rfrederick87

Is it safe to assume there was no trauma leading up the present complaints? A 12 lead would be nice with CAD risk factors and extensive history; but useless giving the pacemaker. There are several argument of NTG over Labetalol. I do not view her experiencing a HTN crisis. No diaphoresis, SOB, or chest pain. Unless she is having a right wall infarct, I don't see NTG "bottoming" out her BP. Labetalol is a more "stable" drug to give; I suppose. (I don't feel any drug is safe or stable; and each pose there own risk) Perhaps continue the NTG. Perhaps switch to labetalol. What did the patient report post NTG admin? Did she find relief? Keep up with the NTG. Include some paste. If no relief, still continue the NTG or move towards the labetalol. It's either or really in my humble opinion. Looks like based on the limited V/S follow up you provided though, the NTG is working. Labetalol is indicating in my area down by the bayou. So I would give that. And considering the lasting effects of labetalol, she would benefit from it "longer" if you will.

Looking at your 4 and 12 leads. Nothing pokes out as "STEMI" other than the LP12 interpretation. I understand your concern for the elevation in v1 and v2. But consider you QRS width. It is greater than .12. I would question whether or not those wide QRS complexes are physical contraction. If PVC's then no. The elevated ST segments are only noted on those wide complexes. That's inherent. I would not trust calling a STEMI alert based on the monitor. Except for the occasion of new onset LBBB. But we would need to dig into the axis variations which are for the most part WNL. Maybe off slightly, nothing to indicate infarct however. I notice you list a history of NIDDM. Safe to assume non-insulin dependent diabetes? Did you check a blood sugar. Frequent syncope with disorientation can be a red flag. Either way, ASA and NTG administration in the field with a suspected head injury is a NO NO. If, the closed head injury you suspected is in fact that, and secondary to the fall, ASA would effectively remove/restrict the body's compensatory mechanisms of coagulation. And NTG, being a vasodilator, we would increase the blood flow to the injured site; worsening the injury. You were right for with holding. Good job on cervical stabilization. You have an injury above the clavicle with AMS thus an unreliable patient. We do not know if there is or is not a cervical injury. Good job erring on the side of caution. A spine board would be pushing it, and really not necessary. Careful with high flow oxygen. A proven vasoconstrictor and if we have an injury, in the head, could cause hypoxic problems near/around the injury site. Low flow is sufficient given the PVC's. The heart and brain are connected more than one may think. It is quite possible the closed head injury you are suspecting is causing the PVC's. There are several STEMI imitators out there. I applaud you for considering all possible diagnosis'. Did you follow up to decipher the outcome? But no, no STEMI to be noted.

Good evening all. Checking out the site. Some good reads on here. A little about myself. Been in EMS for 10 years now. Been employed with East Baton Rouge Parish EMS as an inner city Paramedic with lots of thrills, blood, sweat, and tears. Currently on a hiatus enjoying a slower pace offshore in the Gulf of Mexico. Looking at relocating to Colorado in the next few years. Anybody from that area care to chime in on some good spots? I'm looking into Loveland, Greeley, and the Denver area. Looks like Thompson Valley EMS and Denver Health seem like good spots. Ideally I would like a pension program considering EBR EMS offers a great retirement package (if you live to see it without getting shot). Stay safe! Richard