AnthonyM83 Posted October 5, 2008 Share Posted October 5, 2008 Heart sounds good? Maybe some sort of imaging to check for damage to pericardial area and contents. Kick him with another soccer ball and try to reproduce? Blood work. Gases, heart enzymes, etc. History, Allergies, Meds, general patient interview. I've only known two people who did the thump on witnessed arrests and it worked both times (regained pulse). But I'm sure those who tried it unsuccessfully were less likely to share with others they used it. I imagine it could throw one into a worse rhythm (but so can a shock, right?). Link to comment Share on other sites More sharing options...
chbare Posted October 5, 2008 Author Share Posted October 5, 2008 XII Lead Heart tones: S1 S2 no murmur, gallop, rub, etc. What are you looking for with the ABG? What are you looking for with the Chemistry? Cardiac enzymes are negative. What imaging do you want and what are you looking for? Healthy kid, no medical history, normal if not a bit on the athletic side regarding build. Neuro exam is unremarkable. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted October 5, 2008 Share Posted October 5, 2008 What is something you should be looking for on the EKG in a patient like this? Link to comment Share on other sites More sharing options...
firedoc5 Posted October 5, 2008 Share Posted October 5, 2008 Just to back up a little bit and probably repeating some of the others. Sinus-brady after defib, you are right with the Atropine, but would hold off on the Bicarb (down time not long enough). Give 1mg. Epi, and 1mg/kg of Lidocaine. You want to protect those ventricles and keep him from going back into v-fib. How long of an ETA? If too long, hang Lido drip. I might have missed it, but when you get a sinus rhythm back, does he regain any kind of consciousness? Spontaneous respirations? I've been out of the loop for a day or two and there are so many reasons for a kid like that to go down and I'm sure it's already been given so I won't even start to guess. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted October 5, 2008 Share Posted October 5, 2008 Someone beat me in with the cardiac dysrhythmia due to the blow to the chest. I know the pre-cardial thump, but don't want to hijack the string with what I have as it's history. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted October 5, 2008 Share Posted October 5, 2008 What is something you should be looking for on the EKG in a patient like this? I am not sure what you are specifically looking for but I would look for ST segment changes, J waves, PR interval changes, hypertrophy, and ectopic beats. Those are what come to mind. Sinus-brady after defib, you are right with the Atropine, but would hold off on the Bicarb (down time not long enough). Give 1mg. Epi, and 1mg/kg of Lidocaine. You want to protect those ventricles and keep him from going back into v-fib. How long of an ETA? If too long, hang Lido drip. With CPR and defibrillation the kid regained a pulse. I would expect his pulse to be slower and to not just start galloping at full speed. Within a few minutes his pulse rate should start to come back up. This would be one of those good times to sit on your thumbs and wait. Atropine forcing the heart to contract faster may be a bit too much at this point. I would hold off on it. Great idea though to have antiarrhythmics ready. Without ectopy, I would be a bit hesitant to start a lidocaine drip. Providing this kids heart does not stop, his body will return to homeostasis (hence he has even regained conscience) and do what is best for itself. I would hold off on medication until we figure out what exactly is going on. How about a set of vital signs? Glucose? Toxicology report? Does the kid have any complaints since regaining conscience? Does he remember what happened? Link to comment Share on other sites More sharing options...
chbare Posted October 6, 2008 Author Share Posted October 6, 2008 So, what does everybody think? Lidocaine or amiodarone following successful defibrillation? We need to consider the risks and benefits of giving these agents. One of the goals following ROSC is to try to stabilize cardiac activity. Did the patient's cardiac activity stabilize without the use of agents rather quickly? While I will not say you are incorrect in giving agents, do we need to give every V-fib arrest these agents? Can we actually monitor and provide supportive care? A little "benign neglect" perhaps? Tox screen is negative. Blood Glucose is : 116 mg/dl. He remembers taking an elbow to the chest prior to "passing out." No history of caffeine intake or energy drinks. At this point can we assume it may be related to the blow? If that is the case, what problems can we rule out? Myocardial contusion vs tamponade vs commotio cordis vs congenital problem? Can we rule any of these in our out? What criteria can we use to identify the problem and rule out other problems? Take care, chbare. Link to comment Share on other sites More sharing options...
njmedic1485 Posted October 6, 2008 Share Posted October 6, 2008 Any personal or familial history of unexplained syncope? If a 12 lead was done does it show a long Q-T or any S-T segment abnormalities? I imagine any shot hard enough to precipitate v- fib could cause myocardial contusion. If the kids heart rate and BP normalizes on it's own I don't really see the need for an antiarrythmic. Some oxygen, an IV line and a little cautious monitoring sounds right to me. Link to comment Share on other sites More sharing options...
chbare Posted October 6, 2008 Author Share Posted October 6, 2008 No known history. XII lead is unchanged from the prior post. Vital signs are stable. With the information on hand, does myocardial contusion seem likely? Take care, chbare. Link to comment Share on other sites More sharing options...
chbare Posted October 6, 2008 Author Share Posted October 6, 2008 I must apologize. Somebody asked about an echo and chest x-ray and rationale for the procedure. The echo is normal. Normal wall motion, normal valve motion, and normal left ventricular ejection fraction. The chest x-ray is normal. The heart is not enlarged and no pulmonary abnormalities are noted. Take care, chabre. Link to comment Share on other sites More sharing options...
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