was performed on 9/14/06 with prednisone premedication but it was negative for aspiration. The patient had difficulty weaning from vent and was finally extubated on 0/22/06. She had a single set of coag-negative Staph positive blood cultures from Quinton catheter on 8/8/06 and was treated with vancomycin dose by renal levels. An Echo on 8/1/06 showed an EF of 60 to 65% with mild concentric left ventricular hypertrophy and no wall motion abnormalities. The patient was continued on telemetry and treated with her home dose of beta-blocker with good response and was gradually advanced to an oral diet with no signs of aspiration status post extubation. She was also given heparin subcutaneously and Nexium as prophylaxis. The patient is full code and will likely need rehab and is being screened by PT and OT and will likely be discharged to rehab when bed is available.
Has this patient ever been treated with insulin nph
Advair Diskus 250/50 one puff inhaler b.i.d., insulin NPH 50 units q.a.m. subcu