mobey 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? YES! Just remember that DVT's are on the venous side, meaning that the clot would have to pass through the microcirculation in the respiratory system before reaching the heart and causing an MI. The pulmonary circulation can be thought of as "Clot filters", which is why pulmonary embolisms are common in people with DVT risk factors. HOWEVER.... There is a possibility the patient has a Patent foramen ovale, which is a "Hole" between the atria allowing a clot to bypass the pulmonary circulation. Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2010 Author 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? Absolutely, a consideration to place on the list of differentials. I included a totally unremarkable coag profile and D-dimer to give people working with this differential more to go on. Take care, chbare. Link to comment Share on other sites More sharing options...
DartmouthDave Posted April 19, 2010 Share Posted April 19, 2010 Hello, 1. ACS (negative Tn) 2. PE (negative D-Dimmer) 3. Zebra? -->We have treated for ACS (ASA, Plavix, NTG, O2, Metoprolol, Enoxaparin) and drawn labs. -->We have treated reasonably well for a PE. Maybe start a Heparin infusion as opposed to Enoxaparin. If possible, an echo/ultra sound (depending on what is available and what staff is available) and take a look at the right ventricles. I am not an expert on this but I know sometimes a PE will cause RV dysfunction. Or any other odd cardiac things gooing on. -->No CT scanner I assume? -->What is CMP???? I have read about the S1Q3T3(invert) rule but I have never seen it or had much luck with it. Again, if he is pain free and stable lets not transfer this fellow until a Dx is hammer down some more. I assume the flight would be a long haul to Germany? Or, as a civilian dose a private company fly him to Saudia Arabia?? (I will have to call my brother he worked in KAF as a NO). -->Is there a Zebra we are missing? I get tunnel vision sometime. Cheers Link to comment Share on other sites More sharing options...
chbare Posted April 19, 2010 Author Share Posted April 19, 2010 Hello, 1. ACS (negative Tn) 2. PE (negative D-Dimmer) 3. Zebra? -->We have treated for ACS (ASA, Plavix, NTG, O2, Metoprolol, Enoxaparin) and drawn labs. -->We have treated reasonably well for a PE. Maybe start a Heparin infusion as opposed to Enoxaparin. If possible, an echo/ultra sound (depending on what is available and what staff is available) and take a look at the right ventricles. I am not an expert on this but I know sometimes a PE will cause RV dysfunction. Or any other odd cardiac things gooing on. -->No CT scanner I assume? -->What is CMP???? I have read about the S1Q3T3(invert) rule but I have never seen it or had much luck with it. Again, if he is pain free and stable lets not transfer this fellow until a Dx is hammer down some more. I assume the flight would be a long haul to Germany? Or, as a civilian dose a private company fly him to Saudia Arabia?? (I will have to call my brother he worked in KAF as a NO). -->Is there a Zebra we are missing? I get tunnel vision sometime. Cheers He would go to Dubai; about three hours if you manage to get a leer or hawker, 5-6 hours with a possible refuel stop in Kandahar by way of a King air 200 if you cannot get a jet. You have CT, CMP is a complete metabolic panel or chem 12, echo is unremarkable. Not really a zebra, but perhaps somewhat of an atypical XII lead when considering the problem. Take, chbare. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 20, 2010 Share Posted April 20, 2010 He would go to Dubai; about three hours if you manage to get a leer or hawker, 5-6 hours with a possible refuel stop in Kandahar by way of a King air 200 if you cannot get a jet. You have CT, CMP is a complete metabolic panel or chem 12, echo is unremarkable. Not really a zebra, but perhaps somewhat of an atypical XII lead when considering the problem. Take, chbare. How much energy drink has he consumed? I remember Dust telling me sometime back that he treated a guy similar to this who had drank many many red bulls. Did he take anything over the counter or illicit? Link to comment Share on other sites More sharing options...
Kiwiology Posted April 20, 2010 Share Posted April 20, 2010 I'll get warmed up then .... Tehran morning Hawker november niner zero one november bravo medivac checking in at three six zero, squawk charlie six one seven eight, we're direct SIDAD then direct TASMI, we'd then like to proceed to hmm ... let me get back to you Link to comment Share on other sites More sharing options...
chbare Posted April 20, 2010 Author Share Posted April 20, 2010 No stimulants or illicit substances on board. So, you are looking at a Medevac? Take care, chbare. Link to comment Share on other sites More sharing options...
spenac Posted April 20, 2010 Share Posted April 20, 2010 Wow second EKG no axis deviation, no hemiblock, no bundle block. Did we have right EKG? Was one EKG malfunctioning? Did he get a heart transplant while being transported? Link to comment Share on other sites More sharing options...
chbare Posted April 20, 2010 Author Share Posted April 20, 2010 A great question and one the receiving facility asked us. They initially thought there was a problem with the paper speed; however, the repeat XII lead was totally unremarkable. Take care, chbare. Link to comment Share on other sites More sharing options...
Kaisu Posted April 20, 2010 Share Posted April 20, 2010 so.. transient aberrant conduction... hmm.. something weird and wonderful with the conduction pathways perhaps? PS.. in pmHx, what is "appy"? Don't know the term. Link to comment Share on other sites More sharing options...
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