chbare Posted September 17, 2009 Share Posted September 17, 2009 You are called to the scene of a male complaining of general malaise and "just not feeling right." Take it from here. Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted September 17, 2009 Share Posted September 17, 2009 You are called to the scene of a male complaining of general malaise and "just not feeling right." Take it from here. Take care, chbare. What is the scene? What is my general impression of the Pt? weight?, odour? dress? hygiene? Link to comment Share on other sites More sharing options...
spenac Posted September 17, 2009 Share Posted September 17, 2009 How old? Any health problems? Any meds? Link to comment Share on other sites More sharing options...
chbare Posted September 17, 2009 Author Share Posted September 17, 2009 (edited) Scene appears safe without overt hazards. You note a 54 year old male sitting up in a chair without any obvious distress. He has a history of HTN and takes Toprol XL 50 mg PO Q 24. Surgical history is significant for an appy and lap chole. The patient is well dressed with good hygiene and appears to be slightly overweight. Take care, chbare. Edited September 17, 2009 by chbare Link to comment Share on other sites More sharing options...
itku2er Posted September 18, 2009 Share Posted September 18, 2009 What are his VS, Any change in Meds recently? Has been in contact with anyone with the flu? What does the 12 lead show? O2 sat. Any unusal happenings in his life lately? Link to comment Share on other sites More sharing options...
chbare Posted September 18, 2009 Author Share Posted September 18, 2009 Vital Signs: P- 60 strong & regular, RR- 19 & unlabored, SPO2- 94% RA, Pain-0/10, "I just don't feel right," Temp- 37 C, B/P- 150/100. No recent medication changes, no exposure to any known illness, no one in the hose is sick, nothing unusual or of particular interest in his life. XII Lead: Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted September 18, 2009 Share Posted September 18, 2009 (edited) Yikes. Start 02 nasal cannula @ 6lt Iv TKVO ASA 160mg I'm thinking B-Blocker - Metoprolol 5mg q5min x3 doses. Load to ambulance (we carry this dude) Transmit ECG for possible Vital heart resusitation (field thrombolytics). Any chest pains past few days? Exertional dyspnea? Fatigue? Family history? WTF is a lap chole?? laparoscopic.....? Oh no.... wait..... treat the patient not the monitor!!! Cancell everything, just O2 and transport LOL Edited September 18, 2009 by mobey Link to comment Share on other sites More sharing options...
chbare Posted September 18, 2009 Author Share Posted September 18, 2009 Lap chole= Laproscopic removal of the gall bladder. 6 LPM Via NC may be a bit uncomfortable. So, you have your IV, you gave your ASA, and you do beta blockade with style and grace. -No Chest Pain -No dyspnea -Generalized malaise Ok, so lets talk about fibrinolytics in the field: +What are the indications? Does this patient meet criteria based on our findings? This is where critical thinking comes into play guys. Serious decisions here and perhaps a humbling reminder of the real implications of doing these advanced procedures in the field. +What about contraindications? Cath lab team has been activated; however, they are 90 minutes out. Take care, chbare. Link to comment Share on other sites More sharing options...
mobey Posted September 18, 2009 Share Posted September 18, 2009 Lap chole= Laproscopic removal of the gall bladder. 6 LPM Via NC may be a bit uncomfortable. So, you have your IV, you gave your ASA, and you do beta blockade with style and grace. -No Chest Pain -No dyspnea -Generalized malaise Ok, so lets talk about fibrinolytics in the field: +What are the indications? Does this patient meet criteria based on our findings? This is where critical thinking comes into play guys. Serious decisions here and perhaps a humbling reminder of the real implications of doing these advanced procedures in the field. +What about contraindications? Cath lab team has been activated; however, they are 90 minutes out. Take care, chbare. I am going to let someone else take it from here. Awareness is really my only knowledge of VHR. I know how to use the kit, but without the questionaire in front of me I don't really know the exclusion criteria (still learning in school). obvioustly we need to know when the surgeries were, any complications, Hx of stroke, bleeds, ulcers etc... I cannot enlarge the pic, but on my laptop screen I am seeing ST elevation of 1mm or greater in the septal leads although it is a little foggy (love cheap wal-mart laptops) so that meets our initial criteria for VHR (thrombolytics, but obvioustly I have to go through the "check sheet". But this ECG would be transmitted for physician review and I expect the cell to ring shortly to discuss thrombolytics with the cardiologist. thx for the scenario, I look forward to learning from it. Link to comment Share on other sites More sharing options...
chbare Posted September 18, 2009 Author Share Posted September 18, 2009 (edited) No problems with ulcers, bleeding, AVM's or any complications related to his surgeries. No history of stroke or head trauma. His blood pressure is 130/78. So, you are looking for the presence of STEMI? Does this ECG meet the criteria for a STEMI? It may be somewhat debatable. However, does this really look like the "typical" STEMI? What two criteria must be met in most cases for ECG evidence of STEMI? You were nearly there on one of the criteria. Edit: No cardiologist yet and the ER doc says it's your call. Take care, chbare. Edited September 18, 2009 by chbare Link to comment Share on other sites More sharing options...
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