firedoc5 Posted August 11, 2008 Share Posted August 11, 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? With the description of pain (10/10, distress) and knowing that he had to be feeling ill, possibly with N & V causing even more straining, all of which can cause more vagal stimuli. Dehydration is an issue, but not to the point he needs rapid fluid replacement. One IV WO should be sufficient. Non-trauma fluid replacement should be in slower and in moderation than trauma/ hypovolemic. One fluid to consider is D5 NS + KCL. I believe hypotension is due to bradycardia, not fluid depletion. Dehydration is more gradual. This gentleman stated it was sudden onset. Also, it seems like I remember something about if A-fib is not already chronic, bringing up HR may correct A-fib. Also take into consideration his age, 70. May have other underlying conditions not yet diagnosed. I'm posting this quickly sitting next to my wife in the hosp. I'll explain more under "Personal" schtuff. Link to comment Share on other sites More sharing options...
zzyzx Posted August 12, 2008 Author Share Posted August 12, 2008 Hey Firedoc, I hope your wife is feeling better. Standby for a PM. I think you posted just as I submitted my last post. My reason for giving the fluid challenge was that he was hypotensive and I suspected an inferior MI with right-ventricular involvement. I wasn't too worried about his BP (90 systolic) at that point, but started two large IV's in case he bottomed out. (Also, in my county the ER's will do two IV's on any STEMI.) I was also worried that he might develop a heart block or get significantly brady, and AZEP's made a good point about attaching pacer pads just in case. Link to comment Share on other sites More sharing options...
letmesleep Posted August 12, 2008 Share Posted August 12, 2008 I would agree with that last statement, in this case with the further details given, the pacer pads would have been an excellent idea! Link to comment Share on other sites More sharing options...
firedoc5 Posted August 12, 2008 Share Posted August 12, 2008 Outstanding on the pacer pads. Personally, I'd rather see what his BP would do if you raised the heart rate first. If you bring up the heart rate but is still border line hypo-tensive, then try the fluid challenge. Then go from there. I guess that's what I was trying to say in the first place. Just couldn't get it out. I'm just really leary of over loading him with fluids, especially too rapidly. Link to comment Share on other sites More sharing options...
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