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Chest Pain

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If the patient is mentating well with a good pressure, I/O him and set up an Amiodarone infusion, 150mg over ten. I've performed an I/O to a cx pt. before, didn't seem to be a problem with the EZ-IO anyway.

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I'd like to see a copy of the ECG as well, but even without it we can form a differential of three possibilities (assuming widened QRS):

  • VT
  • SVT with aberrant conduction due to bundle branch block
  • SVT with aberrant conduction due to the Wolff-Parkinson-White syndrome

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Have you ever started an IO on a conscious patient?

Yes, why? Are you implying that's a contraindication?

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No. I'm implying it hurts like a motherfucker when you infuse fluids lidocaine flush or not. Just because you can do it doesn't always mean it's the best thing, or right thing, to do.

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Of the several times I've started a IO on an adult patient they all said that what they remember most was the pain of the initial infusion(if they remembered anything at all). After it was going for a while, they said it was fine.

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You are called to a residence at 2000 hours for a patient experiencing chest pain.

Upon arrival, you enter the residence and find a 73 year old patient laying on his bed in obvious distress. The pt. is awake and alert. Describes 9/10 substernal chest pain of sudden onset. He has a history of triple bypass surgery and took one baby aspirin prior to your arrival. Pt. doesn't take any other meds regularly. He is diaphoretic and has a rapid, strong, radial pulse.

He is moved to the stretcher and expediently to the ambulance. V/S are taken and reveal 122/92, heart rate 160, respirations 16 nonlabored. Cardiac monitor is placed and V-Tach is shown on the monitor.

Treatment?

ABC's &General Impression.

PMHX & PSHX, Allergies.

When Did it start?

Description of Pain?

Radiate?

Any motion/action relieve pain?

Did the 81mg ASA offer any relief?

Has this happened before?

When was 3Xbypass?

Any complications w/ bypass?

Pacemaker?

Cardiologist? (just to help facility obtain records for Pt. care)

Recent illness/Hospitalization's?

Coughing alot?

Hx of reflux?

Baseline vitals before moving Pt. If he can stand, grab a repeat BP/HR. Get in the rig.

High flow O2 w/ EtCo2. 3 IV attempts w/out success? Drop head and establish an EJ if possible, If no success, IO.

This Pt. presents w/ a rate of 160, but a appropriate Systolic BP of 122. If systolic is still>100mmhg;

150mg Amiodarone over 10min.

If Pt. has acute onset compromised BP, Give versed 0.1mg/kg via IOP or INP w/ atomizer.

Synch Cardiovert @ 100J w/ fast patches.

V-tach resolve?

Yes: 150mg Amio infusion

NO: Cardiovert @ 150J

Other treatment would include:

FSBS

EtCo2

12-Lead (No nitro was given for CP due to not knowing 12-Lead results, Need to Rule out right sided MI prior to nitro admin.)

If pacemaker is indicated, verify pacer spikes, if over pacing, Place magnet over pacemaker to turn it off, consult OLMC for further.

Sorry to ramble, alot of variables in initial scenario. Curious to know what outcome was :pc::confused::iiam::thumbsup::excl:

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No. I'm implying it hurts like a motherfucker when you infuse fluids lidocaine flush or not. Just because you can do it doesn't always mean it's the best thing, or right thing, to do.

It's not a lidocaine flush per se. It's an incredibly slow push of lidocaine 40-50mg IO prior to any flush to anesthetize the affected nerve endings (I'm talking half a lidocaine pre-load over 2 minutes slow). After waiting 4-5 minutes for the lidocaine to take affect hammer home a 10cc flush to create a sort of pocket in the marrow space. If the lidocaine has been administered properly and given an appropriate amount of time to take effect, the flush is not a whole lot more painful than initiating a large bore IV. I've done this procedure with a number of patients and it works. The problem most paramedics have is that they push the lidocaine too quickly, and or don't wait long enough to slam in the pre-infusion flush.

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I'm well familiar with the process. That being said, if you're going this route it should be because you can't get a peripheral IV started. If you need access this badly do you really have time, more importantly does your patient have time, to wait the 6-7 minutes for this whole process to take place?

In the scenario outlined by the OP you'd be at the hospital faster than it would take to get an IO set up and actually infusing.

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