Dispatched to 28 y/o M DIB

[Dustdevil]

I could be wrong, but you guys may still be barking up the wrong tree.

I think they are halfway there. I'm leaning towards a little "decompression" of sorts, but not pleural. :wink:

[akflightmedic]

I thought Ruff had posted the link??

Tamponade so maybe a little pericardiocentesis? But I had a reason for not suspecting tamponade earlier now I can not remember why. I am just waking up, give me an hour or two and I will get back to ya....lol.

I admit I went looking for zebras on this one...

[scope2776]

Okay! Excellent responses! Thank you!

He was in fact suffering from acute pericarditis.

I didn't really come out and say it, but, he did have orthopnea, hence the pain got better after "getting up" to call 911. Tough call, I was wanting to see if anybody stuck their neck out either way, MI or pericarditis and your differential dx.

From the website where I got the ECG: "Normal sinus rhythm at rate of 90. Diffuse ST segment elevations are noted especially in leads II, aVF, V2-V6, with concavity upwards. PR segment depressions are noted in several leads as well; very clearly in lead II. The above changes are classic for acute pericarditis. Only a scant majority of cases of pericarditis will have such a diagnostic tracing however. Differentiating the ST changes of pericarditis from those of ischemia and early repolarization may be problematic. The lack of reciprocal ST depressions helps with regard to ischemia. Early repolarization usually is not present in both the limb leads and the precordial leads. In V6 if the apex of the T wave is less than 4 times the height of the onset of the ST segment, this is a point against early repolarization. In this case, since the history is that of a 27 year old male with sharp pleuritic chest pain worse when lying supine, the diagnosis becomes somewhat less obscure! One last point: arrythmias appear to be relatively uncommon in these cases. "

Thoughts?

[ittybitty1313]

Immediately starting with some treatment I would put the fellow on 6lpm of o2 by nasal. I am guessing that DIB is the same as SOA or SOB. Not one I have heard b4.

I know I'm new at this but if your patient is having SOB and respirations are elevated as his is wouldn't you put him on NRB @ 12 - 15 lpm?

[p3medic]

Okay! Excellent responses! Thank you!

He was in fact suffering from acute pericarditis.

I didn't really come out and say it, but, he did have orthopnea, hence the pain got better after "getting up" to call 911. Tough call, I was wanting to see if anybody stuck their neck out either way, MI or pericarditis and your differential dx.

From the website where I got the ECG: "Normal sinus rhythm at rate of 90. Diffuse ST segment elevations are noted especially in leads II, aVF, V2-V6, with concavity upwards. PR segment depressions are noted in several leads as well; very clearly in lead II. The above changes are classic for acute pericarditis. Only a scant majority of cases of pericarditis will have such a diagnostic tracing however. Differentiating the ST changes of pericarditis from those of ischemia and early repolarization may be problematic. The lack of reciprocal ST depressions helps with regard to ischemia. Early repolarization usually is not present in both the limb leads and the precordial leads. In V6 if the apex of the T wave is less than 4 times the height of the onset of the ST segment, this is a point against early repolarization. In this case, since the history is that of a 27 year old male with sharp pleuritic chest pain worse when lying supine, the diagnosis becomes somewhat less obscure! One last point: arrythmias appear to be relatively uncommon in these cases. "

Thoughts?

How about I told you so?

[CBEMT]

I know I'm new at this but if your patient is having SOB and respirations are elevated as his is wouldn't you put him on NRB @ 12 - 15 lpm?

Still cookbook treatment, just a different book.

[speedygodzilla]

Still cookbook treatment, just a different book.

Boy on boy. The amount of O2 you give a patient depends on their condition. It is not just a on and off switch like they teach you in basic class. Yes for the test it is, at least the ones I have taken. You have to look at a few factors on like their speaking, skin color, pulse ox, and their level of awareness. I am sure that some others could give you better answers but that is how I see it. On the posting here it hard for me to judge what lpm of O2 to give as I deal better with things hands on. Lot of the patients I see in the hospital are put on 4 lpm NC when they present SOA. (I work at a couple different ERs as a Tech, and am a EMT-

[CBEMT]

The amount of O2 you give a patient depends on their condition. It is not just a on and off switch like they teach you in basic class.

That's what I've been trying to tell YOU, Mr. "6 or 15."

Oy vey... :roll:

[AnthonyM83]

You know, except COPD patients with no SOB and children on blow-by or ped masks, I don't think I've ever put anyone on anything other than high flow on NRB. If they're in such distress that they have signs of SOB, 2-3 word dyspnia, accessory muscle use, cyanosis around lips, then they get whatever dose will keep their reservoir bag filled.

[CBEMT]

You know, except COPD patients with no SOB and children on blow-by or ped masks, I don't think I've ever put anyone on anything other than high flow on NRB. If they're in such distress that they have signs of SOB, 2-3 word dyspnia, accessory muscle use, cyanosis around lips, then they get whatever dose will keep their reservoir bag filled.

I put people on low-flow all the time who aren't really having much difficulity at all, but their sats are down enough that I need to give them a little boost, and a NRB would clearly be overkill.