ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Dwayne, I'm just messing with ya. Good question about the ntg, but no she has no taken any. Look above for when you get when you finally hook up the monitor. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 17, 2007 Share Posted December 17, 2007 Dwayne, I'm just messing with ya. Good question about the ntg, but no she has no taken any. Look above for when you get when you finally hook up the monitor. Of course Doc...I count on it! Also, I think we're going to add renal failure to this ladies list of ailments. I haven't worked out all the 'whys' yet, but I'm going to take a shot after work if someone else hasn't beat me to it. I want to try and figure out as many of the angles as I can, instead of simply the treatment...which I think (though am not sure) is pretty standard. Thanks for taking the time to do this for us Doc. Have a great day! Dwayne Link to comment Share on other sites More sharing options...
njmedic1485 Posted December 17, 2007 Share Posted December 17, 2007 Wow, that's an extraordinarily ugly looking 12 lead, I'm thinking hyperkalemia. How has her urine out put been? any extra sources of potassium (dietary, supplements)? ALong with the comfort O's I'd like to put in an IV line and run in 200 cc's of normal saline,keeping an ear on lung sounds of course and go to the hospital. Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 Wow, that's an extraordinarily ugly looking 12 lead, I'm thinking hyperkalemia. How has her urine out put been? any extra sources of potassium (dietary, supplements)? ALong with the comfort O's I'd like to put in an IV line and run in 200 cc's of normal saline,keeping an ear on lung sounds of course and go to the hospital. I'm not confirming nor denying that the EKG shows hyperkalemia (very US govt like of me). She tells you she has been peeing fine. She takes Kdur, but is taking the same dose she has for the last 2 years. She says that her doctor decreased her lasix dose a few days ago. She then tells you that she is feeling worse. She is more lightheaded and has a funny feeling in her chest. Her repeat 12 lead is unchanged. Her HR is the same but her BP is down to 88/56. You drop in the 200cc bolus with no chage in her BP or lung sounds. What else do you want to know/do? Link to comment Share on other sites More sharing options...
spenac Posted December 17, 2007 Share Posted December 17, 2007 Temp is 98.7 (you can make that rectal if you are so inclined). Oh ERDoc you remember the funniest topic ever on the city, I'm touched. :twisted: :roll: Link to comment Share on other sites More sharing options...
spenac Posted December 17, 2007 Share Posted December 17, 2007 You mentioned pulse rate, but what is it's quality? Is it palpable at all 4 extremities? Palpate abd. Any tenderness? Any pulsating masses? Link to comment Share on other sites More sharing options...
p3medic Posted December 17, 2007 Share Posted December 17, 2007 Good case! So, she is taking her standard K-dur supplement, however is taking less lasix recently. She is also on digoxin. So, the million dollar question; is she hyperkalemic secondary to acute dig toxicity, or is she hyperkalemic secondary to increased (relative) pottasium load? Or, is there another underlying pathology, that would be unlikely for us to flesh out in the field? Clearly her cardiogram is of concern, and her sx's are worsening as we speak. I'd likely discuss this case with med control, but I'll make a leap and assume the radio is dead, no batteries, doctor is in the head, etc.... Fluid challenge sounds like a plan, nebulized albuterol, and NaHCO3....I'm on the fence with Ca+ because of the distinct possibility this is secondary to her dig, If I were to give the calcium I would go with gluconate v.s. chloride, preferably after MD consult. Link to comment Share on other sites More sharing options...
zzyzx Posted December 17, 2007 Share Posted December 17, 2007 Coming in late on this one too....Wow, that is an ugly ECG. Wide complex, nasty T-waves...Like everyone else, my first thought is hyperkalemia. Does she normally have an irregular pulse? How does she describe the funny feeling in her chest? Is she still oriented? Since she's now feeling worse, let's lay her down, bump up the oxygen, and give more fluid challenges (paying close attention to lung sounds), and will seriously consider dopamine. Of course we are enroute to the ER, preferably a cardiac care center. Sodium bicarb sounds like a good idea too, but I would consult with a physician before I did that. Someone mentioned albuterol. I understand that this is a treatment for hyperkalemia and that it shifts K+ into the cells, however I'm not well educated on everything that's involved with that use. (Our transport times are usually 5-10 minutes, and we don't have any protocols for treating hyperkalemia except in a full arrest.) Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 I'm touched. :twisted: :roll: Hopefully not with a rectal thermometer! Link to comment Share on other sites More sharing options...
ERDoc Posted December 17, 2007 Author Share Posted December 17, 2007 You mentioned pulse rate, but what is it's quality? Is it palpable at all 4 extremities? Palpate abd. Any tenderness? Any pulsating masses? The pulse is present in all extremities, but it is thready. No abd tenderness or masses. Link to comment Share on other sites More sharing options...
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