Arizonaffcep Posted December 4, 2008 Author Share Posted December 4, 2008 Onset of pain? Was it sudden? Does it radiate? Describe the pain. Any associated symptoms (nausea, vomitting, diaphoresis, shortness of breath)? Does anything make it better or worse? Has he ever had a similar pain? Onset-"I was reaching for my coffee when I got this unbearable pain in my chest!" Radiation-"No-it's right here <<points to center of chest>>" SOB-A little Skin-Pale/Cool/Diaphoretic No nausea Nothing seems to make it better-but the pain is increasing. Similar pain-"No! I've never had anything like this before!" Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 4, 2008 Author Share Posted December 4, 2008 I'm in az also so no beta blocker in my drug box. I would like to start giving the pt morphine. I can give up to 14 mg under standing orders. Since this pain is not appearing as cardiac. and absent pedal pulses. I'm leaning towards a TAA. Patching for MD input would be a good idea. I would hold off on the ntg until I talked to a dr. Does morphine help him? Morephine does lower his BP slightly...still fairly elevated though...nothing else. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 4, 2008 Author Share Posted December 4, 2008 So...it sounds like the consensus is a thoracic AA-what other S/S might be associated with it? The interesting part for me from the CE was the pain difference-anyone care to venture why this is different from cardiac CP? I'm not talking mechanism...but onset, quality, etc. And of course, the ever popular question-"WHY?" Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 5, 2008 Share Posted December 5, 2008 Yes arizona, i would love to get some closure on the scenario, please share all details, especially what led you away from giving him a ntg and killing him. Typically, my AA's had back/shoulder pain, or describe their pain as "tearing". Luckily for me, most have had the "I am about to die look", and were hypotensive, or had the pulsatile mass and absence of femoral pulse", so it was fairly easy for me to make the correct diagnosis. I can see where many would have treated this as cardiac pain. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted December 5, 2008 Author Share Posted December 5, 2008 Basically, that's what happened (TAA). The pain can (especially with "text book patients" end up being tearing, etc. They usually do have the look of death, although that is kind of an "oh crap" sign. The way the Dr who ran the simulation was telling us was, one of the best indicators to determine AA vs. cardiac CP is pain-in that cardiac CP takes a little while to happen, vs. AA where the patient can usually tell you to the nano-second when the pain started. For instance, "I was reaching for my coffee" or "I was getting out of bed..." Clearly, a main goal should be to bring this pts bp down, don't want to dislodge a clot that's hanging on by a platelet:)...in AZ NTG and morphine would be the way to go. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 5, 2008 Share Posted December 5, 2008 Arizona, its been awhile since i have been in EMS, so I realize some things have changed, but I dont think ntg and morphine are the way to go. Both drugs dialate, and I would think the last thing you would want to do is dialate an artery that is already tearing apart. If I am wrong, please correct me, cause you never know when i might get back on the bus one day. Good scenario though. Link to comment Share on other sites More sharing options...
mediccjh Posted December 5, 2008 Share Posted December 5, 2008 Arizona, its been awhile since i have been in EMS, so I realize some things have changed, but I dont think ntg and morphine are the way to go. Both drugs dialate, and I would think the last thing you would want to do is dialate an artery that is already tearing apart. If I am wrong, please correct me, cause you never know when i might get back on the bus one day. Good scenario though. They are used for the vasodilatory effects by reducing stress on the walls of the arteries. You want to avoid ASA though, since it thins the blood, and can increase bleeding. Target B/P range is 70-90 systolic, because you don't want any pressure against the wall where the tear is. Link to comment Share on other sites More sharing options...
p3medic Posted December 5, 2008 Share Posted December 5, 2008 The problem with lowering the blood pressure with ntg alone is a potential for rebound tachycardia, increasing stress on the arterial wall. Beta blockade would be a better choice, either with ntg or without. Link to comment Share on other sites More sharing options...
mediccjh Posted December 5, 2008 Share Posted December 5, 2008 I agree; however AZ does not have beta-blockers on the truck. Aortic aneurysms run in my family. At least I know how I'm going to die. Link to comment Share on other sites More sharing options...
mobey Posted December 5, 2008 Share Posted December 5, 2008 Dropping the pressure is the way to go... I agree. I would start Nitro spray and a B-Blocker on scene, then once loaded, hang a nitro drip and titrate with the morphine to BP. I would like to use morphine as well as NTG to help him with the pain. Link to comment Share on other sites More sharing options...
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