case 3-63 F with admission for dyspnea

• metastatic papillary thyroid cancer.
• ct chest abdo pelvis-no pe, large mediastinal mass, lung mets, and modest pericardial effusion.
• admitted to CTU with CCU consult for PCE options
• DNR M3 established-no CPR, ICU, intubation

pericardiocentesis under guidance, 400 ml liberated

t/f to PCU for ongoing care

handover...

• catheter 'migration'?
• worsening clinically
• POCUS-large PCE
• hypotensive, afib, pulses neg
• CCU reluctant to go back in

what if she arrested?
what if she were a full code?

case 3 conclusion

• 2.1 L liberated next day, bloody.
• 2 days of clinical improvement
• died post procedure day 5 with brief respiratory decline

Case 4
55 M with met lung ca and pathologic # L2
DNR 3

sent for vertebroplasty
had fentanyl/midazolam
procedural sedation

after procedure
hallway post M & F
decreased LOC, apnea, cyanosis. Pulses?

what to do next? CPR?

Case 4 conclusion
CODE BLUE CALLED
given full dose naloxone and flumazenil

returned to ward in pain, stable otherwise. Aspiration?

pt stabilized in pain crisis overnight. Made it to hospice, died 48 h later