Cardiovascular System Case Study

Review the following case:
Part I—The Discovery
Cast of Characters
Sam Garrison—Detective
Roma and Clint Underhill—The hot couple
Kavita Dickson and Larry Gonzales—emt paramedics
Renee Volenbach—Physiologist in the Biology Department at Noletown University
Friday, 7PM
Roma and Clint Underhill had both had a long day. They were the owners of a successful real estate company in Desert Palm. Each had several clients, and the strain of the current real estate market was getting to them. It had been an unusually cool day for January, with temperatures hovering around 60 degrees. On coming home they decided to relax in their hot tub with some wine. While Roma changed from her work clothes, Clint said that he would join her in the hot tub after he took his Lasix.

Saturday, 8AM
“911… Please state your emergency.” “Oh, Oh, I… I… ”

“Ma’am, please calm down and tell me the address.”

“I think…, yes, OK, it’s… it’s 1223 Oak Creek Drive.” “What is the problem, please?”

“I’m the maid for Mr. and Mrs. Underhill and… and I didn’t find them in the house when I came in this morning, so I looked around outside. I just found them in their hot tub out back. They are under the water. Please come, please come now!”

“Yes, ma’am, I’m alerting the EMTs and an ambulance will be on the way. Please go out front and wait, so the paramedics can find the address quickly.”

Saturday, 8:10AM
Paramedics Kavita Dickson and Larry Gonzales brought the ambulance to a stop at the end of a long driveway next to an impressive two-story mansion. The maid was on the front steps and quickly directed them to the back patio where the hot tub could be seen.

Empty bottles of wine were on the ledge surrounding the hot tub. Kavita quickly climbed up the steps and saw the bodies of the Underhills on the bottom of the hot tub. As she got into the water, she exclaimed, “This water seems really hot. Let’s see if we can get them out.” Larry climbed in after her and together they dragged the bodies out of the hot tub and onto the patio. It was obvious that both had been dead for some time. Kavita called the dispatcher.

“Listen, Linda, this hot tub case is a DOA, but something is not right. How about sending the medical examiner and a detective out to look the situation over. Tell them to bring a thermometer!”

Part II—The Investigation
Saturday, 9:30AM
“115 degrees! What is this thing doing so hot?” Sam Garrison asked Kavita as he removed the thermometer from the water.

He was investigating the death of Roma and Clint Underhill, prominent real estate brokers in Desert Palm. “This hot tub should be no more than 109 degrees.”

He remembered reading a Consumer Product Safety Commission flyer on hot tubs and wondered if the tub was associated with the death. The bodies were being taken away for autopsy as he took in the scene.

“Hmm. What about these bottles of wine? It looks like they had a party—all by themselves! The medical examiner will check their blood alcohol level (bal, or blood alcohol concentration—bac) and we’ll be able to see his complete report on Monday. We may even be able to determine their cause of death with that information. I’ll ask the maid about any medications.”

He went into the sunroom off of the patio to where the maid was being consoled by another officer. “Ma’am, can you tell me if the Underhills were taking any medicine?”

“Well, sir, I know he was complaining about having to use the bathroom a lot since he returned from the doctor’s office about two weeks ago. You might look in the cabinet over the sink where they keep aspirin and such.”

Sam looked where she indicated and found a recently filled bottle of Lasix.

Monday Afternoon
Monday afternoon, the medical examiner phoned Sam with the following information:

bal (Blood Alcohol) of the couple was .20
Roma weighed 120 lbs; Clint weighed 160 lbs
Time of death estimated at 2am Saturday morning
There was a therapeutic level of Lasix in Mr. Underhill’s blood, but none in Mrs. Underhill’s blood

Part III—The Final Report
Later Monday Afternoon
Detective Garrison returned to police headquarters and, after reading the medical examiner’s complete report, began the process of writing his own explanation of what happened to the Underhills. As he wrote, he thought about all that had happened and began to wonder about the physiology associated with the couple’s death. The level of alcohol found by the medical examiner was high but was not necessarily sufficient to cause their death, but was it a contributing factor?

ANSWER THE FOLLOWING QUESTIONS: 250 WORDS

1. What were the specific effects of the Lasix, hot water, and alcohol on the couple’s blood pressure?
2. Describe 2 mechanisms by which the body would compensate for a falling blood pressure.
3. Describe several procedures that might have helped save the couple if they had been found unconscious with their heads still above water and alive.