island emt Posted April 4, 2013 Share Posted April 4, 2013 (edited) Just off the top of my head: Lets check BG 70 yo morbidly obese,CHF, COPD gotta be diabetic also. Any hx of afib.? blood thinners? what meds is she on and why? What is she being rehabbed from? really quality healthcare facility " Staff says they think she was okay yesterday, but they're not sure." How long has she been gorked without them noticing? Pupils? responsive to light & accommodation? If your having that much trouble palpating a pulse better get a long IV catheter and get ready to go fishing for peripheral access or look to see if you can get a feel for the EJ. Call for the hose apes for lifting Get the bariatric truck enroute. Hey Mobey: what do you think of the X series????? Inquiring minds want to know. How about a review in another thread Edited April 4, 2013 by island emt Link to comment Share on other sites More sharing options...
MariB Posted April 4, 2013 Share Posted April 4, 2013 I need to know the rehab. If she has a pace maker or defib, I mean, could she be withdrawing from drugs? What's the rehab? Link to comment Share on other sites More sharing options...
chbare Posted April 4, 2013 Share Posted April 4, 2013 Assuming the environment is safe and we did not place pads over any patches on the patient's skin, we have an unstable patient with a tachycardia and barring "smoking gun" information from her chart, synchronised cardioversion is indicated. Link to comment Share on other sites More sharing options...
DartmouthDave Posted April 4, 2013 Share Posted April 4, 2013 Hello, What is the axis? Cheers Link to comment Share on other sites More sharing options...
fakingpatience Posted April 6, 2013 Share Posted April 6, 2013 Any peripheral / dependent edema (might not be in legs on pt if she is bed confined) ? Any improvement in GCS with 02? Quick BGT and pupil check. Lets place an IO before cardioversion. Highly considering RSIing (+ gag reflex), either way, lets get our airway kit out before we cardiovert, should things go poorly. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted April 6, 2013 Share Posted April 6, 2013 What everyone else has said.... Plus Go ahead and do the cardioversion. At this point, it seems safe to presume the patient's atrial loading is poor due to the rate, leading to venous congestion and subsequently pulmonary edema. The hope is to normalize the rate to allow for proper circulation of blood. With that problem fixed, her pressure should come up and can then use CPAP. As far as your question of something to do before cardioversion, are you in reference to vagal maneuvers? Being non-responsive I doubt she would follow commands. If you are brazen, you may decide to do a carotid sinus massage. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted April 8, 2013 Share Posted April 8, 2013 Also, unless I missed it somewhere, it seems like we're making some really big assumptions of this patients weight based on a description of "obese" Share Link to comment Share on other sites More sharing options...
island emt Posted April 9, 2013 Share Posted April 9, 2013 (edited) Dwayne: I don't consider a person OBESE until their fat rolls have Fat rolls. Not talking the rolls you can hide a twinkie in :: the kind of fat rolls where they lose their Chihuahua in. Someone who can lose 150 0r 200 pounds and still be obese. When a Pt's calfs are bigger than my waist, they are obese. Edited April 9, 2013 by island emt 1 Link to comment Share on other sites More sharing options...
mobey Posted April 9, 2013 Share Posted April 9, 2013 Dwayne: I don't consider a person OBESE until their fat rolls have Fat rolls. Not talking the rolls you can hide a twinkie in :: the kind of fat rolls where they lose their Chihuahua in. Someone who can lose 150 0r 200 pounds and still be obese. When a Pt's calfs are bigger than my waist, they are obese. I believe that is called morbid obeisity Link to comment Share on other sites More sharing options...
BEorP Posted April 9, 2013 Share Posted April 9, 2013 Also, unless I missed it somewhere, it seems like we're making some really big assumptions of this patients weight based on a description of "obese" Share Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. If her ideal weight is 100lbs, and she weighs 125, correctly identifying her as obsese, then I think that many of the assumptions that have been made based on her weight would be illogical, right? Link to comment Share on other sites More sharing options...
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