MedicRN Posted April 18, 2006 Share Posted April 18, 2006 Tenorminin (Atenolnol) all blockers........ end in LOL! no Joke! Taking meds as Prescribed, his MD is older than him. Slow rate ask RN MEDIC! He's taking a few meds which don't play well together :shock: Dig + Atenolnol = increased bradycardia Dig + Lasix = kypokalemia/increased risk of dig tox Atenolnol + Lasix = possible hypotension Is the heart rhythm a sinus rhythm (are there p-waves for every QRS??) Is the R-R equal? Link to comment Share on other sites More sharing options...
Guest Posted April 18, 2006 Share Posted April 18, 2006 DAMN IT, THE Tires Flat on the truck......What next? About the only thing to do is treat symptomatically as an ambulance typically does not carry Digibind. Link to comment Share on other sites More sharing options...
Callthemedic Posted April 18, 2006 Share Posted April 18, 2006 Sorry if I'm butting in but isn't the treatment here glucagon and some fluids? Didn't read the whole thread. Link to comment Share on other sites More sharing options...
rat115 Posted April 18, 2006 Share Posted April 18, 2006 o, I'm late coming into this one....I'd have done the c-spine, o2, immoilization of the leg, iv (But I would put the iv bolus since he's jaundiced for 500cc before lessening it to tko) and had the son find out the meds.... now..... Foxglove...What's the pt taking that for? Who started him on it? Does his cardiac doc know that he's taking it? How many a day? How long has he been taking this? Do we have the bottle of pills so they can be tested for purity and strength? (Foxglove is highly poisonus if it builds up and can be deadly.) I would be concerned about a possible drug interaction. "--Medicinal Action and Uses---Digitalis has been used from early times in heart cases. It increases the activity of all forms of muscle tissue, but more especially that of the heart and arterioles, the all-important property of the drug being its action on the circulation. The first consequence of its absorption is a contraction of the heart and arteries, causing a very high rise in the blood pressure. After the taking of a moderate dose, the pulse is markedly slowed. Digitalis also causes an irregular pulse to become regular. Added to the greater force of cardiac contraction is a permanent tonic contraction of the organ, so that its internal capacity is reduced, which is a beneficial effect in cases of cardiac dilatation, and it improves the nutrition of the heart by increasing the amount of blood. In ordinary conditions it takes about twelve hours or more before its effects on the heart muscle is appreciated, and it must thus always be combined with other remedies to tide the patient over this period and never prescribed in large doses at first, as some patients are unable to take it, the drug being apt to cause considerable digestive disturbances, varying in different cases. This action is probably due to the Digitonin, an undesirable constituent. The action of the drug on the kidneys is of importance only second to its action on the circulation. In small or moderate doses, it is a powerful diuretic and a valuable remedy in dropsy, especially when this is connected with affections of the heart. It has also been employed in the treatment of internal haemorrhage, in inflammatory diseases, in delirium tremens, in epilepsy, in acute mania and various other diseases, with real or supposed benefits. The action of Digitalis in all the forms in which it is administered should be carefully watched, and when given over a prolonged period it should be employed with caution, as it is liable to accumulate in the system and to manifest its presence all at once by its poisonous action, indicated by the pulse becoming irregular, the blood-pressure low and gastro-intestinal irritation setting in. The constant use of Digitalis, also, by increasing the activity of the heart, leads to hypertrophy of that organ." About getting moving.....Is there another ambulance that can help out? Is the pt's condition worsening to the point that I feel he needs to be flown and, if so, is there a medivac available? Link to comment Share on other sites More sharing options...
RaceMedic Posted April 18, 2006 Share Posted April 18, 2006 Can i get a twelve lead please sir ? Link to comment Share on other sites More sharing options...
MedicRN Posted April 18, 2006 Share Posted April 18, 2006 But the Patient is looking not so good, ashen Grey, struggling to breath. RR> 30 now. Lung sounds at this point?? ::::: pulls out intubation equipment and sets up ::::: Link to comment Share on other sites More sharing options...
Guest Posted April 18, 2006 Share Posted April 18, 2006 Sorry if I'm butting in but isn't the treatment here glucagon and some fluids? Didn't read the whole thread. No worries, at all, cheers all. But this is going way faster than I had ever anticipated. OMG! Am I being tested....short answer YUPPERS, this is fun, this senario is going to get tougher I bet! How am I doing so far? Ok, could you explain why you would want to use glucagon? Are you suspecting beta Blocker OD? :?: Link to comment Share on other sites More sharing options...
Guest Posted April 18, 2006 Share Posted April 18, 2006 Lung sounds at this point?? ::::: pulls out intubation equipment and sets up ::::: Bilateral Chest sounds like a swimming pool. But before we get into Intubation a +++ Any advice for someone on a back board in the Back of a rig in a BLS situation? Now en route to a definitive care center? I can think of one thing? Please remember, I'm just a dumb EMR! If anyone tells me different I might cry! ps rat, thank you. Link to comment Share on other sites More sharing options...
Callthemedic Posted April 18, 2006 Share Posted April 18, 2006 Ok, could you explain why you would want to use glucagon? Are you suspecting beta Blocker OD? :?: Yes Syncope of cardiac or orthostatic origin. Beta blocker toxicity fits Jaundice: decreased liver function and failure to breakdown blood by-products. Can the "jaundice" be seen in the sclera? Link to comment Share on other sites More sharing options...
rocket Posted April 18, 2006 Share Posted April 18, 2006 Bilateral Chest sounds like a swimming pool. But before we get into Intubation a +++ Any advice for someone on a back board in the Back of a rig in a BLS situation? Now en route to a definitive care center? I can think of one thing? Please remember, I'm just a dumb EMR! If anyone tells me different I might cry! ps rat, thank you. Well it seems like this patient is suffering from a rapidly worsening case of pulmonary edema. And he's asking for exactly what he needs....to get upright. I suppose at some point the criticality of this patient's breathing would supercede the need for spinal precautions....somewhat tantamount to a rapid extrication from a wrecked vehicle but I'd hate to have to justify that on paper or in court. So here are some possibilities: I suppose you could tip the board up a bit on the stretcher to get him somewhat upright. Beyond that maybe you could slide in a KED or short board to maintain as much spinal protection as possible while allowing him to pivot at the hips and get some relief? -Trevor Link to comment Share on other sites More sharing options...
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