Kiwiology Posted April 19, 2010 Share Posted April 19, 2010 Honestly I have no idea, showing the limits of my knowledge here! Link to comment Share on other sites More sharing options...
spenac Posted April 19, 2010 Share Posted April 19, 2010 Treat as an active MI based on symptoms until proven otherwise as presumed new onset LBBB could be hiding any ST elevation/depression. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2010 Author Share Posted April 19, 2010 So, we did the following; 1) oxygen 2 LPM NC 2) ASA 325 mg crushed 3) nitroglycerine 400 mcg Sl 4) metoprolol 5 mg slow IV 5) Get him the hell out En route his pain improves to a 0/10 and you arrive safely at your destination about an hour later. What do you want at the military hospital? Take care, chbare. Link to comment Share on other sites More sharing options...
spenac Posted April 19, 2010 Share Posted April 19, 2010 Full cardiac panel. Xray. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2010 Author Share Posted April 19, 2010 (edited) Cardiac enzymes are negative, coags are normal, d-dimer is negative, AP chest is unremarkable, CMP is normal. Patient remains symptom free. Take care, chbare. Edit: WTF, two posts in one? Edited April 19, 2010 by chbare Link to comment Share on other sites More sharing options...
joesph Posted April 19, 2010 Share Posted April 19, 2010 Cardiac enzymes are negative, coags are normal, d-dimer is negative, AP chest is unremarkable, CMP is normal. Patient remains symptom free. Take care, chbare. Edit: WTF, two posts in one? Stress test him? cardiac enzymes can take awhile how long after on set to blood work? Link to comment Share on other sites More sharing options...
Kiwiology Posted April 19, 2010 Share Posted April 19, 2010 Stress test him? cardiac enzymes can take awhile how long after on set to blood work? I wouldn't be keen to stress test somebody who might be having an infarct as you know he migt um, die. Link to comment Share on other sites More sharing options...
DartmouthDave Posted April 19, 2010 Share Posted April 19, 2010 Hello, No cath lab I assume! =) Also, I may be overly fatigued, but are those Q-waves in V1 to V3? Add Plavix 300mg PO, Enoxaparin 1mg/kg, change from NTG SL to IV. Maybe top up the Lopressor (5mg was given) to a total of 15mg. Review the labs (Hgb, lytes). Top up Mg and K if need be. Consult a friend. Any way to get hands on an old 12-lead? Was one done for a medical on a civilian contractor? Not too family contractors in A'stan. I would like to know if this is an old or new BBB. Maybe take a look with an Echo/US as well. Any family members have MI young? Odd that this is the first time he 'ever felt this way.' I am not saying that a patient can not have a big MI out of the blue. But, usually, they have angina, worsening SOB, fatigue, et al......before the big STEMI. Also, his age. Possible.....but not common. If her was 56.....different story. Wait...see if the pain come back. Repeat the Troponin in 4 hours with an other 12-lead. Be conservative. If it is a STEMI treat with TNK. Cheers Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2010 Author Share Posted April 19, 2010 You can always try to evac out of country. Repeat XII lead: Take care, chbare. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted April 19, 2010 Share Posted April 19, 2010 A quick question from the BLS sector, here: is there any possibility, due to long hours flying a desk, that this patient may have Deep Vein Thrombosis, and threw a clot? Link to comment Share on other sites More sharing options...
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