spenac Posted July 8, 2008 Share Posted July 8, 2008 (Before you say anything, this call was one I ran, Terri just posted it for me. Bash me if you want, I don't usually pay attention to that stuff) Very good post young lady. Don't let us grouchy old people keep you from sharing more on the forums. Since I believe you are an EMT-B I would say oxygen/ Aspirin and hope ALS gets on scene quickly. If not notify hospital immediately that you are coming with a cardiac patient. Give all details so they realize not just BS. Now if you are ALS, Oxygen, Aspirin, Double large bore IV's at rate to maintain Systolic above 90 and to push meds if patient goes south. Will consider more as scenario grows. Thanks for great post. Link to comment Share on other sites More sharing options...
GypsyMedic Posted July 8, 2008 Share Posted July 8, 2008 Hey! I had one of those last week! Lady was taking a nice walk and after five minutes felt funny and sat down. With us, she was pale, cool, diaphoretic and looked just awful. Started at a nice rate of 80 and three minutes later in the ambulance she was in the 40's. Straight to cath! Went very smoothly, which was great. Thanks for the posting! It's great to see other opinions and comments. Link to comment Share on other sites More sharing options...
mobey Posted July 9, 2008 Share Posted July 9, 2008 With that, allow me to ask a few other questions? -Hoarse voice noted? Alright I give, please enlighten me! What the heck does a hoarse voice have to do with aneurism or MI?? Link to comment Share on other sites More sharing options...
Paramagic14 Posted July 9, 2008 Share Posted July 9, 2008 i second that..... Link to comment Share on other sites More sharing options...
chbare Posted July 9, 2008 Share Posted July 9, 2008 If you think the location of a thoracic aneurism or aortic dissection, (Talking two different problems here) you can imagine how blood and pressure can back up in some arteries. In addition, you can imagine how you can put pressure on structures. (esophagus) In some cases, you can have cranial nerve involvement and involvement of the trachea, esophagus, and other vascular structures. Remember, lots of stuff is effected by these conditions. In some cases you can appreciate, coughing, dysphagia, and a hoarse sounding voice. Plus, it is a question on the CEN exam. Take care, chbare. Link to comment Share on other sites More sharing options...
mshow00 Posted July 9, 2008 Share Posted July 9, 2008 I have not learned much about 12 leads, but is the pt not haveing a RBBB as well? As I understand(albeit with minimal knowledge) with the funky complex in lead II, III, and AVF in the "up position" means a possible RBBB correct? Please educate me on this. Link to comment Share on other sites More sharing options...
chbare Posted July 9, 2008 Share Posted July 9, 2008 Leads II, III, and AVF look at the inferior wall of the heart. Your V leads look at the septal wall, and anterior wall. Your bundle branches are located in that general area of the heart. A good rule of thumb is to look at V1 and do what is called the "turn signal criteria." If you identify a BBB (QRS wider than 0.12 seconds), up will be a a RBBB and down will be a LBBB. I will attempt to post some 12 leads of RBBB vs LBBB. EDIT: I think you you see is the actual ST elevation pattern or current of injury through the inferior leads. Take care, chbare. Link to comment Share on other sites More sharing options...
BushyFromOz Posted July 9, 2008 Share Posted July 9, 2008 Tombstones...... I dont have 12 leads to work with. In fact, the 3 leads we have are non-diagnostic so i would be in the funky position of weather to give nitrates or not with this pt with LD 2 and 3 like that. :? chbare, would'nt there be RAD or LAD for a BBB? not questioning you, 12lds are outside of my abilities so i only know what i have taught myself O2, ASA and morph. And a big IV, and IC crew would be good as well Link to comment Share on other sites More sharing options...
chbare Posted July 9, 2008 Share Posted July 9, 2008 In some cases; people compare the current of injury in an inferior wall MI to fireman hats. While, the current of injury for an anterior septal MI is compared to a tombstone. BushyfromOz: I am not sure I understand your question? Are you asking about the artery involved or axis deviation? Yes, axis deviation is associated with bundle branch block and fascicular hemiblocks. Pathological left axis deviation is highly indicative of left anterior fascicular hemiblock (LAFHB). This can be associated with both inferior and anterior MI. Many times LAFHB will have concomitant RBBB. Right axis deviation can be associated with left posterior hemiblock and RBBB. Clear as mud eh? Take care, chbare. EDIT: Jessi, please let me know if I have taken this too off topic and I will be happy to start a new thread or take it to PM. This is your scenario and I do not want to hijack it. Link to comment Share on other sites More sharing options...
BushyFromOz Posted July 9, 2008 Share Posted July 9, 2008 sorry mate, i misread one of your other posts, forget the qestion, i have saeen the light (much like this patient may) Link to comment Share on other sites More sharing options...
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