Chief1C Posted December 22, 2010 Share Posted December 22, 2010 What's the ETA on my chopper? Link to comment Share on other sites More sharing options...
mobey Posted December 22, 2010 Share Posted December 22, 2010 What's the ETA on my chopper? Do you routinely call helocopters without an assessment? It is hard for me to justify a helo at the point that you called it... we had no info yet. Perhaps you were joking? Link to comment Share on other sites More sharing options...
Underdawg3ate1 Posted December 22, 2010 Share Posted December 22, 2010 (edited) Sorry Ruff, didn't catch the additionals there. That being said.....ambulance is ready to go eh? Good, no stay and play here! I'd tell my driver to not kill us...a saying comes to mind....don't drive faster then your gardian angel can fly......yea.....well....your gardian angel is a raped ape....try to keep up with him!! Medevac is to far away assuming it takes 50 minutes to get to the scene and then maybe 20 to the hospital, ALS support 2 hours away won't do either so it's John Wayne time. Warm up the AED and BVM, ( I'd think it would be a good idea to apply the pads just in case) scratch the 2 lpm for 15 lpm. I'd put the pt in a trendelinburg position and tell my newb once he's finished getting a set of vitals.....to do another one and so on and so on. obtain temprature, and just monitor and reassess pt for further changes. I would ask for any kind of guidance and would update them if there were any changes. Med Command would be notified of what we have, This doesn't seem like a panic attack to me, something is definately whacked out with her heart. (I don't see too many SVT calls)....white cloud here. Edited December 22, 2010 by Underdawg3ate1 Link to comment Share on other sites More sharing options...
Chief1C Posted December 22, 2010 Share Posted December 22, 2010 Do you routinely call helocopters without an assessment? It is hard for me to justify a helo at the point that you called it... we had no info yet. Perhaps you were joking? Perhaps Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 22, 2010 Author Share Posted December 22, 2010 She's really not feeling well now. I still have problems posting pictures to show here but heres the link to the EKG http://i4.photobucket.com/albums/y136/ruffems/ekg1.jpg Link to comment Share on other sites More sharing options...
mobey Posted December 22, 2010 Share Posted December 22, 2010 Hmmm... The pic shows up about 2" by 2" It looks to be V-Tach.... but like I say it is VERY small and when I ctrl+ it gets too fuzzy. Anyone wanna help out, is the QRS narrow? Link to comment Share on other sites More sharing options...
Chief1C Posted December 23, 2010 Share Posted December 23, 2010 2x2 is being too generous. It looks like a dark gray box. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted December 23, 2010 Share Posted December 23, 2010 What is her pulse quality? How do her lungs sound? Pupils? What position is she found in? How lethargic is she? Do you mean obtunded? Can she follow instructions to attempt a vagal maneuver? (Blow the plunger out of a 40cc syringe?) If not, do I have carotid massage in my protocols? (If so might want to auscultate carotids first, though this woman would seem low risk) As with Mobey, while I'm dinking with vagaling I need a med count. What meds does the hubby take, could she have confused the bottles? What does her nasal sinus look like? I don't mean to imply that some rich people might participate in the use of common illicit drugs, but lets take a peek anyway. Having trouble loading the strip Ruffster? Go the easy way and it will make the call more fun anyway, "While assessing your pt the drunk, musclehead son drops his barbel on your monitor smashing it and causing it to catch fire forcing you to shot put it into the swimming pool." Carry on... :-) At this point, if she is obtunded, O2 15Lpm/nrb, LLR (Left Lat Recumbent), 14/16g IV initiated at or above the AC hanging NS TKO, prep for electrical cardioversion. It's hard to imagine what is going to happen here that is going to prevent me from welding this gal in the next half a minute or so. Also with Mobey, I don't see any reason to fly. What advantage will they bring to the table at this point? Dwayne Link to comment Share on other sites More sharing options...
emtannie Posted December 23, 2010 Share Posted December 23, 2010 I will take a shot at this… Symptomatic tachycardia at rate >250, lethargic, hypotensive….. definite candidate for cardioversion. As only medical hx is the SSRI prescription which matches the anxiety attacks, overdose is a possibility, but we can’t really solve that right now, unless she admits to it, we know time of ingestion, and we have charcoal and gastric lavage in our protocols (and I don’t want to do that in my ambulance – I don’t want to clean that up!). Going with Dwayne’s tx, so far, IV is in, monitor is on, O2 is being administered, we have hx andf vitals, she is still conscious, and I am assuming vagal maneuvers didn’t work…. I would explain to her and her family that I need to shock her heart to attempt to reset it to a normal rate, and I will give her an analgesic (fentanyl) and sedative (Versed) prior to welding her. Given the distance we have to travel, and I agree with others that getting the chopper is not something we want to stay on scene and wait for right now, I wouldn’t stay and play too long, but I would try to cardiovert on scene. Once I have attempted cardioversion, I want to move into differential diagnosis, but I have the feeling Ruff doesn’t want me to do that yet….. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted December 23, 2010 Author Share Posted December 23, 2010 Ok since my 12 lead is a grey box let's just say that the rhythm is a wide tachycardia at a rate of 270. Bp still 80/40 resp 12. Not obtunded just lethargic. More in an hour Sent from my SPH-D700 using Tapatalk Link to comment Share on other sites More sharing options...
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