zzyzx Posted August 6, 2008 Share Posted August 6, 2008 Here's a call I ran the other week. Nothing too crazy, but interesting in a some ways... We were called priority 3 (lowest ALS priority; w/o lights and sirens) to someone having "muscle cramps." We arrive to find our patient, a 70-something male, lying flat on his back in the livingroom. C/C: chest pain, described as pressure, midsternal, radiating to L arm. 10/10 (he looked like he really was in a lot of distress). Started suddenly when he was washing his car. skins: pale, cool, diaphoretic breath sounds: rate of 20. clear. PO 98%. pulse: 60, peripheral pulses present, irregular BP: 90 systolic (don't remember the bottom #) ECG: sorry, but I don't have the strip. He was in A Fib, apparently a new onset. The service I now work for does not yet have 12-leads (embarrassing, I know, but we're getting them soon.) History/meds: HTN, nothing else I gave ASA and O2, and I started two IV's and ran them wide open on the short drive to the ER. We spent less than 10 minutes on scene and went code to the nearest cardiac care hospital. I told them everything that was going on, but still we waited a half hour to get a bed, and another 10 minutes after that before anyone came around to do a 12 lead. The hospitals 12-lead showed no ST elevation (so this was about an hour into the event), and labs had not come back yet. Any thoughts? Link to comment Share on other sites More sharing options...
itku2er Posted August 6, 2008 Share Posted August 6, 2008 Was it Hot outside? Was he physically fit or not? Any inversions on the ekg? Link to comment Share on other sites More sharing options...
zzyzx Posted August 6, 2008 Author Share Posted August 6, 2008 Yes, it was 100 degress outside. I can't judge if he was physically fit, but he's 70, so... No inversion on the monitor, but again, it's only a 3-lead. Link to comment Share on other sites More sharing options...
akroeze Posted August 6, 2008 Share Posted August 6, 2008 From reading what you said here he seems to meet the criteria for cardioversion Link to comment Share on other sites More sharing options...
AZCEP Posted August 7, 2008 Share Posted August 7, 2008 From reading what you said here he seems to meet the criteria for cardioversion Except for the little matter of his rate being 60/minute. No dig eh? Link to comment Share on other sites More sharing options...
akroeze Posted August 7, 2008 Share Posted August 7, 2008 I just realized what I did and came back to change it but someone already caught it :oops: Link to comment Share on other sites More sharing options...
zzyzx Posted August 7, 2008 Author Share Posted August 7, 2008 I'll be at work until Friday night, so I won't be able to answer any more questions about this scenario until then. Link to comment Share on other sites More sharing options...
firedoc5 Posted August 7, 2008 Share Posted August 7, 2008 Sounds heat related. Still a possible MI, just not being detected by ECG yet. I wouldn't have started two IV's. Hypotension probably due to cardiogenic situation, not hypovolemia. You don't want to overload him. Since bradycardic, 0.5mg. Atropine. O2 15L/NRM if tolerated. If heart rate and BP comes up, adm. MS for chest pain. I can't believe you had to wait that long for a bed with a patient in that situation. Either they had a whole lot of critical patients already or you were just being ignored. Personally, I would have kept requesting a bed ASAP to whoever. Don't be embarrassed for not having 12 lead yet. We did III lead for years before 12 lead was available in the field with no major repercusions that I know of. Link to comment Share on other sites More sharing options...
zzyzx Posted August 10, 2008 Author Share Posted August 10, 2008 Firedoc, I'm gonna have to disagree with you on the use of atropine. Why would you want to use atropine rather than fluids? Link to comment Share on other sites More sharing options...
WelshMedic Posted August 10, 2008 Share Posted August 10, 2008 I also have my doubts about the atropine. I would have deemed this rate and pressure as acceptable under the circumstances. On that note, I certainly would not have started 2 IV's and run them wide open. This is almost certainly a cardiogenic cause and is therefore not helped (probably hindered) by pushing fluids to that extent. I am a little old-school in a lot of respects. I still believe that although we should support and comfort the patient appropriately, it is not always appropriate to perform all interventions just because you can. We should realise that our main aim is to transport to an appropriate facility and not to "cure" the patient with cookbook medicine. WM Link to comment Share on other sites More sharing options...
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