fiznat

Wow thanks for all the quick responses guys! Reading back, I see that I didnt ask the original question very well. So to clarify a few things: This is assumed to be a tachy, narrow complex rhythm. Something that looks like SVT on the monitor, albit pulseless. Say just for sake of argument the rate is at 175. I realize that a supraventricular rhythm in a pulseless patient is probably extremely rare, but I'm in medic school and its usually interesting to discuss these kinds of "what if" scenarios. The question is mostly- fix the rate first, or treat it like any other PEA and follow the regular ACLS PEA algorithm (CPR, 5 H's, 5 T's, Epi). I'm aware of our reason for using epi during other kinds of arrest (for alpha effects), although I understand that in PEA we're hoping for much more of a beta (specifically inotropic) response. Cardioversion is nice to slow down the rhythm, but even if we achieve a "normal" rate with this treatment, the patient will still be pulseless. My confusion comes from the priority of treatment in this case: attempt to fix the pulselessness (which it is assumed is not simply a rate/refill problem and therefore a true PEA), or attempt to fix rate and THEN pulselessness? This instructor seemed to be advocating the latter- although I may have misunderstood. Perhaps he is saying this because it wouldnt be a good idea to give epi to patient who is already at a rate of 175 (regardless of the pulselessness), and we need to slow the rate down before we can attempt to stimulate some mechanical function with the catecholamines? About the instructor himself- this is not coming from our regular class instructor, but rather from and adjunct guy who came by to help out with labs. He is very well respected though, I would never throw his advice away without careful consideration (like I'm doing).

I heard this in my medic class the other day. I'm in my 2nd semester now, about 6 months into the class and I've never heard this before. I respect the guy who told our class this, and I'm sure the information comes from somewhere but I just dont understand the reasoning for it. My understanding of what PEA is: "a rhythm that you would expect to produce a pulse, yet doesnt." ...So why wouldnt tachy (>150) rates also fall under this definition? I figure (depending on the patient of course) that you can expect even really tachy rates to produce some sort of pulse, even if it may be weak. My instructor was saying that if we've got a pulseless patient with a rate of >150 on the monitor, we should go after rate (adenosine/calcium channel blocker/etc) first before attempting to fix the pulseless problem (epi). Is this really true? It seems backwards to me...

In Hartford we have 2 major hospitals we transport to (a lvl 1 and a lvl 2)- the lvl 1 hospital does not accept EMS blood draws, but the lvl 2 hospital does. As far as techinquie and "accurate" blood draws or whatever, I'm in medic school right now and we do clinicals at the same level 2 facility I mentioned above. We do blood draws in the ER all the time as part of IV practice, and the instruction/technique is exactly the same as that performed in the field. I see no reason why EMS blood draws should be treated any differently than an ER blood draw as the technique (and equipment!) is exactly the same. Also, even in the ER I was never taught any specific order to fill the tubes, so I dont know how much that really matters... Like I said, I'm just a medic student right now but I really dont see any good reason to deny EMS blood draws other than as an attempt to control who gets to charge for the service.

New guy here: <-- EMT (halfway through medic school) for AMR in Hartford CT.