chbare Posted October 5, 2008 Author Share Posted October 5, 2008 You identify coarse ventricular fibrillation and defibrillate. Following defibrillation, you note a slow weak carotid pulse. You note the following on the monitor: Take care, chbare. Link to comment Share on other sites More sharing options...
emtd29 Posted October 5, 2008 Share Posted October 5, 2008 Sounds good to me, three min down with CPR, V-Fib, lets light him up and see what happends. Initial thoughts Congenital defect (may need a internal defib) Acc pathway Myo/endocarditis (since we have no history.... ok it's a far stretch... in fact I change my mind) Blunt force trauma causing a rythm disturbance (Damn, can't remember the medical term) Cardiomyopathy Large PE I think the term you're looking for is "commotio cordis" eMedicine Article From a BLS point of view (no ALS available... does happen) if he goes out again: CPR, shock if indicated and a dose of High Flow Diesel to the ER otherwise. recovery position, High Flow O2, watch that airway monitor VS and run like hell to the ER Link to comment Share on other sites More sharing options...
mobey Posted October 5, 2008 Share Posted October 5, 2008 That would be the term... Thanks buddy. Sinus Brad OK 1st year Paramedic student here (just started Pharm last week so teach me oh wise ones) Atropine 1mg. 5% Sodium bicarb bolus ummm.... 250ml (ok, pulled this out of the air, don't really know this drug yet..please school me gently) Vitals Is he breathing on his own? Link to comment Share on other sites More sharing options...
chbare Posted October 5, 2008 Author Share Posted October 5, 2008 I think the term you're looking for is "commotio cordis" eMedicine Article From a BLS pont of view if he goes out again: CPR, shock if indicated and a dose of High Flow Diesel to the ER otherwise. recovery position, High Flow O2, monitor VS and run like hell to the ER Possibly; however, can we definitively say that is the problem laying out on the soccer field? Please explain the reasoning for giving bicarb? His heart rate begins to increase slowly without intervention and you note spontaneous respirations. En-route to the ER, he regains consciousness and his vital signs remain stable. His neurological status is grossly intact without any noted deficits. Upon arrival, you transition into the receiving team. How will you manage and assess this patient? Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted October 5, 2008 Share Posted October 5, 2008 Possibly; however, can we definitively say that is the problem laying out on the soccer field?. No No, I was just throwing out my DD, keepin the wheels turnin you know. Please explain the reasoning for giving bicarb? Damn I knew I would get caught with my pants down, I was thinking to treat the acidosis caused by cardiac arrest. I am not going to lye chbare, I am 2 mos into a 2 year program, I really do not know this stuff that well. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted October 5, 2008 Share Posted October 5, 2008 Bruising to the chest? I'm sure witnesses saw if he got hit right before going down. Can't determine commotio cordis in the field for sure, but can have very heavy suspicion. While on the topic, do people still do precordial thumps here? Link to comment Share on other sites More sharing options...
chbare Posted October 5, 2008 Author Share Posted October 5, 2008 No problem considering the DDX. Just challenging everybody to think and research hopefully. All the considerations thus far should be ruled out. Now that we are in the ER, how will we further investigate and treat this patient? Most of you have a pretty strong working diagnosis, how will you go about proving or disproving your suspicions. As far as the bicarb issue: No problems, just challenging you to research and learn. With acidosis, it is very easy to get ourselves trapped into the give bicarb mentality. However, consider the following. Acidotic hearts do not like to respond to therapy. This patient had rather quick ROSC following one defibrillation attempt. The down time was three minutes, with a witnessed arrest (bystanders at least), and immediate CPR. This is a situation where we may not see significant acidosis. In addition, what are some of the complications associated with bicarb therapy? Could these complications in fact prove to hamper our resuscitation efforts? The precordial thump has fallen out of favor these days. No definitive evidence saying it is a helpful procedure. Some reports of it both helping and causing harm. Take care, chbare. Link to comment Share on other sites More sharing options...
defib_wizard Posted October 5, 2008 Share Posted October 5, 2008 If the pt arrests in front of you, a precordial thump can be done. This does work but not every time. the other down side to this is people see you hitting a pt. They don't understand your trying to help the person. Link to comment Share on other sites More sharing options...
fireflymedic Posted October 5, 2008 Share Posted October 5, 2008 Okay, time for me to join in the playground here. Can't help but wonder a couple things. One what's this kid's build like? Are we tall and skinny or stocky or what? Have we had some involvement with steroids possibly? Other issue is underlying cardiac that wasn't diagnosed. Have had several instances of that within the last year here of cardiomegaly that wasn't diagnosed until these seemingly perfectly healthy players were randomnly hitting the ground. Two basketball players, a soccer player, and a runner. What do his pupils look like? Any indications of head trauma of any sort? What do I want as far as treatment in ER? Since this sounds alot like recent episodes we've had I'm gonna push for a Chest x-ray, echo as I want to know if his heart is enlarged, and if so how is it functioning now? Can I have a 12 lead as well? Just for kicks and giggles run labs to see if his lytes are off balance. This guy may have been out in toasty weather, not taking in enough water, got dehydrated, and that caused cardiac abnormalities. Plausible for sure. As far as the bicarb, I'm with CB on not giving it with 3 min of down time and immediate CPR after witnessed arrest. Bicarb really only plays a role when you've had long down times with no CPR. That's when the acidosis factor starts kicking in and you may see benefit there. Our general rule is 15 or more, then bicarb, but less than that, we'll work 'em otherwise. Other services may work differently, but that's how we roll. Thanks CB for the good scenarios - you make me work there ! My brain gets tired ! Link to comment Share on other sites More sharing options...
Timmy Posted October 5, 2008 Share Posted October 5, 2008 Has he had any sports drinks like Redbull, V, powerade? Link to comment Share on other sites More sharing options...
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